We can’t control what others do and we can’t stop misfortune from striking. But we can control our own actions. Those who are financially prudent will most likely enjoy success, even if events don’t always go their way.
So, what do you think. Are physicians paid too much or earn too little? No matter, there are consequences to these cuts or not making them for that matter. Medicare costs will rise or perhaps access to care will be affected.
Physicians would receive a 3.4% cut in their Medicare reimbursement under a final rule released Thursday by the Centers for Medicare & Medicaid Services (CMS).
Overall, the finalized calendar year 2024 physician fee schedule conversion factor is $32.74, a decrease of $1.15, or 3.4%, from 2023, CMS said in a press release.
CMS’s Positive Spin
The press release cast the final rule in a generally positive light, noting that it would “support primary care, advance health equity, assist family caregivers, and expand access to behavioral and certain oral health care … [The] final rule also provides payment for principal illness navigation services to help patients and their families navigate cancer treatment and treatment for other serious illnesses.” . . .
But physician groups were not so positive. “The finalized reduction to the Medicare conversion factor will result in untenable payment cuts for family physicians and reiterates the urgent need for long-term Medicare payment reform,” Steven Furr, MD, president of the American Academy of Family Physicians, said in a statement. “Practices across specialties report challenges meeting growing patient needs as practice costs rise and annual, compounding Medicare payment cuts undermine practice viability and patient access. With this in mind, Congress must modernize Medicare’s outdated physician payment system by enacting annual inflationary adjustments and providing relief from budget neutrality requirements.”
If you think the Medicare payments are going into the pockets of physicians, think again. The doctors who earn the most money are typically in private practice, are surgeons or specialists that do invasive procedures.
Do you know who the lowest pain physicians are? Pediatricians. Also internist, family practice doctors. Many physicians spend 13+ years in training and graduate with huge loans, over $200,000. What are their loans in Europe like?
There is already a shortage of primary care physicians and cutting their pay does not incentivize new doctors from entering those fields. Who do you think is taking care of senior citizens _primary care needs_? Not the surgeons, invasive cardiologists, etc.
Now we have EHR which is not patient care oriented. EHR is to maximize billing. Physicians have less time to spend with patients because they are sitting in front of computers most of the time.
And then there’s medical malpractice costs which are through the roof….
If I were starting over, I would work for the insurance companies or hospital administration. That’s where the money is in healthcare.
I do think we should raise the maximum payment into social security taxes. Why should someone who nets two million a year pay the same as someone who makes only $160,200.
I’m surprised that the fee would be cut. Leaving it as is would in effect be a cut. The CMS has hired some masterful spin writers . Their take is impressive.
“…America has the highest-paid general practitioners in the world. ”
“The United States is the country with the highest inequality level…across the OECD, Mexico and Turkey excepted.”
“What’s more, in the 18 states where lesser-paid nurse practitioners are allowed to do primary care without a doctor’s supervision, their treatment is just as good in terms of health outcomes and better in terms of patient satisfaction.”
It’s not just the billionaires. Income disparity in the U.S. is a problem.
My Dad used to say, the difference between Communism and Capitalism is that in Communism, it is “From each according to his ability, to each according to his needs”
(German: Jeder nach seinen Fähigkeiten, jedem nach seinen Bedürfnissen)
With Capitalism, “it is just for a man to keep what he has earned.”
(German: Es ist nur Sache des Menschen, das zu behalten, was er verdient hat)
The harder (or smarter) you work, the more you earn.
But, Dad said, it’s hard to understand how any man literally works a hundred, or even ten times harder than I do.*
In the U.S., the median wage is under $40,000/yr. Median household income about twice that.
I never understood why Biden and company promised not to raise taxes on anyone under $400,000. (The average U.S. physician earns $350,000 a year. Top doctors pull in 10 times that. …Washington Post, 2023)
My household is about median income, and, IMHO, we would be willing and able to increase our taxes (and those above us, progressively.)
*Or a thousand times more, in the case of billionaires.
The median annual wage is nearly $50,000, higher for men alone.
I have no doubt Americans would agree to raise taxes on someone else and yet 40% pay no income tax. In Europe their higher taxes are spread across everyone mostly by way of a VAT and extra fees on certain purchases and usages.
The idea of working harder relative to pay is misleading. A mechanic works harder than an executive in physical terms, but that is hardly the only measure of value for work. A radiologist earns around $750,000 a year reading the results of scan, MRIs etc. He surely does not work harder, but what about skill, risk, training and how many people can do the job.
In addition, the really high paid have far more at risk than the worker who goes to work, does their job, collects their pay and goes home.
The average doctor salary in Italy is about a fourth of a U.S. doctor +/-. U.K. is about half.
May be our doctors are twice as good, or work four times as hard, but I doubt it. Same goes for most other professions.
