How about naming the House and Senate negotiators who torpedoed the bill, rather than letting them hide in the shadows??
110
It's demoralizing to know that, once again, politicians of ALL stripes takes the position of MONEY. Their MONEY. Their campaign MONEY. MONEY. MONEY.MONEY. The financial well being of their constituents means nothing to them, because it's not their MONEY. Like the White House beside them, fleecing the American citizen of MONEY is "big game" (hunting ref) to them.
When will we EVER learn?
38
Who are they lawmakers who gutted the bill, publish their names!
71
"According to the Congressional Budget Office, the approach would tend to lower pay for doctors in those specialties by an average of 15 percent to 20 percent, because it would shift negotiating leverage in favor of insurers."
I note that once again the negotiating leverage would be shifted to a profit seeking and/or regulatory third party. No mention of the patient who should be the "leveraging" party.
True emergency care is a special case in that the circumstances dictate that the patient may have little choice in time, place, doctor, options for care, etc. As such a more universal approach such as a government mandated fee schedule for emergency care may be a reluctant necessity.
Otherwise, care decisions including pricing and payment should be determined at the level of patient and provider, without third party intervention, except a universal back-up plan that insures everyone in the country against bankruptcy caused by medical bills.
22
What is going on with the comment section?
My last two submissions on the over-sized earnings of US doctors compared to those from OECD have not been published.
Summary: Despite the US physicians earning the world's highest average salary they produce mediocre outcomes. Their over-sized compensation affords them lobbying the Congress and spending for media advertisements to scare the general public so they can maintain their gilded compensation.
49
There are states like Washington where a compromise on this issue has been reached if Congress would look to it. Giving the insurance companies more leverage over rates in an uncompetitive manner where they can use that leverage to demand in network reimbursement from doctors they haven't signed in to their networks is not wise policy. The physician profession is under stress while adapting to numerous transformations including payment reform, behavioral health integration, and work on social determinants of health, just to name a few, all while dealing with ever increasing administrative burden and a lack of HIT interoperability. The physician suicide rate is up to twice the average. Perhaps waiting on this issue is just wise public policy. None of us want a surprise medical bill and those who have been financially harmed due to practices of having an out of network physician treat them even when they're in an in network hospital deserve help. However, that doesn't mean that doctors should bear the full burden. The insurance companies should share that burden especially when it now seems as if their top priority is finding ways not to cover things and to deny claims from patients and caregivers.
28
Can NYT please, please, please explain how insurance companies purposefully not place Emergency Physicians in-network knowing that patients can’t choose. Insurance companies don’t pay the Physician fairly when the patients use the Emergency Room appropriately. The patient gets the bill and insurance companies blame the doctors who want to get paid. Insurance companies refuse to negotiate a good deal with the doctors knowing that that keeping them out of network saves them money and sends the rest of the bill to patients and blames doctors. It’s a tactic that’s working because no one blames the insurance companies.
69
The hospitals are the ones who are surprize-billing patients, NOT doctors. Doctors' fees are highly regulated by insurance companies. They are called "facility" fees and are rampant in hospital bills these days, and they are perfectly legal.
31
This issue is better stopped by State Legislatures. In Georgia it is illegal for "surprise" doctors and out of network doctors to appear on the patient's bill.
10
The title is disingenuous. Doctors win again? I don't remember the last time the neighborhood family doc won anything except more adminstrative burden and lower reimbursement, compounded by the student loan debt they are saddled with.
88
@GP Exactly.
21
Americans coddle doctors. It's not only Congress. Go to a dinner party with Democrats. Mention medical specialists make way more, on average, than any other profession in the world. The Census Bureau's top 10 professions by wage are all MD specialties, and most of the next 10. The conversation tanks. It's like bringing up religion.
The AMA scuttled Truman's attempt at universal care. It kept the Johnson administration from expanding Medicare beyond the elderly and Medicare the poor. Only recently have insurance, pharmaceutical, hospital industries become major barriers.
I took organic chemistry in college, back when course books were on reserve. That course's books had key pages ripped out. The professor told me it was pre-med students, who needed at least a B in a class graded on a curve. She also said that when they succeed, they'd beg, cry, tell her she was wasting a parent's sacrifices. Then they'd insult her. As tough as a professsor might be, this had an effect.
I checked out the medical school's books at the U bookstore. Three or four textbooks, at the undergrad level. Today some med students don't bother with textbooks at all, just use the internet. Not rocket science.
Doctors should be taken down a notch. Assessments of their diagnostic abilities do not promote confidence. We should look forward to robots replacing surgeons, because surgeons make a lot of mistakes. Stop treating doctors like gods.
25
@Brian. No reason to be bitter about not getting into medical school. When I was a premed, I never saw that kind of behavior. Most of the stories that circulate about premed behavior are simply apocryphal. Most of my colleagues know that the devil is the insurance industry. That’s where your attention should be focused, not “bringing doctors down a notch”. And, I can assure you, while some medical specialties are vulnerable to robots/A.I. such as Radiology and/or Pathology, it will be a long long long time before robots replace real surgeons.
37
I would like to be on public record My name is Jean Antonucci .I am a family physician in rural Maine . have seen every patient the day they called or the next for 14 +yrs AND I am always on time.I have superb quality and costs metrics.
