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Med School DEI Admissions - Trump Admin Investigates

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PalmettoTiger1

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Jan 24, 2009
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fskillet said:
It sounds racist because it is. If your default position about a black doctor is that you don’t think he’s qualified for his position because of the color of his skin then yeah you have a racist predisposition. I guess it’s something that you recognize it, but that definitely has racist undertones.
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You seek to make it RACIST

Your race to the bottom of the barrel to make it about RACISM is disappointing for me on that you choose to go low instead of deep diving into the facts and reality of DEI being used as an EQUITY EQUALIZER

To me it is all about the Racist DEI where EQUITY RULES OVER MERITICRACY

It should be reversed where MERITOCRACY RULES OVER EQUITY

ENOUGH SAID so stop with the DEI and Equity if you want me to consider you to be a rational open minded person

Otherwise I will ignore discussing anything with you if you start with IMPLIED RACISM OR TDS OR WHITE SUPREMACY to try and create leverage based on me feeling bad about peoples lives and bad choices because I am white and modestly successful.

That came with family supporting me, hard long work over many years, luck , and other factors such as building relationships with people.

I will defer from judging your level of RACISM as I believe we all have tribal tendencies however my concern is based 100% on the use of DEI to allow unqualified people to enter Medical School and then treat people

if you did not see the earlier MANTRA it goes like this

What do you call the top graduate of medical school and the last place graduate DOCTOR

So I am concerned that we need to have that last place finisher as smart and educated and qualified as can be

With DEI the bottom feeders are far from being qualified

Has nothing to do with skin color but with intelligence, skills and education

On these I am 100% on having the best possible folks serving me
 
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tigres88

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PalmettoTiger1 said:
You seek to make it RACIST

Your race to the bottom of the barrel to make it about RACISM is disappointing for me on that you choose to go low instead of deep diving into the facts and reality of DEI being used as an EQUITY EQUALIZER

To me it is all about the Racist DEI where EQUITY RULES OVER MERITICRACY

It should be reversed where MERITOCRACY RULES OVER EQUITY

ENOUGH SAID so stop with the DEI and Equity if you want me to consider you to be a rational open minded person

Otherwise I will ignore discussing anything with you if you start with IMPLIED RACISM OR TDS OR WHITE SUPREMACY to try and create leverage based on me feeling bad about peoples lives and bad choices because I am white and modestly successful.

That came with family supporting me, hard long work over many years, luck , and other factors such as building relationships with people.

I will defer from judging your level of RACISM as I believe we all have tribal tendencies however my concern is based 100% on the use of DEI to allow unqualified people to enter Medical School and then treat people

if you did not see the earlier MANTRA it goes like this

What do you call the top graduate of medical school and the last place graduate DOCTOR

So I am concerned that we need to have that last place finisher as smart and educated and qualified as can be

With DEI the bottom feeders are far from being qualified

Has nothing to do with skin color but with intelligence, skills and education

On these I am 100% on having the best possible folks serving me
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You just KNOW this dude and his parents picketed to fight against integration in his schools in the 60's. They probably had signs too!
 
LafayetteBear

LafayetteBear

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baltimorened said:
is coming from a "poor" background a protected class???
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No, but there are many court opinions stating that being from an economically disadvantaged family is a factor that may be, along with other factors, taken into account in the admissions process. I thought I was pretty clear in my explanation of that.
 
LafayetteBear

LafayetteBear

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baltimorened said:
so, based on your analysis, all we're doing is transferring discrimination from race to class. Wouldn't the entire process be fair to everybody is that decicsons were based solely on the individual, regardless of race, religion etc and class? How is it fair if a Child of yours - rich, white, educated in private schools - was rejected solely on that basis.
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No, making admissions decisions solely on the basis of each individual's grades and test scores would not, in fact, be fair. That is beyond obvious.
Someone who grows up in a wealthy family, attends private schools with great faculties, has tutors as and when necessary, and has familial and other connections that facilitate admission into exclusive colleges and graduate schools has a very clear advantage over someone who does not. Expecting them to have identical grades is absurd.

