US doctor salaries and cost of care

[ks.234]

Type into the YouTube search bar "why universal healthcare won't work" and you'll see lots of videos explaining why it won't work.
Of course it's a load of b***shit, but it's surprising how many Americans believe it. But not only Americans, I know there are plenty of British people who believe the UK healthcare system isn't working because "people are living longer" and "it needs to be privatised so it can be run more efficiently".
The source of the problem has got to be the right-wing media. Why else would people think this way?

Yes, the media is projecting a right wing narrative, but it is the false Thatcherite narrative that government has ‘no money of it’s own’ that grips the imagination to the extent that people believe that any government spending will have to be covered by a rise in their own tax burden. It is a method of control that says, ‘if you vote for improved health care, or tackling the environment, the you will be presented with a heft bill to pay for it’.

This false narrative is in effect right now with the NI tax rise, and sadly, the media has not had to do a persuading job to sell the false narrative, most voters just accept it.

In fact it seems to make people quite angry to be told that their tax does not fund government spending, such is the depth of the deception and the extent that it has infected the whole narrative before the media gets hold of it. The media is just manipulating a pre existing condition.

Government spending is constrained by many things, but revenue from taxation is not one of them.

 

[Heckyman]

My uncle emigrated to Canada and moved to the USA in his retirement. Healthcare in the USA has cost him a fortune. He explained the system to us once, “Americans don’t want to pay for someone else’s illnesses. It’s not until they get sick themselves that they start to question the system.”

 

[ks.234]

My uncle emigrated to Canada and moved to the USA in his retirement. Healthcare in the USA has cost him a fortune. He explained the system to us once, “Americans don’t want to pay for someone else’s illnesses. It’s not until they get sick themselves that they start to question the system.”

This is the power of the false Thatcherite/Reganite narrative.

 

[Sue Pertwee-Tyr]

Yes, the media is projecting a right wing narrative, but it is the false Thatcherite narrative that government has ‘no money of it’s own’ that grips the imagination to the extent that people believe that any government spending will have to be covered by a rise in their own tax burden. It is a method of control that says, ‘if you vote for improved health care, or tackling the environment, the you will be presented with a heft bill to pay for it’.

This false narrative is in effect right now with the NI tax rise, and sadly, the media has not had to do a persuading job to sell the false narrative, most voters just accept it.

In fact it seems to make people quite angry to be told that their tax does not fund government spending, such is the depth of the deception and the extent that it has infected the whole narrative before the media gets hold of it. The media is just manipulating a pre existing condition.

Government spending is constrained by many things, but revenue from taxation is not one of them.

I think the problem is that the reality is quite counterintuitive.

 

[Heckyman]

This is the power of the false Thatcherite/Reganite narrative.

I see, next time I’ll suggest he asks the Federal Government to print more money to pay his bills.

 

[ks.234]

I see, next time I’ll suggest he asks the Federal Government to print more money to pay his bills.

Are you saying that the Thatcher narrative is true?

or are you suggesting that government money should be used to settle private debts? What next time?

 

[John]

One thing unique about the United States is all the pharmaceutical ads you see on television promoting the viewer to ask your doctor about so and so drug. I’d say drug ads represent 25 percent of the commercials one sees on adult tv programs.'
A typical 30 minute show has 10 minutes of commercials. Maybe one reason there is a distrust of the medical community in the US whose doctors and universities are bought and paid for by them.

 

[Heckyman]

Are you saying that the Thatcher narrative is true?

or are you suggesting that government money should be used to settle private debts? What next time?

Just trying to highlight the difficulty in dislodging the “Thatcher narrative”. Had I told my uncle that healthcare needn’t be paid for by individuals because the government can just print money, my uncle would have just said, “eh?”.

 

[John]

https://www.medpagetoday.com/popmedicine/popmedicine/96891

Note that these are average salaries.

"Plastic surgeons have an average annual salary of $526,000"
"Orthopedic surgeons have an average annual salary of $511,000"
"Dermatologists have an average annual salary of $394,000 per year"

Little wonder, when combined with exhorbitant drug pricing, armies of "billing specialists" to deal with insurance and bill collection, and layers of management that health insurance for a family of 4 costs $25k+ per year.

Land of the (not) free (at the point of service).

My wife contributes $3,500 out of her paycheck a year to cover the two of us with $2,900 deductible per person. Basic checkups and screenings ie. Colonoscopy’s, mammograms are covered 100 percent. The employer contribution is $14,000 which also includes dental. Most employers offer similar or better plans. My daughter works in the insurance industry and her benefits are much better than ours.

An employee can put away $8,800 per year tax free from their paycheck into an HSA account that can accumulate and be used to pay for future medical expenses.

 

[John]

https://www.medpagetoday.com/popmedicine/popmedicine/96891

Note that these are average salaries.

"Plastic surgeons have an average annual salary of $526,000"
"Orthopedic surgeons have an average annual salary of $511,000"
"Dermatologists have an average annual salary of $394,000 per year"

Little wonder, when combined with exhorbitant drug pricing, armies of "billing specialists" to deal with insurance and bill collection, and layers of management that health insurance for a family of 4 costs $25k+ per year.

Land of the (not) free (at the point of service).

To be fair, U.S. doctors also pay a fortune for schooling and do residency afterward where they work like a dog and get paid very little. They then incur large costs for insurance and those related to running their practice.

 

[gordon]

There appears to be a certain kind of Trumpish American who sees public health care as a bad thing because it’s “socialist”.

If our NHS had not been around for so long, I wonder if the same thinking would have traction over here?

It's not about socialism, though that's an argument often made by the right. It's about race. Republicans were for social spending up until the passage of the civil rights act, and have been against social spending ever since. They're against anything that benefits non-whites, even if they would benefit too.

