Bill introduced to eliminate PSLF

[evilbooyaa]

Yes and the poor person with Medicaid on the street with an open fracture should fend for themselves given their priorities in life and resources.

My personal tragedy doesn’t give me domain over other people’s stuff and autonomy....so yes

That is the line of logic that hard-core libertarians support, likely until it's on them or their families. You're advocating for complete removal of EMTALA, of all safety net programs in the country.

In your ideal world view, the poor and middle class (because let's be real, only those who are extremely wealthy can truly afford healthcare with private insurance only given what co-pays and co-deductibles routinely are) who develop any severe illnesses would die in extremely disproportionally high numbers due to lack of medical care, due to lack of funds to purchase worthwhile insurance.

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[VA Hopeful Dr]

That is the line of logic that hard-core libertarians support, likely until it's on them or their families. You're advocating for complete removal of EMTALA, of all safety net programs in the country.

In your ideal world view, the poor and middle class (because let's be real, only those who are extremely wealthy can truly afford healthcare with private insurance only given what co-pays and co-deductibles routinely are) who develop any severe illnesses would die in extremely disproportionally high numbers due to lack of medical care, due to lack of funds to purchase worthwhile insurance.

False. Look into the Health Sharing programs.

 

[iqe2010]

I'm waiting for the day Medicare stops funding residency. You know it's coming.

America is going full on fascist.

Canada isn't looking too bad, especially for primary care.

 

[IslandStyle808]

Primary care can be much cheaper than anyone realizes. Go do some research into Direct Primary Care and get back to me.

I know about direct primary care and feel it is great to cut out the middle man.

What about tertiary care (ex. even simply keeping the person stable before going to a bigger hospital) in smaller towns of 10,000 and less do you feel people like surgeons can be kept in these small areas permanently?

 

[Neopolymath]

Have you considered moving out of the US to a country with a system more in line with your beliefs. Perhaps a place where you can sit on your tower of money and poor people around you can die on the streets. Thankfully, they will have no domain over yours or others stuff or autonomy so it'll be great.

Somalia is a libertarian paradise, but you will never see their kind moving there. They want to benefit from American society while whining incessantly about the very ideas that make us different than Somalia.

 

[Roxas]

Somalia is a libertarian paradise, but you will never see their kind moving there. They want to benefit from American society while whining incessantly about the very ideas that make us different than Somalia.

Replace Somalia and libertarian with Venezuela and progressive and the same point is made

 

[deleted480308]

That is the line of logic that hard-core libertarians support, likely until it's on them or their families. You're advocating for complete removal of EMTALA, of all safety net programs in the country.

In your ideal world view, the poor and middle class (because let's be real, only those who are extremely wealthy can truly afford healthcare with private insurance only given what co-pays and co-deductibles routinely are) who develop any severe illnesses would die in extremely disproportionally high numbers due to lack of medical care, due to lack of funds to purchase worthwhile insurance.

Or the poor could seek charity care, a great deal more of which could be afforded if the govt wasn’t taking people’s money and if there wasn’t a mentality that the govt would handle everything

 

[deleted407021]

Replace Somalia and libertarian with Venezuela and progressive and the same point is made

Both are pretty stupid and lacking nuance, so let’s just bring it back to the middle, I say.



Anyway, I would personally look to how other countries have their education systems put together and see if they have any pointers. Endebting kids with sometimes 6 figures of non-dischargeable loans seems like a bad direction to take with education.

 

[VA Hopeful Dr]

I know about direct primary care and feel it is great to cut out the middle man.

What about tertiary care (ex. even simply keeping the person stable before going to a bigger hospital) in smaller towns of 10,000 and less do you feel people like surgeons can be kept in these small areas permanently?

Depends on whether the demand is there. I don't know enough about other specialties to really say.

 

[RedoxRxn]

Replace Somalia and libertarian with Venezuela and progressive and the same point is made

You can't compare socialist countries that have been embargoed heavily the U.S. and say" see socialism does not work!" .Look at other countries that have great safety nets like certain countries and Europe and compare it to the U.S.

 

[deleted480308]

You can't compare socialist countries that have been embargoed heavily the U.S. and say" see socialism does not work!" .Look at other countries that have great safety nets like certain countries and Europe and compare it to the U.S.

Like greece?

 

[RedoxRxn]

Like greece?