A very legitimate question is how much weight should be assigned to the economically disadvantaged kid's having to overcome that disadvantage, and how much disparity in grades and test scores should that be allowed to offset. That's a very fair question to debate. But expecting that an applicant from the first background and an applicant from the second background will have comparable grades and test scores is both laughable and myopic.

If you disagree then that's just another subject on which we'll have to agree to disagree.
 
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fatpiggy

fatpiggy

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Aug 18, 2002
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firegiver said:
Im not upset brown people exist or that they might outnumber me in the future. Are you thr moron that is scared?
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I’ve never seen someone get so upset over their inability to practice racism. Cry harder.

Just so the world knows loud and clear

DEI IS RACISM AGAINST WHITE PEOPLE.
 
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tigres88

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fatpiggy said:
I’ve never seen someone get so upset over their inability to practice racism. Cry harder.

Just so the world knows loud and clear

DEI IS RACISM AGAINST WHITE PEOPLE.
Click to expand...
 
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baltimorened

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May 29, 2001
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LafayetteBear said:
No, making admissions decisions solely on the basis of each individual's grades and test scores would not, in fact, be fair. That is beyond obvious.
Someone who grows up in a wealthy family, attends private schools with great faculties, has tutors as and when necessary, and has familial and other connections that facilitate admission into exclusive colleges and graduate schools has a very clear advantage over someone who does not. Expecting them to have identical grades is absurd.

A very legitimate question is how much weight should be assigned to the economically disadvantaged kid's having to overcome that disadvantage, and how much disparity in grades and test scores should that be allowed to offset. That's a very fair question to debate. But expecting that an applicant from the first background and an applicant from the second background will have comparable grades and test scores is both laughable and myopic.

If you disagree then that's just another subject on which we'll have to agree to disagree.
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I don't want to disagree with you again, because even though you lean a lot further left than I ever will, most of the time I find your posts to be reasonable (but not always :)) But how about this scenario, 2 students, one from well to do family (not wealthy) and one from an economically disadvantaged family (although we'd have to define those two characterizations) both attend the same high school - it does happen...both have access to the same classes, take the same college entrance exams at the same time. Why would one get greater consideration than another.

I have recent experience with friend's child...normal kid, I'd guess we'd classify him as coming from a well to do family, 4.4GPA, 1520 on SATs, active in HS organizations....gets wait listed from home state university. He does have one major disadvantage, he's a white male. Now he as also applied to some more prestigious universities as well...BC, Notre Dame, Alabama (prestigious?) wait listed on all of them. Now, I'm not a conspiracy theorist, especially because I have no idea of the qualifications of students accepted before him, but his positioning on wait lists has to be questioned.

Now I don't know where this young man would fit in your scenario, but in my opinion, a person with his bona fides deserves to be considered on the basis of his accomplishments not any other fact. It is not his "fault" that he was borne into a white, middle class family, and his family is not applying, he is.

That's why I say, we should be consistent in how we make our decisions. How do you quantify the differences in a family wealth, race, national origin in making these kinds of decisions. And, trying to do so will frequently, if not always, raise the question if the selected one is the most qualified.

Just my reasoned opinion
 
hawkeyetraveler

hawkeyetraveler

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For the record I’m generally a “the best/smartest candidates should be admitted regardless of any race, gender, orientation, etc.” guy. The admissions processes should be monitored to ensure no bias exists one way or the other. Graduate education is not the place to fix demographic gaps in education/readiness. You have to solve that problem WAY before someone graduates college. Just make sure the process is blind to those factors for medical school.

Having said that there is a much bigger problem here: demand for medical care exceeds supply. So what I really think we should have Congress consider is how to safely increase the supply of doctors. Ironically going after DEI admissions is not the big issue IMO and could risk compounding the problem by further choking supply.

The #1 root cause of the supply gap, as I understand it, is that residency is basically supported by our tax dollars (paid mostly by Medicaid if Gemini is right). Most hospitals cannot afford residency without subsidies which effectively puts a federal cap on new doctors minted per year.