Most other OECD countries have much less income disparity than the U.S. Not just for doctors, but for engineers, attorneys, CPAs, you name it. That is before taxes and transfers.
“Everybody” does not pay taxes after redistribution. Many lower income are “net” tax recipients. Much more so than the U.S. Income redistribution
We appear to be better of that Mexico, there’s that.
Europeans live and think differently, accept less in some regards. A retired friend of mine in England is convinced his health care is free as he pays no pays no premiums or out of pocket costs while forgetting about all the payroll taxes in working years and that they have been waiting since last Feb for hip surgery. Europeans drive small cars, hardly an SUV or pickup in sight, they live in smaller houses. They accept less, pay higher taxes and expect more in return from government programs.
Would Americans seek out the least costly, discount physician? We equate cost with quality and then complain about insurance premiums.
So it sounds like doctors, attorneys, engineers, and other professionals (CEOs?) in Europe are accustomed to doing with much less than in the U.S. One wonders why? It seems like that was the norm in the U.S. also, until the 80s. What happened? Was it political or social/cultural?
The important thing, I think, is that the lowest income are able to survive with relative security and even dignity, both the unskilled employed and old/disabled who are unable to work.
Forgetting the billionaires for now, it seems like a lot of the “middle class” are overpaid.* It’s actually wasteful, IMHO. The Cato Institute says inequality is a myth, partly because wages and prices are set by virtually billions of consensual transactions every day, but I question that. The first thing they teach in econ 101 is the concept of “perfect competition”. Second thing they teach is, there’s no such thing.
*That includes me and people such as yourself, no offense intended.
Inequity is not a myth, but it is irrelevant. The billionaires take nothing from the middle class, prevent no one from achieving wealth. Most of the great wealth was achieved by creating something and was rewarded by the stock market and investing all of which is open to anyone. As long as there is no blocking of opportunity, no intentional holding people down, I see no problem with wealth. And, keep in mind the value for society created by many billionaires – millions of jobs, others wealth, improvements in our lives. Nobody really wants equality, they want to be on the upper end of inequality. Inequality is relative as well.
I may sound like I’m beating a dead horse, but I probably don’t disagree as much as you think, with one caveat.* Even Cato says disparity is not a problem, …but poverty is.
The U.S. has among the highest poverty rates of OECD countries, and there is a big difference between states, from 18+% in Mississippi to under 6% in New Hampshire. It’s not because people in Mississippi are somehow inferior.
Where this matters is when social welfare programs are the first and easiest budget cuts when times get bad, as they often do.
*”If you’re poor, it’s your fault.” Anyone who works hard enough can be successful.
Yes, poverty is the problem, but that is not the same as inequality. The goal is to raise those out of poverty and you don’t do that by pulling down others. In the end we will never eliminate poverty or inequality as both have been with us forever. Human nature is a factor in both. We need to be sure that nothing blocks opportunity.
QUINNSCOMMENTARY 
If you think the Medicare payments are going into the pockets of physicians, think again. The doctors who earn the most money are typically in private practice, are surgeons or specialists that do invasive procedures.
Do you know who the lowest pain physicians are? Pediatricians. Also internist, family practice doctors. Many physicians spend 13+ years in training and graduate with huge loans, over $200,000. What are their loans in Europe like?
There is already a shortage of primary care physicians and cutting their pay does not incentivize new doctors from entering those fields. Who do you think is taking care of senior citizens _primary care needs_? Not the surgeons, invasive cardiologists, etc.
Now we have EHR which is not patient care oriented. EHR is to maximize billing. Physicians have less time to spend with patients because they are sitting in front of computers most of the time.
And then there’s medical malpractice costs which are through the roof….
If I were starting over, I would work for the insurance companies or hospital administration. That’s where the money is in healthcare.
I do think we should raise the maximum payment into social security taxes. Why should someone who nets two million a year pay the same as someone who makes only $160,200.
LikeLike
I’m surprised that the fee would be cut. Leaving it as is would in effect be a cut. The CMS has hired some masterful spin writers . Their take is impressive.
LikeLike
“…America has the highest-paid general practitioners in the world. ”
“The United States is the country with the highest inequality level…across the OECD, Mexico and Turkey excepted.”
“What’s more, in the 18 states where lesser-paid nurse practitioners are allowed to do primary care without a doctor’s supervision, their treatment is just as good in terms of health outcomes and better in terms of patient satisfaction.”
https://www.econlib.org/archives/2013/02/a_reason_us_doc.html
LikeLike
It’s not just the billionaires. Income disparity in the U.S. is a problem.
My Dad used to say, the difference between Communism and Capitalism is that in Communism, it is “From each according to his ability, to each according to his needs”
(German: Jeder nach seinen Fähigkeiten, jedem nach seinen Bedürfnissen)
With Capitalism, “it is just for a man to keep what he has earned.”