Out here on the ground, ordianry hardworking docs had no idea about those physicians who objected to surprise billing .I choose to believe that whoever organized against this was a minority of selfish folks. Now this small group has done harm both to the rest of us docs and to the good folks of this country. My spouse was once the object of such a despicable practice and we refused to pay the bill. Anesthesia and ortho and derm and etc etc already make 3-5 times what I do. Most people think of THOSE salaries as what we all make This was despicable behavior on the part of whoever those forces were that were behind the failure of this effort This does not represent doctors as a whole, I assure you .I am for a single payer /would not object at all to medicare for all and am disgusted by my so called colleagues behavior. I do believe that MOST docs who benefit from this are decent and were not behind this Disgusting and sad. One more strike against the miserbale American health care system
62
I appreciate your comments and they reflect the majority of my lifelong experience with our physicians.
However if a majority of physicians actually feel this way why is the AMA not lobbying for this viewpoint? They are a powerful lobby which reflects and supports the values of their membership.
16
When will we realize that doctors are the enemy of American health care? They severely restrict the supply, and are responsible for the system we now have. Doctors forced this on us and doctors fight like tigers to keep it. True, they may not all be happy with the paperwork that insurance demands, but doctors are responsible for this.
They are often incompetent hacks, and their salient feature is their whinging about anything and everything that “attacks” doctors. Recently I wanted to reschedule my annual eye doctor check up scheduled for late Oct. 2019. Could I make it later in the day? No. Could I make it in coming weeks? No. When could I reschedule? How about June 2020–no wait, July 2020. Being a doctor means to be in the service industry. What other service industry can treat its customers like this.
If you do not think that most doctors are incompetent hacks, read DIAGNOSIS and/or watch some on NETFLIX. I do not like the series, as the writer, a doctor herself, becomes the story and is the hero of the whole series. But it shows how incompetent doctors are and how they charge for their incompetences, even sending these bills to collections, forcing one patient into bankruptcy.
SOLUTION: Allow doctors to compete. Graduate MANY more doctors and create more residency programs, if they are truly needed. Right now medical graduates are not able to do anything without this period of indentured servitude, working unreasonably long hours, killing patients
15
MFA, as promulgated by the far left ( Bernard and Warren) will never pass the House much less the Senate. This article makes it clear that even with a Dem majority we can't pass such legislation.
Most Dems will not vote for such unpopular and radical laws.
It, like most of their pie in the sky plans, is dead before it even gets presented.
These two are the kiss of death and their nomination would translate into four more years of Trump.
Pete has the answer: MFA who want it.
150 million Americans are not going to just kiss away their private health insurance to satisfy the far left agenda of the two extremists.
As more Americans realize how much Pete thinks as they do and is out to protect us from both Trump and left wing fascism, my way or the highway, they will continue to contribute to his current surge.
Tune in tomorrow for the debate and watch Pete, our next and best president.
3
Who are the mysterious congressional leaders who put the kibosh on this legislation? Seems like a pretty important piece of information for this article to include.
30
Really? A party whose nominees all seem to favor Medicare for all or Medicare for all who want it could not provde "strong enough support" from its leadership to stop surprise billing.
The hypocrisy is mind bending! And no recourse against individual politicians because the " leadership" made the decision. Obviously leadership advised by the bag man who handles contributions from the medical industrial complex to the Democratic party.
And we should trust this crew and their promises?
9
It always comes down to what's doable and to the mundane, but essential, vote counts. That is a piece of why I think it is foolish for the Democrats to go for a blow up the whole system approach. That's a way to end up with nothing, even if voters give us the chance to try.
2
Greedy doctors win again. The American people lose again.
7
Name the names of sham Democrats. These insidious politicians need to be exposed for what they are. The fifth columnists.
15
No names? This is a story about a popular piece of bipartisan legislation endorsed by the White House that was derailed by a small number of members of Congress who quietly backed a narrow special interest over everyone else. And the Times won't tell you who they are?!! The only member mentioned is Greg Walden, who was for the bill. Who are the people who scuttled it?!!!
This is poor reporting.
24
"Sharply reducing pay to doctors," as Sanders and Warren want to do to help pay for their single-payer plans is insane. There is already a shortage of physicians in several specialties and a critical one in family practice...the very specialty that will see the greatest increase in demand as everyone suddenly becomes insured.
Reduce compensation during a time of existing shortage and increase demand; yeah, that sounds smart, alright.
13
@Jim How about increasing the intake of students at the medical schools? What is holding it back? Why not introduce a 6 year, post high school MD curriculum that is widely prevalent the world over? Increase the number of students and tuition subsidies for those willing to serve in under-served communities? If all these measures are inadequate, allow H1B doctors from English speaking countries to serve temporary stints?
9
"Sharply reducing pay to doctors," as Sanders and Warren want to do to help pay for their single-payer plans is insane. There is already a shortage of physicians in several specialties and a critical one in family practice...the very specialty that will see the greatest increase in demand as everyone suddenly becomes insured.
Reduce compensation during a time of existing shortage and increase demand; yeah, that sounds smart, alright.
2
"Several people close to the negotiations said it did not have strong enough support from the Democratic leadership."
Why doesn't this piece name this 'leadership" and asks them to explain their position publicly?