 

[Sue Pertwee-Tyr]

The term 'socialism' seems to be a proxy for 'communism' which is itself a proxy for 'Russian' or 'Chinese'. It's not ideology, it's xenophobia and a hangover from the cold war.

 

[chartz]

Have those types learnt anything since the 60’s?
Don’t they teach history there?

 

[k90tour]

The cost of the NHS is certainly less than reported by Gov. figures. I know a few senior front line medics and the hours put in vs paid is a large mismatch. All junior doctors, and certainly most nurses ( not sure about consultants, world of their own) work many more hours than their paid for. In theory they should get paid but the hours are instead banked and to be taken as leave instead,.. never happens, they disappear in to a black hole at the end of the year.
Apologies, rant over,
John

I can tell you that this applies to consultants as well. My wife, until the covid re-arrangements swept away her office, kept a pillow and a sleeping bag under her desk so that she could stay close to patients during the night. Never stops working. Travels the world , or used to, to train other doctors and did so in her spare time, and largely with her own money. Was teaching in India when she received a call to come back to London asap because they wanted her for a particular patient the next morning. One overnight flight available, first class. She paid with her pwn money and never put a bill in. Landed at 6am and straight into theatre. Too busy to do paperwork.

Whilst teaching in USA, she was offered 5 x her UK salary not to go home. Not about the money. Still here.

 

[chartz]

Admirable.

 

[sean99]

My U.K. daughter went to NYU for surgery on a brain tumour.
U.K. docs said nothing could be done for her and to take her home and make her comfortable as she died.
U.K. gov accepted that US had treatments they could not match and funded her treatment.
28 years later she is a qualified solicitor.
On the other hand my son living and working in NY needed a crown. His insurance paid half. He stumped up the other half - $2000!
Health provision is complicated.

The UK underspends on healthcare. The US overpays for healthcare. As ks.234 says this is a political choice in both countries, and it results in death and suffering. I'm very pleased for you and your daughter, but I think you'd find US healthcare charges much more rapacious now than 30 years ago.

 

[sean99]

My wife contributes $3,500 out of her paycheck a year to cover the two of us with $2,900 deductible per person. Basic checkups and screenings ie. Colonoscopy’s, mammograms are covered 100 percent. The employer contribution is $14,000 which also includes dental. Most employers offer similar or better plans. My daughter works in the insurance industry and her benefits are much better than ours.
An employee can put away $8,800 per year tax free from their paycheck into an HSA account that can accumulate and be used to pay for future medical expenses.

I agree that if you are in full time employment you are shielded from a lot of the cost. However my experience has been that health insurers are quite adept at not paying and trying to wear you down when you question them. I was presented with $6000 of bills for my routine screening colonoscopy because my insurer claimed the provider was out of network (they were not). It took two months and hours of phone calls to resolve. My wife had routine OBGYN cover denied from an in-network provider for a bullshit reason. 6 months of phone calls later we finally were reimbursed for $2000 (for an IUD).

Plus don't take any ambulance rides, since they are almost always out of network. A 15 minute, 5 mile hospital to hospital transport for my wife was billed at $5000 and we had to pay $3000. Should have taken an uber.

I agree that doctors are severely burdened by medical education costs of $500k or more - this too is a scam (on the doctors), and by insurance (also a scam). Doctors' salaries are also only a small percentage of healthcare costs, and the majority of doctors I've met here have been very good.

I remember a few years ago the CEO of Blue Cross of Massachusetts was reported to be earning around $9million.
https://www.healthleadersmedia.com/strategy/former-ma-blue-cross-ceo-got-86m
This is a small, regional insurance company with a few million customers. That's more than the head of the UK NHS, who is in charge of healthcare DELIVERY (not just payment) to a nation of 65 million.

My current plan has an annual $1500 out of pocket limit, so not HSA eligible - however that out of pocket limit doesn't apply if the insurer finds a reason to simply reject the claim, which I have experienced whenever I go over my out of pocket limit and they have to start paying for things.

 

[ks.234]

The UK underspends on healthcare. The US overpays for healthcare. As ks.234 says this is a political choice in both countries, and it results in death and suffering. I'm very pleased for you and your daughter, but I think you'd find US healthcare charges much more rapacious now than 30 years ago.

I think @Bob McC points to a particular problem in the muddle headed financing of UK health care.

On the one hand the NHS is underfunded and so has to operate very close to its bottom line, leaving little fiscal room for its own R&D and investment in its own improvement. On the other hand it actually pays out to the private sector for treatments it can’t provide itself due to lack of investment in its own R&D, and in so doing contributing to private sector profits and thereby private sector fiscal space to invest in….its own healthcare R&D.

In short, we have a public service that at the same time as being itself underfunded, as a consequence of being underfunded, is actually forced into contributing to the funding of the private sector.

Mad, but true.

 

[Joco]

I can tell you that this applies to consultants as well. My wife, until the covid re-arrangements swept away her office, kept a pillow and a sleeping bag under her desk so that she could stay close to patients during the night. Never stops working. Travels the world , or used to, to train other doctors and did so in her spare time, and largely with her own money. Was teaching in India when she received a call to come back to London asap because they wanted her for a particular patient the next morning. One overnight flight available, first class. She paid with her pwn money and never put a bill in. Landed at 6am and straight into theatre. Too busy to do paperwork.

Whilst teaching in USA, she was offered 5 x her UK salary not to go home. Not about the money. Still here.

Thanks for your reply k90tour, words kind of fail me when I hear of the selfless actions by people, they truly are and should be an inspiration to us all.

 

[Cav]

If you work for a Public Institution that is chronically underfunded, you do yourself, your colleagues, the Institution and the public no favours by essentially working for nothing.