(German: Es ist nur Sache des Menschen, das zu behalten, was er verdient hat)
The harder (or smarter) you work, the more you earn.
But, Dad said, it’s hard to understand how any man literally works a hundred, or even ten times harder than I do.*
In the U.S., the median wage is under $40,000/yr. Median household income about twice that.
I never understood why Biden and company promised not to raise taxes on anyone under $400,000. (The average U.S. physician earns $350,000 a year. Top doctors pull in 10 times that. …Washington Post, 2023)
My household is about median income, and, IMHO, we would be willing and able to increase our taxes (and those above us, progressively.)
*Or a thousand times more, in the case of billionaires.
LikeLike
The median annual wage is nearly $50,000, higher for men alone.
I have no doubt Americans would agree to raise taxes on someone else and yet 40% pay no income tax. In Europe their higher taxes are spread across everyone mostly by way of a VAT and extra fees on certain purchases and usages.
The idea of working harder relative to pay is misleading. A mechanic works harder than an executive in physical terms, but that is hardly the only measure of value for work. A radiologist earns around $750,000 a year reading the results of scan, MRIs etc. He surely does not work harder, but what about skill, risk, training and how many people can do the job.
In addition, the really high paid have far more at risk than the worker who goes to work, does their job, collects their pay and goes home.
LikeLike
The average doctor salary in Italy is about a fourth of a U.S. doctor +/-. U.K. is about half.
May be our doctors are twice as good, or work four times as hard, but I doubt it. Same goes for most other professions.
Most other OECD countries have much less income disparity than the U.S. Not just for doctors, but for engineers, attorneys, CPAs, you name it. That is before taxes and transfers.
“Everybody” does not pay taxes after redistribution. Many lower income are “net” tax recipients. Much more so than the U.S. Income redistribution
We appear to be better of that Mexico, there’s that.
https://cepr.org/sites/default/files/styles/popup_small/public/image/FromMay2014/causafig1.png?itok=_6BXZjgI
.
LikeLike
Europeans live and think differently, accept less in some regards. A retired friend of mine in England is convinced his health care is free as he pays no pays no premiums or out of pocket costs while forgetting about all the payroll taxes in working years and that they have been waiting since last Feb for hip surgery. Europeans drive small cars, hardly an SUV or pickup in sight, they live in smaller houses. They accept less, pay higher taxes and expect more in return from government programs.
Would Americans seek out the least costly, discount physician? We equate cost with quality and then complain about insurance premiums.
LikeLike
So it sounds like doctors, attorneys, engineers, and other professionals (CEOs?) in Europe are accustomed to doing with much less than in the U.S. One wonders why? It seems like that was the norm in the U.S. also, until the 80s. What happened? Was it political or social/cultural?
The important thing, I think, is that the lowest income are able to survive with relative security and even dignity, both the unskilled employed and old/disabled who are unable to work.
Forgetting the billionaires for now, it seems like a lot of the “middle class” are overpaid.* It’s actually wasteful, IMHO. The Cato Institute says inequality is a myth, partly because wages and prices are set by virtually billions of consensual transactions every day, but I question that. The first thing they teach in econ 101 is the concept of “perfect competition”. Second thing they teach is, there’s no such thing.
*That includes me and people such as yourself, no offense intended.
LikeLike
Inequity is not a myth, but it is irrelevant. The billionaires take nothing from the middle class, prevent no one from achieving wealth. Most of the great wealth was achieved by creating something and was rewarded by the stock market and investing all of which is open to anyone. As long as there is no blocking of opportunity, no intentional holding people down, I see no problem with wealth. And, keep in mind the value for society created by many billionaires – millions of jobs, others wealth, improvements in our lives. Nobody really wants equality, they want to be on the upper end of inequality. Inequality is relative as well.
LikeLike
I may sound like I’m beating a dead horse, but I probably don’t disagree as much as you think, with one caveat.* Even Cato says disparity is not a problem, …but poverty is.
The U.S. has among the highest poverty rates of OECD countries, and there is a big difference between states, from 18+% in Mississippi to under 6% in New Hampshire. It’s not because people in Mississippi are somehow inferior.
Where this matters is when social welfare programs are the first and easiest budget cuts when times get bad, as they often do.
*”If you’re poor, it’s your fault.” Anyone who works hard enough can be successful.
For all the Veterans out there…
Thank you for your service.
LikeLike
Yes, poverty is the problem, but that is not the same as inequality. The goal is to raise those out of poverty and you don’t do that by pulling down others. In the end we will never eliminate poverty or inequality as both have been with us forever. Human nature is a factor in both. We need to be sure that nothing blocks opportunity.
LikeLike