14
I agree. I'm sorry but dosen't the buck stop at the top here? I'm angry with Pelosi. What do I say to my family members who want to "Drain the swamp" when such a rightiable injustice is caved to special interests? If the Democrats don't want to lose in 2020 they need to show they are able to act on their professed principles. I'd like the author /NYT to ask for an explanation from the party leadership and take the reponsible Democratic legislators to task publicly for their failure to protect their constituents.
If you don't lead when you are able someone else will.
6
Drs at the Cleveland Clinic are employees. Why don't all hospitals employ drs? Greed. I'm sure the Cleveland Clinic drs make a good salary.
There can be no defense of this practice, esp as to ER drs and anesthesiologists, without whom a hospital would not be a hospital.
I guess people won't spit the bit on this until hospitals outsource nursing, housekeeping, security, and billing too, so patients can get surprise bills from these profit centers too.
Enough is enough.
8
Doctors don't charge whatever they want. There is a standard. Insurance companies do not want to pay the standard. The discussed legislation would allow insurance companies to pay less to doctors without passing savings along to patients. Any disagreements "go to arbitration" which is GOP speak for "sorry sucker". The insurance companies are the un-needed middlemen in the delivery of healthcare.
31
I am a retired surgeon and now a patient. Through these two lenses I have seen the best and worst in our system and it has always been among the worst to watch certain specialties practice this kind of billing (who hasn’t received the surprise anesthesiologists bill after surgery?). What I found even more objectionable were those arrogant enough to feel their services were above the insurance system— so they charge out of pocket for their services.
While the system is bloated with predatory behavior that make practicing medicine expensive (like malpractice premiums, fattened administrations), the patient should not have to absorb the battle that’s waged in the billing office. That’s not in the oath we took.
19
The Upshot writes: "In a final meeting last week, leaders in the House and the Senate met to decide what legislation would end up in the year-end spending bill. Surprise medical billing didn’t make the cut. Several people close to the negotiations said it did not have strong enough support from the Democratic leadership."
So what really went on is that a handful of the Old Guard conservative corporate Democrats sold out Americans by siding with right-wing Republicans to kill this legislation.
Not a "cautionary tale" about Medicare-for-all; rather it's a signal that we Democrats need to vote out all those Republican-lite conservative Democrats.
We got rid of Crowley. We need to keep going!!
20
Most private solo or small group physicians do not get to decide which networks will allow them to participate. When UnitedhealthCare and Connecticare shrank their networks, physicians were generally at the mercy of either the insurers, or, large groups/hospitals which had exclusionary contracts - contracts that limited competition by non-network providers. This allows insurers off the hook for non-network care in plans w/out such coverage. It creates an environment where the big players dominate, and physicians find themselves providing uncompensated care. Is anyone surprised that the shortage of primary care physicians is growing?
23
Why do health care correspondents infer that health care must equate medical insurance?
If this were true one could state that public schools equate education insurance, that our highways equate travel insurance, that police protection equates personal insurance, that protection from foreign invaders is invasion insurance. These beliefs would be absurd.
Medical insurance is unnecessary when universal health care is a right that is provided by a government. Just as public schools, highways, police protection, and our armed forces are not characterized as insurance, health care should not be characterized as medical "insurance".
Of course voters who don't understand that medical care can be available without insurance and independent from inusurance companies, believe and fear the scare tactics that these companies use to thwart the adoption of health care policies that don't involve them.
23
It’s important to note that while S1129, Senator Sanders Medicare for All Act of 2019, anticipates paying lower rates to doctors, there is no conclusion that doctors pay will be less. That’s because Medicare for All eliminates the huge amount of time doctors spend on non-paid administrative tasks like Pre-authorizations, creating more paid clinical time - not more overall work hours, more time seeing patients. That clinical time is paid, thus overall pay is unlikely to decrease, especially since administrative expenses will be drastically reduced.
17
So you’re suggesting the primary care physicians should be happy to be paid less per patient and to see more patients per day. Don’t be surprised when we’re not happy with that idea. I just can’t find myself happy to vote for a pay cut. I make the same amount of money I made 20 years ago.
15
@Michael Lighty ER doctors do not spend much time on purely administrative tasks and most these days are employed by mega groups. When reimbursements get cut, who do you think will get pay cuts- the ER physicians or the executives?
3
A much larger problem is the wide difference in fee that doctors bills for the same treatment. Any national healthcare plan will have to reconcile the Park Ave or Scarsdale doctors salary with the salary of the doctor I see in rural Virginia. Will all doctors get the same compensation from the Warren/Sanders national health system? If not, who decides? Please tell us.
8
@Donna Gray Most doctors are contracted with insurance companies at a set fee schedule that they must adhere to. Those docs on Park Ave. charge cash and can charge whatever they want. Their patients gladly pay for it. It's not a big problem. Our healthcare system has much bigger issues to contend with.