I’m no expert on this, so my question to the Drs out there is this: should we overhaul how residency is done?

I’m a small government guy generally, so would prefer a market solution if one existed, but in the absence of that this might be an area where spending upfront to create more doctors alleviates a much higher societal cost down the road due to demand exceeding supply...would love to see the math on that.
 
fatpiggy

fatpiggy

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hawkeyetraveler said:
For the record I’m generally a “the best/smartest candidates should be admitted regardless of any race, gender, orientation, etc.” guy. The admissions processes should be monitored to ensure no bias exists one way or the other. Graduate education is not the place to fix demographic gaps in education/readiness. You have to solve that problem WAY before someone graduates college. Just make sure the process is blind to those factors for medical school.

Having said that there is a much bigger problem here: demand for medical care exceeds supply. So what I really think we should have Congress consider is how to safely increase the supply of doctors. Ironically going after DEI admissions is not the big issue IMO and could risk compounding the problem by further choking supply.

The #1 root cause of the supply gap, as I understand it, is that residency is basically supported by our tax dollars (paid mostly by Medicaid if Gemini is right). Most hospitals cannot afford residency without subsidies which effectively puts a federal cap on new doctors minted per year.

I’m no expert on this, so my question to the Drs out there is this: should we overhaul how residency is done?

I’m a small government guy generally, so would prefer a market solution if one existed, but in the absence of that this might be an area where spending upfront to create more doctors alleviates a much higher societal cost down the road due to demand exceeding supply...would love to see the math on that.
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While I'm sure changing residency may help in some fashion, on the surface without researching, it seems like that would be too small of a change to get the changes you are requesting.

I think the problem of too few doctors is multi-faceted. With a push towards socialist medical care, doctors worry they won't be rewarded for their investment. It's expensive to go to medical school. Another thing the doctors around me complain about are insurance costs. We all know health insurance billing is a huge scam.

My neighbor doctor got so fed up with insurance she left her job to start a practice that is self-pay. They don't accept insurance (they are thriving).

And in the scope of this thread, why would our smartest people go into medicine only to be passed over for people who are less qualified yet have more melanin in their skin? Why make a huge investment, when such a trivial thing can derail you? Racism has to go from every facet of our lives. The government should be colorblind.
 
hawkeyetraveler

hawkeyetraveler

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fatpiggy said:
While I'm sure changing residency may help in some fashion, on the surface without researching, it seems like that would be too small of a change to get the changes you are requesting.

I think the problem of too few doctors is multi-faceted. With a push towards socialist medical care, doctors worry they won't be rewarded for their investment. It's expensive to go to medical school. Another thing the doctors around me complain about are insurance costs. We all know health insurance billing is a huge scam.

My neighbor doctor got so fed up with insurance she left her job to start a practice that is self-pay. They don't accept insurance (they are thriving).

And in the scope of this thread, why would our smartest people go into medicine only to be passed over for people who are less qualified yet have more melanin in their skin? Why make a huge investment, when such a trivial thing can derail you? Racism has to go from every facet of our lives. The government should be colorblind.
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Agree they should be color blind.

As I said, I’m no expert. But from what I’ve read on this the real issue is that residency slots are artificially limited by federal funding. And because medical school rankings are heavily biased towards residency placement this creates a major pressure on them to constrain supply to match the rate they project they can place people in residency. The whole system gets choked because of one critical step in the process. So solve for that.

I would love to hear from our resident doctors on the real issues underlying this.
 
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fatpiggy

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hawkeyetraveler said:
Agree they should be color blind.

As I said, I’m no expert. But from what I’ve read on this the real issue is that residency slots are artificially limited by federal funding. And because medical school rankings are heavily biased towards residency placement this creates a major pressure on them to constrain supply to match the rate they project they can place people in residency. The whole system gets choked because of one critical step in the process. So solve for that.

I would love to hear from our resident doctors on the real issues underlying this.
Click to expand...

