Dean Baker’s Articles on Healthcare
Barkley has mentioned this particular article several times now. I would be negligent if I did not post a link to it so we could read it. New Health Care Plan: Open Source Drugs, Immigrant Doctors, and a Public Option, 25 March 2017, CEPR, Beat The Press, Dean Baker.
There are two obvious directions to go to get costs down for low- and middle-income families. One is to increase taxes on the wealthy. The other is to reduce the cost of health care. The latter is likely the more promising option, especially since we have such a vast amount of waste in our system. The three obvious routes are lower prices for prescription drugs and medical equipment, reducing the pay of doctors, and savings on administrative costs from having Medicare offer an insurance plan in the exchanges.
This short article is worthy of a read also. Why Do Proponents of More Immigration Never Mention Doctors? 08 February 2017, CEPR, Beat The Press, Dean Baker.
If we got the pay of our doctors down to the levels in other wealthy countries it could save us close to $100 billion a year.
More on Healthcare to follow.
Dean’s proposals are fine and dandy, Run, but every single on of them are pie-in-the-sky proposals simply because they all require a change in our system of government…. and haven’t seen Dean do one article yet at any time on what he proposes to change or system of gov’t.
We can all propose what needs to be done … in fact that’s precisely what the current administration and congress are doing as we speak, and what the Obama administration proposed to even get Obamacare. Teddy Roosevelt proposed a national system too, and they there was the failed attempt to even get off the ground by the Clinton administration. In fact as you know it was the Clinton attempt that got the right wing conservative think tanks to propose what we now call ObamaCare and which a Republican governor (Romney no less) put into Massachusetts..
Of course since all these things in the past the Supreme Court ruled that who-ever has enough money to spend can use it to get the representatives and senators they want elected to get elected .. so now money talks more than it ever did before.
I’m sick and f…ing tired of hearing everybody gripe about what’s wrong with our health care system (past or present or potential future) with a zillion different proposals for how to “fix” it depending on ideologies of what gov’t is for or should be for, or depending on whose vested interests are at stake, the fact remains that nobody and I mean NOBODY is willing or has proposed what to do to changer our political system to make a lower cost, high health care, affordable system national standard even remotely possible.
I always love or usually love what Dean Baker’s proposing on a variety for subjects.. but he, like everyone else is long on what we want and empty on how to get there. .. and keep it there.
If you got doctor pay down to the same level as other countries, then FMGs would have no reason to come here. We would lose 25% of our physician force. Wonder what that would do to salaries.
What is the mechanism for forcing doctors to take a pay cut? I guess we expect them to just lie down and take it? And which party is going to take up this cause and guarantee hundreds of millions of dollars in contributions to the other party?
All these big ideas are great, but they look like political non-starters. It makes sense to focus on the ones that can pick up some political traction and that have already been endorsed by one of the parties: the public option, drug importation, Medicare negotiation of drug costs and higher taxes on the wealthy.
Getting to universal health insurance coverage will wring huge administrative costs out of the system. When providers know when and by whom they will be paid, they will not have to spend so much time and energy finding what pot to put an uninsured person’s costs into, fighting pre-existing conditions and annual and lifetime caps issues, confusing patients and collecting sums owed, etc. etc. Hospitals will no longer need to have one billing administrator for every bed (as Duke reportedly did a few years ago).
“providers know when and by whom they will be paid, they will not have to spend so much time and energy finding what pot to put an uninsured person’s costs into, fighting pre-existing conditions and annual and lifetime caps issues, confusing patients and collecting sums owed,” Pretty much gone by the wayside now and computerization has been the one of the goals also.
When the PPACA came out, the CBO was compared and scored higher in cost than the PPACA. Lets say the Gov decided to implement the public Option and installed the controls necessary to change the fee for services environment, control pharma and hospital supplies, and hospitals and clinics as they do in European countries. “What is the mechanism for forcing doctors to take a pay cut? I guess we expect them to just lie down and take it? And which party is going to take up this cause and guarantee hundreds of millions of dollars in contributions to the other party?”
Are you stating we should have a public option or single payor without those controls? This would be tantamount to breaking the piggy bank.