1
I am a rtired physician, and "surprise billing" needs to stop. When a surgeon asks a practice partner to assist in a surgery, he/she knows if the assistant does not participate with the patient's insurer; when a hospital hires a practice to staff the ER or provide radiology or anesthesiology services, the hospital knows with what insurers the practices participate. There is no "surprise" to the hospital or practices in the bills. Physicians know when they do or do not participate in an insurance plan, and they also choose to not participate in a plan when they have a captive patient base (e.g., ER, surgery, radiology, pathology) and can bill "non-par" for higher rates. Hospitals need to require all contract physicians to accept all plan rates from insurers with which they (the hospital) participate, and if a practice chooses to have a "non-par" surgeon assist in a procedure, they (they practice) must then swallow the uncovered fee and not be able to balance bill the patient. This is only fair.
101
@Bob Parker bob - I have to disagree with 2 statements you've made. 1st "...they also choose to not participate in a plan when they have a captive patient base...", this statement is only partially true. As you must be aware health insurers have specialty panels, from time to time they close their panels to new MDs - essentially the carrier is choosing for the MD to be OON. Now of course carriers do this to maintain a specialty to patient ratio in a geographic region in order to honor their existing contracts with other MDs. Currently BCBS and UHC have closed panels in our geographic area - should the MDs just....move to a place where the panels are open? Will the government cover the cost of that move? To that same point, BCBS is currently "non-renewing" contracts here for the same reason. So had the MD just moved here to be in the panel only to be non-renewed because they now have too many MDs in-network...should he just move again?
2nd issue is your statement"... if a practice chooses to have a "non-par" surgeon assist in a procedure... what if said hospital has on on-call schedule with an assist from a different practice? Who "forces" the MD into a 85% of CMS contract? The hospital I assume? In the case of neurosurgery assists...you really believe the hospital has that power over this specialty? Because they don't, there aren't enough neuros to replace them with.
It is amazing what you believe in retirement after you've already made YOUR money and paid YOUR loans.
9
@Bob Parker
Everyone in the hospital should be in the same insurance plans. Problem in the ER is that you cannot control who comes through the door.
Now it becomes an out of network issue and why should the doctors eat that?
8
My daughter is in her fourth year of med school and wants emergency medicine. She currently has approximately $240,000 in debt so she can enter a part of the medical field with interesting drawbacks: patients treat the ER as their GP, specialists treat them as less talented, patients are angry for waiting, assaults on ED personnel are out of control. Her desire for this field was to help patients in crisis. When a patient rolls through the door, do they want to be quizzed about insurance issues and sent away or treated? It is NOT the ER doctor's fault. Talk to the administration. Talk to insurers about "out of network". Interesting that it's the ED doctors everyone is gunning for.
Ever call your doctor, you know, the one in your plan, at any other time than Monday to Friday from 9-5? Recording: "If this is a medical emergency, call 911."
28
@JPP My wife is an ER physician, but in the MidWest. The benefits of this specialty are; no call, schedule flexibility, and a very competitive salary. Your daughter will earn her full potential in her first year, no ramp up or buy-ins required.
Locums is an interesting program where you can work shifts in various hospitals across the country, generally at a higher rate (less total hours work necessary).
My wife, however, does work for TeamHealth (they won the contract at the hospital, physicians could either switch employers or move to a different hospital). But surprise billing doesn't seem to be an issue with her patient population.
ER can be a great field, but the patient population makes a big difference. In areas that are super wealthy, every patient will write a letter to the CEO about how long they had to wait. In super poor areas, drug seeking and other social maladies can make for disruptive patients.
She actually works in NW Indiana, rather than in Chicago, because the patients are friendlier and less prone to abuse the system.
4
@JPP My wife is an ER physician, but in the MidWest. The benefits of this specialty are; no call, schedule flexibility, and a very competitive salary. Your daughter will earn her full potential in her first year, no ramp up or buy-ins required.
Locums is an interesting program where you can work shifts in various hospitals across the country, generally at a higher rate (less total hours work necessary).
My wife, however, does work for TeamHealth (they won the contract at the hospital, physicians could either switch employers or move to a different hospital). But surprise billing doesn't seem to be an issue with her patient population.
ER can be a great field, but the patient population makes a big difference. In areas that are super wealthy, every patient will write a letter to the CEO about how long they had to wait. In super poor areas, drug seeking and other social maladies can make for disruptive patients.
She actually works in NW Indiana, rather than in Chicago, because the patients are friendlier and less prone to abuse the system.
Please refer your daughter to White Coat Investor and read about "Live like a Resident" Use the attending salary to rapidly pay down debt while living on $50K/yr. Debt can be paid off in 1 or 2 years.
2
@JPP Not only this, but EMTALA (Emergency Medical Treatment and Labor Act) explicitly forbids EDs (and by extension, the ED doctors who work there) from refusing care, regardless of insurance status. Therefore, EDs can't even tell patients "By the way, the ED doctors here don't take your insurance" without running afoul of EMTALA. Insurance companies know this and intentionally lowball doctor groups. To compound matters, if the doctors refuse the lowball rates, the insurance company gets to only pay the lowball rate anyway and pass the rest on to patients as a "surprise bill" and demonize the doctors as greedy in the process. No wonder insurance groups spent millions to lobby for passage.
16
There is an easy solution to this problem of our pre ACA de facto criminal health care system, an aberration re our peer countries.
A major of Americans are for a system like Canada.
Frame it as that, not a drastic medicare for all or some other immediate shock to the economic system or some socialist model.
Let the public know that whatever they have now they can keep until there is a smooth transition to a private/public model like Canada has.