Might have to go to our main board to get doctors. Not sure we have any real doctors that i am aware of on the politics board.

AI seems to agree with you though.

Seems like a misplacement of priorities by both parties. We spend money one god knows what, but we won't invest in getting more doctors. Seems really messed up. Seems like there would have to be more to the story ....

Yes, residency slots for doctors in the US are artificially limited primarily by federal funding restraints through Medicare's Graduate Medical Education (GME) program.

The Medicare GME Cap​

In 1997, the Balanced Budget Act froze the number of Medicare-funded residency positions (full-time equivalents, or FTEs) at each hospital based on the number of residents they were training in 1996. Medicare is the largest single payer for GME, covering a substantial portion of the costs of training residents (direct GME for salaries/stipends and indirect for the higher costs of teaching hospitals).

  • Hospitals can train more residents than their cap, but they must cover the full costs themselves without Medicare support, which discourages expansion.
  • Per-resident amounts are also based on outdated base years (often 1984–1985), adjusted only for inflation.
  • This cap was enacted when projections suggested a future surplus of physicians, which proved incorrect amid population growth, aging, and rising demand.
New hospitals or programs started after 1996 can get their own caps under specific rules, and there have been modest additions (e.g., 1,000 new positions phased in from the 2021 Consolidated Appropriations Act, with distributions ongoing into 2026 prioritizing rural/underserved areas and primary care/psychiatry).

Impact on Supply​

Medical school enrollment has grown significantly (driven by new schools and class size increases), but residency positions have not kept pace at the same rate due to the funding cap.

  • In recent Match cycles (e.g., 2026), there were records like ~44,000+ positions offered and over 41,000 US seniors/graduates matching, but thousands of applicants (including IMGs) went unmatched overall.
  • This contributes to projected physician shortages (tens of thousands by the 2030s, especially primary care, psychiatry, and in rural/underserved areas).
  • Some hospitals self-fund extra slots, and total positions have grown modestly (via non-Medicare sources or the small federal additions), but the Medicare cap remains the binding constraint for scalable growth.

Ongoing Efforts and Bills​

Bipartisan legislation (e.g., the Resident Physician Shortage Reduction Act) has been reintroduced to add thousands more Medicare-supported slots (proposals like 14,000 over several years), with priorities for underserved areas. These face cost concerns and have passed in incremental forms but not at the scale many advocates want.

In short, the limitation is policy-driven and artificial—tied to a 1997 cost-control measure that hasn't scaled with need—rather than a lack of qualified graduates or training infrastructure. This is a widely acknowledged issue across medical organizations (AAMC, AHA, AMA), GAO reports, and Congress.
 
hawkeyetraveler

hawkeyetraveler

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fatpiggy said:
Might have to go to our main board to get doctors. Not sure we have any real doctors that i am aware of on the politics board.

AI seems to agree with you though.

Seems like a misplacement of priorities by both parties. We spend money one god knows what, but we won't invest in getting more doctors. Seems really messed up. Seems like there would have to be more to the story ....

Yes, residency slots for doctors in the US are artificially limited primarily by federal funding restraints through Medicare's Graduate Medical Education (GME) program.

The Medicare GME Cap​

In 1997, the Balanced Budget Act froze the number of Medicare-funded residency positions (full-time equivalents, or FTEs) at each hospital based on the number of residents they were training in 1996. Medicare is the largest single payer for GME, covering a substantial portion of the costs of training residents (direct GME for salaries/stipends and indirect for the higher costs of teaching hospitals).

  • Hospitals can train more residents than their cap, but they must cover the full costs themselves without Medicare support, which discourages expansion.
  • Per-resident amounts are also based on outdated base years (often 1984–1985), adjusted only for inflation.
  • This cap was enacted when projections suggested a future surplus of physicians, which proved incorrect amid population growth, aging, and rising demand.
New hospitals or programs started after 1996 can get their own caps under specific rules, and there have been modest additions (e.g., 1,000 new positions phased in from the 2021 Consolidated Appropriations Act, with distributions ongoing into 2026 prioritizing rural/underserved areas and primary care/psychiatry).