I reading a book, The American Sickness by Elisabeth Rosenthal (MD) detailing the financialization of American medicine — that I am going to have to go back over to make a list of all the craziness:
— medical bills; e.g., hospitals getting rid of unprofitable specialties which then set themselves up in large centers and overcharge insurance anything they want in facility fees; anesthesiologists doctors monitoring multiple anesthesiologist nurses and charging separate fees; forget etc., etc.,, make that ad infinitum — hey this is abusiness now;
— drug patents; e.g., environmental regs force sprays to drop certain gases, viola!, prices of inhalers go up 10X, new patents; patent running out on ulcerative colitis pills that have a coating to pass through the stomach into the intestines, cool!, add another coating (often too much), brand new patent, etc., etc., one giant mess.
None of this would happen in Europe or Canada — where the countervailing force of high union density keeps such infamnias from happening — not to say become the way everybody does business.
Just before Rosenthal’s book I read Ron Suskind’s Confidence Men detailing exactly the same kind of financialization on Wall Streeet that almost brought on a depression. Same species eveyrwhere now. One cure: countervailing forces which only labor unions can provide.
Reading Bernie Sanders book “Our Revolution” where he shows that if billionaires go one more step — if they can donate directly (instead of indirectly) to political campaigns then they will completely control Congress (that pols will be their employees). Know what? Rebuild union density and we can outbid (and outvote!) them — Citizens United will present no problem.
But — as Bernie points out — we are a step away from losing it all.
Almost forgot. Doctors. Doctors pre-tax wages after expenses represent 10% of overall medical costs. If I were in the medical racket I would be a PA: $100,000 salary (don’t have to move out of downtown when yuppies move in), high tech job, you have your life left when you leave work. I don’t have the personal calling that lets medical training and practice absorb your whole life.
If doctors wanted to be wealthy, they would have become UPS truck drivers
Steve, care to enlighten us on why FMG’s (Foreign Medical Gradate… now referred to as IMG … International Medical Graduate) wouldn’t want to come here if pay was similar (relative to purchasing power parity) to those in other advanced nations?
And by the way do you have the data on how many IMG’s there are now practicing in the U.S…. how many 10 years ago? 20 years ago? as proportion of all licensed medical doctors?
Steve, just some thoughts on the issue you raised about FMG’s not wanting to come here if physician pay was equivalent in purchasing power party to those of other advanced nations…. I’m waiting for your basis for this assertion.
Physician pay in the US is much higher than in other nations because of the physician’s union … called the AMA. This union controls the number of annual medical school graduates, and licensing (test and credentials) conditions used by the States. The AMA makes sure that supply remains well below demand in order to keep medical professional’s pay as high as possible without causing congress to interfere and make different rules.
The same is true of the AIA (Architects union).
These professional unions are run by and for the professionals to keep the numbers of them sufficiently below demand so that the prices they charge can remain high. The public is led to believe it’s because of demanding professional standards and high costs of Medical School.
The fact is though that the professional standards are no different in the advanced European nations than in the U.S. and Indian physicians just as qualified as any US physician.
The high costs of Medical school isn’t because it costs so much but because the number of AMA approved Medical Schools and Medical teaching positions are limited ..keeping supply of medical school seats low and thus demand far exceeding supply, The demand is then restricted by medical school prices which are bid up until the price equals the AMA’s ‘balance of equilibrium’ equation.
There’s no real reason why there are fewer medical school seats available than demand for them even at the higher prices charged other than the fact that the AMA has to keep the supply of licensed medical professionals limited to keep the prices they charge high. medical e h suE t (even eh
Longtooth- About 25% of US doctors are foreign born. Documented many places, easy to Google. How do I know? I have asked a bunch, plus I look at the Canadian data. I have asked this question of many of the FMGs who who I work with and who work for me. If the pay differential was not large, they would not move. It is difficult to learn a new culture an olive with a new language. Of course, my n here is not that big, so I look at Canada. A Canadian doc can come here and make 40%-100% more depending upon their specialty, but almost noncom here. They don’t have to do a residency here, they can just come practice. They don’t. That suggests to me that the gradient in that range just isn’t high enough.
Steve, maybe I miss your reasoning … you said:
“If the pay differential was not large, they would not move. [from native country to the US.]”
Then you said that Canadian docs who speak the same language and have most of if not identical culture as our own, don’t move here even though
” A Canadian doc can come here and make 40%-100% more depending upon their specialty.”