Educate them, that our peer country models are much cheaper, insure all, give better outcomes ie life spans, infant mortality etc.
Unite don't divide.
17
Currently many young doctors finish medical schools more than $250,000 in debt, Note some schools have started to recognize this problem and are offering tuition free school. In addition, malpractice insurance is expensive, more than $1000 per day for an obstetrician.
Reducing pay for doctors will lead to less young people going into medicine or less qualified applicants to medical school.
Pointing out that in other countries physicians salaries are less does not take into account the economic burden placed upon American physicians
22
@pwb In many countries the education of doctors lasts 5 to 6 years after High school. Unlike the US and Canada where one needs to have an undergraduate degree in order study medicine, limiting the education to 5 to 6 years post high school does not burden medical students with excessive debt. The main fault lies with the US universities that charge usurious tuition and fees for educating doctors.
The entire cost structure of the practice of medicine in the US is rigged against the general public.
12
@Zor While this may be true - it does not detract from the fact that the costs are in existence and need to be covered and simply will not be covered at current in-network rates...not for specialists anyway. Unless we just have PCPs and no other MDs.
1
“Surprise billing would affect very few doctors, mainly emergency physicians and anesthesiologists. “. Isn’t there also concurrently an article in the Times about a shift in the ER? Let’s pay ER doctors even less and then let’s see how many leave the field to work in urgently care, addiction care, administrative work, or just leave medicine completely. Most full time ER doctors are already fed-up and burnt out; reducing their pay 15-20% to make the rest of the world happy will mean longer waiting times and poorer care. There needs to be a more equitable Solution.
29
@Scott What about orthopedic surgeons? Neurosurgeons? Plastic surgeons? They are all effected as well and I'd bet they are appreciated when the care is given...until the bill arrives.
5
Doctors now swim in waters compromised by the evolution of economic conditions. Economic conditions evolve, they happen, most times simply catching up with the only thing that seemingly doesn't change, and that's 'change' itself.
What is playing out upon this daily tableau vivant right now, and though inconvenient for some, is not anything different that what 'Mom and Pop' stores have been dealing with for decades.
Things evolve, they happen.
1
Most doctors support single-payer (Medicare for All). Very few doctors have anything to do with surprise billing. Blanket statements about all doctors opposing reform are inaccurate.
36
@Evidence Guy I don't personally support surprise billing and I'm glad it's illegal in NY state, but several physician professional organizations (including the College of American Pathologists in my own specialty) sent emails to their members telling us to write letters to congress against a surprise billing fix. Part of the reason I'm not a member of that organization...
Also, most doctors are indeed Democrats (especially among the younger cohort), but it's quite a jump from that to "most doctors support single payer", and I suspect much of that support would evaporate the moment that anyone proposed a pay cut for physicians. And make no mistake, hospitals and physician organizations will make it very clear to physicians that they will be getting a pay cut if and when a Medicare for All program that cuts rates is proposed.
7
@Evidence Guy
ER doctors want everyone to have insurance.
3
NY Times needs to do a comparative pay of doctors (pay/GDP per capita) among the OECD countries. Nowhere in the world do the doctors reap such gilded compensation as in our country.
Why should the doctors be compensated several times the wages of comparative highly skilled professionals with similar education, training and skills, i.e. PhD scientists, engineers, & researchers?
No wonder the doctors use their excessive compensation to lobby for protecting their oversized compensation (surprise billing) at the expense of the helpless citizens.
15
@Zor are PhDs engineers or researchers available 24/7? Provide life saving hands on care? Subject to numerous State and Federal regulations? Looking at other OECD Nations and physician compensation is flawed unless it takes into account operational expenses. Do the same for PhDs etc, they are probably paid more than other OECD country counterparts.
9
@Zor
I am a PhD engineering scientist with degree in a field which sees most engineering students struggle with. My better half has both doctoral and medical degrees. So I can see both professions quite closely. While PhD scientists have a rigorous education and work hard, it is no way close to the stress and productivity expected from a clinician. Couple that with the medical school debt, opportunity cost in lost years of residency training which can be 6-8 years beyond medical school for many subspecialties, late start of earning career, mental toll of call and threat of litigious environment, pay of a medical specialist will have to be a multiple of an average PhD scientist to make it worthwhile. That being said, successful PhD scientist often earn more than many medical specialists.
19
@Zor That would be a hard study to do, since training requirements vary widely across the world (even different between the US and Europe).
Many docs in Europe don't complete an undergraduate degree, they go straight into studying medicine. Accreditation would also be different, are the residency programs in Europe the same as US. Are the licensing exams the same?
As others have pointed out, the medical profession is competing for talent against technology, law, engineering, and business. 6 figure salaries are common in many of those fields. A student able to get into medical school could also get into law or MBA programs.
Opportunity costs is also a huge driver. I ran the NPV of a cops earnings from age 18 to 45 and they are the same as the median physician. A cop starts earning $50K/yr at age 20 and is quickly earning near $100K by age 22, the same age a medical student completed undergrad (negative earnings). The physician then has another 4 years of negative earnings during medical school. Then 3 or 4 years at $50k as a resident.
The US has the highest wages for any profession. An engineer in the US earns more than an engineer in Europe, a barber in the US earns more than a barber in Europe.