Impact on Supply​

Medical school enrollment has grown significantly (driven by new schools and class size increases), but residency positions have not kept pace at the same rate due to the funding cap.

  • In recent Match cycles (e.g., 2026), there were records like ~44,000+ positions offered and over 41,000 US seniors/graduates matching, but thousands of applicants (including IMGs) went unmatched overall.
  • This contributes to projected physician shortages (tens of thousands by the 2030s, especially primary care, psychiatry, and in rural/underserved areas).
  • Some hospitals self-fund extra slots, and total positions have grown modestly (via non-Medicare sources or the small federal additions), but the Medicare cap remains the binding constraint for scalable growth.

Ongoing Efforts and Bills​

Bipartisan legislation (e.g., the Resident Physician Shortage Reduction Act) has been reintroduced to add thousands more Medicare-supported slots (proposals like 14,000 over several years), with priorities for underserved areas. These face cost concerns and have passed in incremental forms but not at the scale many advocates want.

In short, the limitation is policy-driven and artificial—tied to a 1997 cost-control measure that hasn't scaled with need—rather than a lack of qualified graduates or training infrastructure. This is a widely acknowledged issue across medical organizations (AAMC, AHA, AMA), GAO reports, and Congress.
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We have a few doctors that made the migration that would know a 1000% more than me. AI was mostly my source for what I wrote above, but of course it can be prone to hallucination.

Personally I would love to see a free market solution to this, but not sure that is viable with all the regulatory (and other) constraints.
 
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GOHOX69

GOHOX69

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fatpiggy said:
DEI is racism against white people. It's so blatant that it's a running joke among white people.

DEI is trash. It's poison. And Trump was absolutely 100% correct to eliminate any program that mentions it. It's that bad.
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And yes, us Asian Indian Americans.
 
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aCEOuProbablyKnow

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This numbnuts is a pediatrician, by the way.

www.yahoo.com

Med school deans come up empty in tense hearing when asked point blank if men can have babies: 'Ridiculous'

Rep. Mary Miller pressed UCLA and UCSF medical school leaders on whether non-biological women can have babies, but neither gave a direct yes or no answer.
www.yahoo.com www.yahoo.com

www.insidehighered.com

House Hearing Puts Med Schools in DEI Hot Seat

Republicans grilled administrators from medical schools at UCLA, UC San Francisco and the University of Illinois over their admissions policies and curricula. Democrats dismissed the hearing as political theater.
www.insidehighered.com www.insidehighered.com

 
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aCEOuProbablyKnow

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hawkeyetraveler said:
We have a few doctors that made the migration that would know a 1000% more than me.
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@Urohawk
@JWolf74
and the retard at UCSF don't know more than a bumpkin farmer.

Farmers know there are males and females, you ******' dipshit.

@GOHOX69, I'd call your curried *** in to pile on, but you sold your soul to this phaggotry when George Floyd passed a bad twenty, if not earlier.
 
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Aardvark86

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1. I think part of the problem is the size of the applicant pool. It's been relatively flat (+/-16% YTY) in terms of total quantity, and while the profession still offers financial and social status, I think the mix of candidates has changed. If you're economically motivated, the easier upside is probably perceived to be tech. If you're lifestyle motivated, being a doctor is a major pain in the *** that has been converted to a volume business rather than a value business, where you implement the median-driven "science" protocol rather than an "art". From where I sit, it's a little more oriented toward "caring profession" mode. That's not necessarily bad as one might argue that the pool composition has shifted to people that you might "want" to be doctors, but they're not the same people who used to be..
2. Probably correct that the residency system costs are a real barrier.
3. Also a victim of its own longer term success at a public policy level. We're at the point where EVERYTHING MUST be covered by insurance as a matter of "right". So now, we have a massive budget suck that has to be managed, and one of the ways that gets managed is for the managers to find every conceivable way for a doctor to not be the one providing the health care service. The only way to deal with that probably isn't increasing supply, but rather reducing demand through insurance and service reforms that reorient health care toward more of a social safety net model.
 