Yet you also say
“About 25% of US doctors are foreign born.”
So why do the 25% foreign born docs come here the if pay differential isn’t sufficiently large enough to entice them?
Does “foreign born” mean educated in non-US medical schools? or just that many foreign born immigrants to the US become doctors in the US?
Are the FGM’s in the US here for residencies or are they here for having set up practice or become employed at US medical institutions post-residency as practicing physicians (as opposed to teaching at med schools).?
“Currently, more than one-quarter of physicians and surgeons in the United States are foreign-born. In addition to physicians, roughly one-fifth of nurses and home health and psychiatric aides, and more than one-sixth of dentists, pharmacists and clinical technicians in the United States were foreign born in 2010. When foreign-born professionals account for 16% of all civilians employed in healthcare occupations and one-fourth of practicing physicians, the system really does depend on a functioning immigration system. There are simply not enough native-born healthcare workers to meet the growing demand–especially in the geographic areas with the greatest need.” https://www.forbes.com/sites/nicolefisher/2016/07/12/25-of-docs-are-born-outside-of-the-u-s-can-immigration-reform-solve-our-doc-shortage/#4b87605d155f
Demand is there, pay might not be as much at whitey.
The National Health Service, the best doctors Pakistan can provide.
“If we got the pay of our doctors down to the levels in other wealthy countries it could save us close to $100 billion a year.” Dean Baker should have followed his own advice and explained that $100B is maybe 3% of all expenditures on health care. That would only counter half of the typical annual rise in health care costs, and you can be that hospital administrators and health care corporations would leap in and eat that $100B in annual savings within a year. I don’t know what Baker has against doctors, but they are basically employees, and a much smaller part of the problem than the move to for-profit health care administration.
Did you go and read Dean’s entire article? This was only a portion. Go and read in entirety both articles.
Some actual facts on IMG’s foreign educated non-US citizen physicians in 2014 (latest census by Federation of State Medical Boards)
– 22.6% are foreign Medical School Educated non-US born practicing licensed physicians. These do not include and are not Canadian physicians practicing & licensed in the US. They are apparently not counted or considered to be IMG’s (International Medical Graduates) by the U.S. State licensing boards or by any other US organization that tracks or counts IMG’s in the U.S. I say apparently, though I can’t find an actual reference, Canadian physicians medical degrees are either all obtained in the US or their medical education and tests, residencies, etc. are not considered “foreign”. .In any event whatever their numbers are in the US they are not among the dominant non-US licensed and practicing physicians. (see list below).
– US residencies (aka physician apprentices) are more easily obtained by the Caribbean Medical School graduates than any other foreign medical schools. Greater and greater percentages of US born and university educated physicians obtain their medical degrees from the Caribbean Medical Schools primarily because there are too few seats available in US medical schools.. (see source below)
– The US lags most European nation’s physician densities (licensed and practicing physicians/100k population) considerably and is only 80% of the average density of Germany, France, UK, and Switzerland.
– To fill annual residency demand there are far too few US medical school graduates each year, and thus IMG’s are in huge demand by hospitals and medical institutions in the US to fill their residency programs every year. Since this is highly competitive, the U.S. can and does obtain the cream of the IMG crop each year for those positions — a serious brain drain from the source nations. However by far the most of them return to their native nation to practice after residencies are completed.
– Most European nations have at least 25% more physicians per capita than the US… obviously then also a lower mis-match in supply / demand ratio’s, hence also lower physician pricing. The AMA’ guild is very effective in keeping US practicing physician prices higher than anywhere else on the globe (in purchasing power parity measure). That guild has had and continues to have undue influence in political power in the US. .
Following is the data I compiled from the listed sources below.
841, 321 Total Licensed & Practicing Physicians.
Of these, 24.7% (207, 840) IMG licensed physicians
Of the IMG physicians, 30, 895 IMG’s are from Caribbean Medical Schools
Of the Caribbean school’s IMG’s 17,425 IMG’s are US citizens
Thus 13,470 are Foreign Caribbean Medical School IMG’s
Thus 190, 415 IMG’s are foreign born ( = 207,840 – 17, 425 IMG’s nnt-US citizens)
Thus 22.6% of licensed & practicing Physicians in the US in 2014 were non-US citizens educated in foreign Medical Schools
2014 Foreign Graduate US currently Licensed & Practicing Physicians Medical Schools Graduating Location (most have been in the US for several years and decades).:
13470 Caribbean Foreign
92,493 Other IMG Schools.