7
Why does this story not identify by name and party affiliation those who voted to approve this travesty? It is absurd to blame "insufficient support" from party leaders. How much "support," and of what type, should be required, to pass such a baby step toward health care cost containment? Perhaps the great grandchildren of Bernie Sanders and Elizabeth Warren will live to see meaningful health care reform in the US.
24
This article goes to show that doctors are not innocent bystanders in the wreckage which is American health care. There are a lot of greedy doctors who are taking advantage of people who cannot possibly know anything about medical billing. I don't think that's true for every doctor, but there is still the almost unspoken issue of doctor compensation. They cannot charge whatever they want.
The fact is, a lot of doctors are overpaid. When my father died in a hospital, the attending physician charged 11,000 dollars for a few hours work as he supposedly tried to save his life, although we had our doubts. The insurance covered it, but I ask, where does that 11,000 dollar figure come from? And mind you, that was just his bill. Forget about the rest of the charges. It's insane.
Doctors are not innocent here.
33
@Sirlar Most doctors in the U.S. are not unreasonably compensated. Not close. Check the data on salaries. These are people who have spent years--many of them well over a decade, uninterrupted, post-undergrad--undergoing some of the most intense training of any field. Many leave medical school with hundreds of thousands of dollars of student loan debt, debt that only grows while they spend years in residencies and fellowships that pay a pittance. And after all that, once they finally become attending physicians, doctors can earn less than many mid-level businesspeople. We really should appreciate America's doctors. Lowering the salaries of overworked ER physicians, who are saving lives daily, by 15 to 20 percent seems foolish.
12
@Sirlar I’m sorry to hear about your dad. I also feel bad that you value your dad’s life so little that you think someone who worked diligently to save his life shouldn’t be allowed to bill the price of a used car for their services (which, let’s face it, the doctor will get a tiny fraction of while the rest goes to hospital admins).
7
While we're on the subject of cutting pay . . .
How about the pay of CEOs, who I think make far more than the $200,000 being attributed to doctors.
OK, that's only one person, but then there are the endless strings of vice presidents, all of whom also make at least 10 times the doctor's pay.
And what do these people contribute to furthering the patient's health?
54
@Linda - The average pay of all CEOs of publicly traded companies in the US is $185K, less than the average pay of doctors, which is $220K.
Oh, you're thinking of the average pay of S&P 500 CEOs? Well, there's only 500 of them, but there's over 1 million doctors.
2
While surprise medical bills must be put to an end, there is something seriously wrong with legislation that punishes those physicians who are doing the right thing by joining provider networks and accepting the rates negotiated with these health plans. The problem with the legislation proposed by Sen. Lamar Alexander (R-Tenn.) and Reps. Frank Pallone (D-N.J.) and Greg Walden (R-Ore.) is not that it appropriately protects patients from surprise medical bills, but that it treats good doctors unfairly by imposing unsustainable pay cuts on top of rates that have already been negotiated downward. The State of New York has the most effective approach to out-of-network billing, which is supported by consumers, health plans, physicians, hospitals and employers. This is the model Congress should adopt, which would protect patients, while at the same time avoid rewarding health plans--which consistently put profits over patients (and their doctors).
31
@Katie O How would this stalled plan have affected doctors who don't participate in surprise billing?
@Steve According to the Congressional Budget Office, 80% of the savings from the proposal would come from cuts to physicians who are ALREADY participating in health plan networks. These physicians, along with those who engage in unanticipated out-of-network balance billing, would see cuts of between 15-20%. Also, if Congress establishes a federal payment benchmark at median in-network rates, there will be little incentive for health insurers to ever contract with physicians because they would only be responsible for paying these lower rates. Over time, this would drive down all physician reimbursement. Furthermore, as physician reimbursement spirals downward, more physicians will be forced to become hospital employees or get join physician staffing companies (the very groups supported by the so-called private equity dark money), consolidating the market even more. This would give these larger entities more leverage to possibly raise health care costs.
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Would it be a reasonable hypothesis that even a modest bill such as this, because it engages clashing powerful interests, requires strong leadership from the White House to pass? If there had been strong leadership from the White House, knowledgeable, forceful, persuasive advocacy, wouldn't it have passed?
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@Just Ben So why didn't Obama pass it?
What about targeting the larger health system problem here? Surprise medical bills seem to be an outgrowth of medical emergencies. Perhaps if access to primary care was reformed the need for emergency care and the number of surprise bills would diminish markedly.
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I have been a practicing physician, a healthplan executive and a state legislator. Now I am a health charitiy foundation board member.
Surprise or balance billing has been a problem for a long time, but is worse now with the ascendency of "network based"insurance products, including Medicare Advantage. The application of out of network benefits, co-pays and deductibles really hurt consumers (patients) who are often unaware that the low premiums they seek are possible by contracts with network providers directing services to them.
This is worsened by exclusive contracts with provider groups. A large group of anesthesia providers might demand an exclusive contract if they are to provide 24 hour service. With the monopoly they have at the hospital, they have little incentive to contract at a discounted rate and are therefore "out of network".
A fairly simple solution is to require that any physician providing services at a network hospital is required to accept the network payment and, if the provider accepts the network payment, it is paid at in-net benefit levels by the insurance carrier when provided at network facilities. This is the type of contract requirement that a state insurance commissioner can regulate.