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aCEOuProbablyKnow

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@Urohawk
Why, other than financial gain, do you pretend to believe in gender ideology and weave it in with your son's sexual preference?

Why do you continue to defend a non-science (and, therefore, non-medical) ideology?

@JWolf74, you're retarded, so disregard the previous questions. Oh, by the way, "disregard" means "ignore," as far as you're concerned.

@GOHOX69, you, despite your fly-attracting-stank, consider yourself a "scientist."

How? and Why? Ya know, considering you believe in the non-science nonsense of "gender."
 
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scotchtiger

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fskillet said:
Personally, if you’re getting into the medical field because you want to be a millionaire you’re doing it for the wrong reasons.
Click to expand...

Lol. What if you want to make a great living AND help people?

Should our best and brightest be forced into modest means if they want to practice medicine and help people?

Should there not be a financial reward for the grueling academic process leading up to becoming an actual MD? 4 years of undergrad, 4 years of med school, residency, etc...

And millionaire is a low bar these days. $1M produces $40K per year in retirement income. Not exactly wealthy…
 
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fatpiggy

fatpiggy

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fskillet said:
Personally, if you’re getting into the medical field because you want to be a millionaire you’re doing it for the wrong reasons.
Click to expand...
Why is that? I don’t get that line of thinking?

Doctors should do all the work, and it’s a lot of work, to pass the boards for a low incentive?

They are supposed to be nuns?

I doesn’t have to be the main reason, but there should be no shame in being rewarded for their hard work. No one deserves their work for free.
 
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scotchtiger

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fatpiggy said:
Why is that? I don’t get that line of thinking?

Doctors should do all the work, and it’s a lot of work, to pass the boards for a low incentive?

They are supposed to be nuns?

I doesn’t have to be the main reason, but there should be no shame in being rewarded for their hard work. No one deserves their work for free.
Click to expand...

The invasion brought us a lot of bitter people who don't think others should earn a good income. It's a strange group.
 
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Aardvark86

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scotchtiger said:
The invasion brought us a lot of bitter people who don't think others should earn a good income. It's a strange group.
Click to expand...
I don’t begrudge docs their economic rewards at all (though I think they’re increasingly illusory as payors have driven protocol based medicine that increasingly makes them cogs in the machine). But it is, or at least should be, still a profession. And what makes a profession distinct from a job is that fundamentally, it must start and flow from a commitment to serving others. Docs who don’t have that aren’t professionals and are bad doctors.
 
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fatpiggy

fatpiggy

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I’m actually surprised by how little some doctors make. It makes a big difference if you are in a private practice vs getting paid by a hospital, but the amount of money doctors make compared to other people I know, I would say many of them are underpaid.

They work long hours, it’s high stress, and their insurance costs are sometimes extreme.

I have a big problem with insurance. For example, I recently had a surgery where the hospital billed my insurance $42,000 but somehow there was a magical “insurance adjustment” of $16,000. That’s still a $ 26k cost. When I asked AI how much the procedure should cost, it estimated $8,000-$12,000.

I dont have a problem with the doctors, but somewhere in the system there is a lot of fat.

The billing and pricing scams should be illegal. There should be one price, and that price should be the same no matter if you have insurance or not. The doctor is doing the same work, why two different prices. Should be illegal.

Additionally, there was no information giving to me on the cost of the procedure before hand. There was no competition or price shopping.


And last, look at the stock chart of UNH since Obamacare was passed. Insurance companies are killing it. There needs to be major reform and I’d start there before punishing doctors.
 
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hawkeyetraveler

hawkeyetraveler

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fatpiggy said:
I’m actually surprised by how little some doctors make. It makes a big difference if you are in a private practice vs getting paid by a hospital, but the amount of money doctors make compared to other people I know, I would say many of them are underpaid.

They work long hours, it’s high stress, and their insurance costs are sometimes extreme.