287 Physician’s per US 100k population 2014
Extracts of some States (lowest and highest physician densities)
1,612 DC (ya think maybe Senators, Reps, Lawyers, & Cabinet members get good health care?)
644 HI (could this be because it’s a nice environment before retiring?)
575 WY (rural)
514 AK (rural)
510 ND (rural)
269 TX (2nd most populous State after CA) & lowest physician density state.
348 ID (rural)
370 CA (most populous State)
Physicians per 100k Population, 2014
410 Sweden (2013)
287 US (80% of Avg Germany, France, Switzerland, UK)
80 South Africa
Source: http://www.oecd.org/els/health-systems/health-data.htm (Frequently Requested Data – Excel Download)
A lot of work and for what? I posted the WHO site which had similar data on doctors and other healthcare specialties. You cam back at 22.6% and mine was slightly higher as quoted by Forbes and obviously taken from somewhere else. Thank you for your efforts . . .
Note that of the foreign (non-US citizen) IMG’s, nearly 98,000 of them are from the poorer nations (see my post of May 23, 4:22 am) of India, Philippines, Caribbean (which I assume includes many of the south American nation citizens getting medical degrees), Pakistan, and Mexico.
Though nation of Medical schools aren’t listed for the other 92,000 currently practicing and licensed physicians in the U.S. I would think most of those also come from other poor nations, rather than from the other advanced European nations or Canada..
Thus if this is the case (and I’m not sure what proportion of the other 92k IMG’s come from other poorer nations) then the draw for IMG’s to the US is not so much that it pays so much more in the US , but that the nations they obtained their Medical degrees from are so much ess able to pay medical prices relative to purchasing power parity income levels. There are thus fewer wealth clients in those nations and hence far more medical physician competition for those wealthy clients which then obviously drive some out and thus seeking other locations to practice where there are more wealthy clients available and less physician competition for them. I assume therefore the European nations also have some proportion of their medical licensed physicians who are also IMGs from poorer nations.
Basically then by the AMA keeping supply low and thus physician prices high with lower physician density per capita then it’s the reduced competition in the US relative to available wealthier clients that draws the IMG’s to the US.
The Forbes article has zero references from where it’s information came … not to mention that the writer is a basic journalist who has no knowledge of medical practices .. and then leaves out referenced sources to boot.. I take Forbes with a grain of salt anyway though, but I wouldn’t consider their stuff to be unbiased or in any event..
Not going to accept your critique LT as it comes to a similar conclusion as most other info does. You are not the expert here. Thank you for your comments though.
Run, what I mean to say is that there are more than enough native born college graduates or college educated people to become physicians, unlike the Forbes articles’ statement concludes, but that the number of medical school seats is far from sufficient to meet demand … leaving thousands of qualified applicants to seek other medical schools in the Caribbean and even then there aren’t enough seats available.
Why on earth would there be too few seats available to meet demand in a capitalist economic system after decades and decades and decades?.. especially when the physician density in the US is so low relative to other wealthy advanced nations?
This is clearly and unambiguously a pure political power issue having nothing to do with qualified people available or even with economics (leaving out the political part)..
You reiterated what Dean has surmised and I have too. Thank you.
Run, I cannot find a posting by you of the WHO site you say you posted a link to. Re you stated in response to my fsmb.org data response::
“A lot of work and for what? I posted the WHO site which had similar data on doctors…”
My “lot of work” was to insure I and others were aware of actual verified data from a known accurate and reliable source. Forbes with uncited source data is worthless junk information. It was also the only source I could find that had a clear breakdown on IMG’s relative to locations and quantities, thus percentage of non-US citizens who were IMG’s
In my experience it usually does take some decent amount of work and time to get verifiable, reliable data… don’t you also find that to be the case?
Go look in “Medicare Does Not Pay For Itself” where I posted it in response to Barkley. You appear to place a lot of credence in numbers being absolute in proof of a point. They are not in many cases when researching issues for me in a plant. Numbers point in a direction for me and then I go an investigate. Forbes made a nice point and coming from this magazine, I find it acceptable and close enough for me to look further.
Thank you for your comments.