The winners are the consumers. But the physicians will too in that they will not have the hassles of trying to collect an unreasonable bill. And the hospital will truly be able to advertise that they are "in network" for all services.
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@John Rusche thanks for the thoughtful comment. Too often, private practice knows they have leverage to operate in a hospital and can dictate terms.
I like your solution, it seems simple and easy to implement.
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@John Rusche
Thanks for highlighting the role of "provider groups". Many of these, particularly in Emergency Medicine (and ambulance services) are, in fact, run by hedge funds. (Soft citation of NYTimes article of a couple of weeks ago.)
As someone who was "gotcha"ed by the radiology service at my oncologist's hospital a year ago, I can testify to the fact that these practices are targeted at populations that are rarely in a position to fight back. Ask yourself why this practice is overwhelmingly prevalent in these specialties. It is, quite simply, extortion.
I have stage 4 cancer and have spent most of the last year fighting with hospital/provider/insurance billing. This is how our current system treats those who are in the last few years of their lives, squeezing as much of their net worth out of them before they die.
Your solution is rational, which means that it will never have sufficient support among the current congressional leadership, regardless of party. We need to replace that leadership.
No one should ever have to answer the question "How much are YOU willing to pay for one more year of life."
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@John Rusche I recall the hospital in Reston VA (where my mother was being treated) had signs that they didn't accept Medicaid patients. Any Medicaid patients entering the hospital through the ER would be treated and, if admittance was required they would be transferred to a different hospital.
High property taxes end up being exclusionary, so rich people want to buy in an area with high property taxes because they know that their neighbors will be a wealthy person too. Networks can create barriers, so not sure you want to allow fences to be built, because they could easily be built to weed out Medicare, Medicaid, and bronze level Obamacare policies.
First, do no harm.
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Nobody ever said overhauling our dysfunctional profit-making healthcare system would be easy. It will take smart, determined leaders with a strong, engaged and uncompromising popular movement, but that's no reason not to try. The answer is not to compromise before the fight, but to fight the fight until we win. Those hacks and profiteers must be shown that no amount of dark money will protect them in future elections.
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For those who fear government control of healthcare, this is what healthcare control of government looks like.
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@JS,
That’s funny.
To me, it looks like LACK of government control of disease care (billing).
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@JS No, this is what government failing to control healthcare looks like.
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Maybe it was the private equity owners who lobbied Congress and not the employee doctors. Before blaming the employee doctors, think about their bosses (usually MBAs, not MDs).
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@Jeremy
Private equity has bought up practices. If you go to a well visit and ask any questions from a previous condition, you get billed for another appointment.
Doctors are trapped.
Let's also address the ambulance chasing industry. Malpractice attorneys in NJ outnumber doctors.
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@Jeremy I would argue that Private Equity is in a position to push reimbursement up for everyone and eliminate surprise billing.
PE doesn't care how their returns are made, just that they are being met. The current system allows 90% of patients to have lower bills than they otherwise would, since 10% of patients will pay higher prices.
The law should be passed, and PE should make sure that all insurance programs are providing competitive reimbursement.
@JPP Does the practice have to agree to being bought up? If it agreed, it is responsible...
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States can and should ban surprise billing. Some states already ban it comprehensively, and other states ban it partially.
If Congress won't act, that doesn't mean the states can't.
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Every time I read about healthcare costs, I read about lobbying.
Industries that lobby to set their own (very handsome) pay.
Who is on the side of people and the US economy? Want to export - then lower home-front costs. Anyone want healthy and financially sound citizens?
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You're right. We need to vote out those corporate democrats making excuses and vote in progressives. Vote out all republicans either way in every position.
Medicare 4 All has huge benefits for people. It would benefit small business to be more competitive with big business. It would free people to take new jobs. It allows access to any doctor you choose as there is no in or out network which is greater choice than our private insurance plans who limit costs and deny you health care to save costs.
Might also be good to show documentation to back up the reasoning. So a few unnamed doctors or very wealthy donors?
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Here is the truth that rarely gets directly addressed in the healthcare debate -- All that money that gets spent on healthcare goes to somebody and reducing healthcare costs means someone is going to get less money (and you can be darn sure they'll lobby congress to stop that).
So from whom do we pull back this money to reduce costs? The doctors and nurses? Insurance companies? Big Pharma? Medical labs? Hospitals? Medical device manufacturers? The dozens of other stake holders who are getting a slice of the pie? All of the above?
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@David,
This question (who do we take money away from) is true for all sectors.
Here is my view - look at what services and products provide the best return for the nation as a whole.
I consider disease care as competing with education and military expenditures, nutrition support and other sectors.
Compare our expenditures in each sector compared to the other nations in the world and consider what we get for our expenditures.
Then adjust where we spend the monies to get the best return on investment.
Easy things - cut military expenditures, increase education and child rearing expenditures.
When it comes to the disease care sector, reduce administrative costs and drug costs, promote non emergency department care, promote scheduled primary care, decrease popular but dubious and expensive procedures and promote less toxic lifestyles.
So, hopefully, people will change to jobs that provide them decent income while providing a better return on investment to all of us.