I have a big problem with insurance. For example, I recently had a surgery where the hospital billed my insurance $42,000 but somehow there was a magical “insurance adjustment” of $16,000. That’s still a $ 26k cost. When I asked AI how much the procedure should cost, it estimated $8,000-$12,000.

I dont have a problem with the doctors, but somewhere in the system there is a lot of fat.

The billing and pricing scams should be illegal. There should be one price, and that price should be the same no matter if you have insurance or not. The doctor is doing the same work, why two different prices. Should be illegal.

Additionally, there was no information giving to me on the cost of the procedure before hand. There was no competition or price shopping.


And last, look at the stock chart of UNH since Obamacare was passed. Insurance companies are killing it. There needs to be major reform and I’d start there before punishing doctors.
Click to expand...
Healthcare is the only business I know where you have no idea what something costs before you show up.

Price transparency is a big one. I get that some procedures are uncertain so it might be difficult to have perfect price transparency. But you could be transparent on the usual range for the procedure with a caveat that it can be more or less depending on circumstance. You could also be more transparent on what each component of care costs. How much is that MRI, a night in a regular hospital bed, the anesthesia they plan to use, etc. Post your list price, let consumers have that piece of info before choosing a provider.
 
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fskillet

fskillet

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scotchtiger said:
Lol. What if you want to make a great living AND help people?

Should our best and brightest be forced into modest means if they want to practice medicine and help people?

Should there not be a financial reward for the grueling academic process leading up to becoming an actual MD? 4 years of undergrad, 4 years of med school, residency, etc...

And millionaire is a low bar these days. $1M produces $40K per year in retirement income. Not exactly wealthy…
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What part of my statement said that doctors should earn less? I said i PERSONALLY didn’t think money should be the sole factor for getting into medicine. Most doctors get into it because they want to heal and help people.

I don’t disparage doctors for making good money, nor do I think they should make less. I was just stating I thought getting into the medical field bc you want to be wealthy instead of wanting to help people was the wrong reason.
 
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fskillet

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Aardvark86 said:
I don’t begrudge docs their economic rewards at all (though I think they’re increasingly illusory as payors have driven protocol based medicine that increasingly makes them cogs in the machine). But it is, or at least should be, still a profession. And what makes a profession distinct from a job is that fundamentally, it must start and flow from a commitment to serving others. Docs who don’t have that aren’t professionals and are bad doctors.
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This is exactly what I was getting at.
 
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Aardvark86

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fatpiggy said:
I’m actually surprised by how little some doctors make. It makes a big difference if you are in a private practice vs getting paid by a hospital, but the amount of money doctors make compared to other people I know, I would say many of them are underpaid.

They work long hours, it’s high stress, and their insurance costs are sometimes extreme.

I have a big problem with insurance. For example, I recently had a surgery where the hospital billed my insurance $42,000 but somehow there was a magical “insurance adjustment” of $16,000. That’s still a $ 26k cost. When I asked AI how much the procedure should cost, it estimated $8,000-$12,000.

I dont have a problem with the doctors, but somewhere in the system there is a lot of fat.

The billing and pricing scams should be illegal. There should be one price, and that price should be the same no matter if you have insurance or not. The doctor is doing the same work, why two different prices. Should be illegal.

Additionally, there was no information giving to me on the cost of the procedure before hand. There was no competition or price shopping.


And last, look at the stock chart of UNH since Obamacare was passed. Insurance companies are killing it. There needs to be major reform and I’d start there before punishing doctors.
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While you are correct to view this as mystifying, it’s mostly white noise historical baggage, and in the net, pricing is relatively market based. To unpack out a bit:

In the old days of indemnity insurance, insurers paid a percentage of a doc’s charges, which obviously creates an incentive to higher charges. Then as fee schedules and other global payment methods for episodes of care (driven my Medicare) emerged, the payment method became lower of charges or fee schedules amount. So still an incentive to keep charges high. And sometimes the rate methods were based on cost to charge ratios that provided similar incentives. And even now, where commercial payors may negotiate rates for being in a network, it’s still lower of rates or charges. Worse yet, if you charge some patients a low amount, insurance contracts may say that becomes your charge for all patients for purposes of the lower of mechanics. So all the incentives point to wildly inflating charges.

but almost invariably, the actual basis for payment (and patient responsibility) is the fee schedule or negotiated rates, and not the charges. Yet when hc entities communicate to consumers, they still communicate based on charges which really doesn’t make sense. In the hospital setting, there are some recent rules that require patients to be told numbers consistent with with actual expectations.