Stephen Rinsler, MD
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Amen brother. All of the above plus the medical malpractice lawyers who have pretty good lobby of their own (and they’re largely Democrats). And then there’s the cost of a medical education.... it is a very complex problem which the simplistic chanting of Medicare for All and evil insurance/pharmaceutical companies does nothing to solve
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For those who naively think they are represented in Washington, this proves again that Washington is owned by lobbyists and corporations. Everyone in Congress (and the White House) has a price. SAD.
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Inquiring minds want to know—who are the members of Congress responsible for making sure this surprise billing provision was not included? And—why does the story not name them or explain why they are not named?
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@Surf City because that would be useful news not infotainment, although I think you could find out from a reference librarian or something
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Exactly! How do we not get to know their names, but we do get to know the name of the ranking member who was disappointed?
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This has to be among the first articles that I've seen which seems to imply that doctors and their pay should be the primary targets for improving our convoluted healthcare delivery system. Doctors don't know which patients have which insurance plans. They just see patients and give them the best care that they can. Do docs want to be paid for what they do? Of course, considering that the average doctor graduates from medical school with over $200,000 in debt and have to complete a low-paying residency that lasts between 3-7 YEARS. Not unrelated, doctors are burnt out and are committing suicide at twice the rate of non-doctors.
To imply that lowering physician pay (which accounts for ~5% of medical costs in this country and which are on par with the pay of physicians in other countries after factoring for debt, training, and GDP) is to completely miss the mark on any discussion that is seriously meant to focus on improving our disgustingly complex and inefficient system.
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@Gabe Doctors are by far the highest paid professionals in America. They are paid close to double what doctors in other rich countries make. Any system that significantly reduces medical costs will have to pay doctors substantially less. The AMA has lobbied hard for decades to artificially increase doctor pay and we should fight back.
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@Gabe Doctors are by far the highest paid professionals in America. They are paid close to double what doctors in other rich countries make. Any system that significantly reduces medical costs will have to pay doctors substantially less. The AMA has lobbied hard for decades to artificially increase doctor pay and we should fight back.
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@Jacob American doctors have to pay FAR more for training than any other country. We also have to do both undergrad and medical school, whereas other countries roll them into a shorter period.
As I like to ask all critics of physician pay, what do you for society's benefit that requires huge amounts of investment in time and money and bearing as ongoing high stress load on a day to day basis?
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"Surprise billing" would not be tolerated for one minute in any other commercial transaction, but interested parties are fighting to retain the ability to ambush and gouge people when they are at their most vulnerable and their very health or life may be at stake.
Nice. That's our for-profit healthcare system in action.
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@Pat
Doctor to Pat:
Your car accident resulted in a compound fracture of your leg. Could I please see your insurance card?
hmm
The imaging is in plan, but you might owe a co-pay
My services will be $xxxx. I cannot prescribe a pain killer until you approve my services. Would you like to consult with your family?
We will have to put you under for the surgery, so you will have to discuss this with the anesthesiologist as well.
If you would like to wait until tomorrow when Dr. Jones comes in, you would be covered.
Of course, by then sepsis might set in but, hey, you won't get a bill.
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This sounds like an ad for Medicare for all. It is certainly a reason to endorse it. You are describing extortion. No one in a civilized country should be subjected to such treatment!
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I think it is important to keep in mind the background for why physicians do not want their pay cut. We as a community take out a house worth of loans, go to school til our mid-thirties, and only then do we make a real salary.
If the government is going to cut our wages, then fine. But they simultaneously should make medical school more financially accessible. We love our patients and want to do good, but this does not mean we want to constantly be in a state of financial panic post-training.
We sacrifice all of our twenties and most of our thirties in training, and there does need to be some benefit for that beyond advancing science and patient care. Tinkering with small aspects of these legislative bills without looking at the full picture is a detriment to physicians and patient care as a whole.
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@Researcher
Financial panic? Try getting a surprise medical bill on top of whatever health crisis you are experiencing.
In every other commercial transaction the price is known in advance and one party cannot ambush the other afterwards with exorbitant surprise bills. This is outrageous and deserves to be prohibited by law.
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@Researcher I’m sorry, but doctors deserve no sympathy. Average physician pay in the US is over $200,000, by far the highest for any profession in America. This bill would have reduced pay for a small number of doctors by around 15%, so they would still be rich, but just slightly less so.
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@Researcher no one, absolutely no one, forces you to become a doctor. And doctors earn well above the median salary in the US, which by the way is $65k. And many of those people have student loan debt as well. How much will it take? A couple hundred thousand to pay off your loans? What is the amount you need to earn that will allow you to think that surprise billing is a scourge?
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What is wrong with this picture: Doctors, hospitals, air ambulance providers, and private equity funds are so panicked at a cut in compensation or profits that they eagerly spend millions of lobbying dollars to maintain the status quo which rips off insured patients. If they stopped lobbying and accepted the pay cuts, I'd say they'd be likely to break even. Their selfish greed is a real black mark. Maybe instead they should be lobbying the Dept. of Education for some relief in college loan debt.
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@me The lobbying was done by private equity groups that have bought physician practices, not by the rank and file physicians.
Doctors don't have time to organize any resistance to the onslaught on our profession- we're too busy taking care of patient and fighting with our EMRs.
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