So … no transparent, a useless historical relic, etc. but not really fraud. and payments do end us based on market or cost based factors
 
fatpiggy

fatpiggy

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Aardvark86 said:
While you are correct to view this as mystifying, it’s mostly white noise historical baggage, and in the net, pricing is relatively market based. To unpack out a bit:

In the old days of indemnity insurance, insurers paid a percentage of a doc’s charges, which obviously creates an incentive to higher charges. Then as fee schedules and other global payment methods for episodes of care (driven my Medicare) emerged, the payment method became lower of charges or fee schedules amount. So still an incentive to keep charges high. And sometimes the rate methods were based on cost to charge ratios that provided similar incentives. And even now, where commercial payors may negotiate rates for being in a network, it’s still lower of rates or charges. Worse yet, if you charge some patients a low amount, insurance contracts may say that becomes your charge for all patients for purposes of the lower of mechanics. So all the incentives point to wildly inflating charges.

but almost invariably, the actual basis for payment (and patient responsibility) is the fee schedule or negotiated rates, and not the charges. Yet when hc entities communicate to consumers, they still communicate based on charges which really doesn’t make sense. In the hospital setting, there are some recent rules that require patients to be told numbers consistent with with actual expectations.

So … no transparent, a useless historical relic, etc. but not really fraud. and payments do end us based on market or cost based factors
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Not sure i agree 100%.

It just so happens that a friend of mine had the exact same broken bone ( a year apart), and had to have the exact same procedure. He lives in San Francisco and I live in Charleston. We compared and the billing was almost the exact same, within $500. That doesn't sound very competitive to me. Same charge, same insurance adjustment, same net costs.

It seems like, on the surface, the people that have insurance are billed higher because they have the ability to pay. So not only do we get charged more for the services, we are also asked to pay more for the insurance. (My insurance is $4500 a month for a family, crazy).

I think it's wrong i was never shown the price beforehand. I think it's wrong that it was never.even.discussed. That is not competition. Not even close to market based factors.
 
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Aardvark86

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fatpiggy said:
Not sure i agree 100%.

It just so happens that a friend of mine had the exact same broken bone ( a year apart), and had to have the exact same procedure. He lives in San Francisco and I live in Charleston. We compared and the billing was almost the exact same, within $500. That doesn't sound very competitive to me.

It seems like, on the surface, the people that have insurance are billed higher because they have the ability to pay. So not only do we get charged more for the services, we are also asked to pay more for the insurance. (My insurance is $4500 a month for a family).

I think it's wrong i was never shown the price beforehand. I think it's wrong that it was never.even.discussed. That is not competition. Not even close.
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1. I dunno that I agree with your inference from the price comparison, for starters. Market prices for ordinary procedures like broken bones do tend to find equilibrium.
2. Beyond that, the bargain isn’t between you and the hospital. It’s between the hospital and your insurer. And the insurer often has national affiliates that tend to find that equilibrium.
3. As to varying insurance prices, sure. Insurance is regulated at the state level based on largely state actuarial assumptions (backed by broader reinsurance risk pools), and Charleston is, well, not San Francisco. (Side note - that is absolutely something we should do away with).
4. As I noted, since 2021 there is a hospital price transparency mandate. Go to cms.gov/priorities/key-initiatves/hospital-price-transparency for more info. You should also find information on your local hospital website. Here's an example portal from my local hospital's webpage: https://www.carilionclinic.org/price-estimates#price-estimates
 
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