Uhmmmmm.... are you blaming their financial collapse on poor people receiving food stamps lol or their banks indiscriminately buying shady financial instruments?

Typical libertarian, blame the poor. It is never the corporations faults.

 

[RedoxRxn]

All i'm saying is where is the outrage among the libertarian crowd over the rampant corporate welfare? All i'm seeing is advocating the removal off certain subsidies for actual people but I hear diddly squat from the free market folk about federal state and local subsidies for corporate persons. Very hypocritical.

 

[deleted480308]

Uhmmmmm.... are you blaming their financial collapse on poor people receiving food stamps lol or the banks indiscriminately buying shady financial instruments?

Typical libertarian, blame the poor. It is never the corporations faults.

All i'm saying is where is the outrage among the libertarian crowd over the rampant corporate welfare? All i'm seeing is advocating the removal off certain subsidies for actual people but I hear diddly squat from the free market folk about government state and local for corporate persons. Very hypocritical.

You must be new to this forum if you think the resident libertarian (me) doesn’t have a seething hatred for corporate welfare too...

 

[Neopolymath]

Replace Somalia and libertarian with Venezuela and progressive and the same point is made

Yes, because being progressives means someone wants communism/socialism.

 

[deleted407021]

Yes, because being progressives means someone wants communism/socialism.

Yeah, I’d say most progressives are liberals and probably don’t do a lot of Marxist criticism.

 

[GoldenFish]

Or the poor could seek charity care, a great deal more of which could be afforded if the govt wasn’t taking people’s money and if there wasn’t a mentality that the govt would handle everything

When in history has charity been an effective substitution for a government program? Are you really saying that charitable contributions could replace a program like medicare and medicaid?

Government is the only entity that has the reach to effectively provide to something like that, and to argue that "charity" can and would take its place is patently absurd.

It is not the goal of govt to ensure the same odds of two disparately wealthy people achieving the same thing (elon musk’s kid will likely do better than mine as elon is kicking my ass right now). The only thing the govt is responsible for is making sure our kids have the same legal right to compete...nothing more

You keep throwing out this cartoonish view of what is going on to try and make a point. Social safety program and taxation exist to make sure that those born into terrible circumstances have some sort of way to compete, and trying to paint as a way to put those who achieve more down is missing the point entirely. Especially when those who are very, very successful (more so than most doctors) likely took full advantage of the system at every step to even get there.

 

[deleted480308]

When in history has charity been an effective substitution for a government program? Are you really saying that charitable contributions could replace a program like medicare and medicaid?

Government is the only entity that has the reach to effectively provide to something like that, and to argue that "charity" can and would take its place is patently absurd.



You keep throwing out this cartoonish view of what is going on to try and make a point. Social safety program and taxation exist to make sure that those born into terrible circumstances have some sort of way to compete, and trying to paint as a way to put those who achieve more down is missing the point entirely. Especially when those who are very, very successful (more so than most doctors) likely took full advantage of the system at every step to even get there.

I've never at all claimed that charity would completely replace every aspect of a huge govt program like medicare/medicaid. I think it would pick up more of the slack than people give credit for, I think it would force some people to consider making better decisions, and I think some folks would simply fall through the cracks. I've openly admitted it does mean some people might die sooner.

What I am still saying, is that despite all that, me having a need doesn't mean my neighbor has an obligation.

 

[radsisrad]

I'm waiting for the day Medicare stops funding residency. You know it's coming.

America is going full on fascist.

Canada isn't looking too bad, especially for primary care.

I don't think you know what that word means. In any event, fascists also tend to be pro-environment and worker-friendly. Things aren't always simple.

 

[radsisrad]

IMO, those that support the current state of events are primarily driven by fear, hate, and jealously of people who aren’t like them. It’s all rationalized and concealed as self-interest.

Lie or terrible misjudgment. Please don't go into psychiatry, as you'd be doing every single one of your patients a disservice.

 

[SunsFun]

Lie or terrible misjudgment. Please don't go into psychiatry, as you'd be doing every single one of your patients a disservice.

Not sure if serious. Do you know the difference between stating a fact vs opinion?

I do appreciate unsolicited career advice thou, stranger from the Internet.

 

[Perrotfish]

Like greece?

Or England, France, Germany, Australia, Canada, or Japan.

 

[educ8r]

Lie or terrible misjudgment. Please don't go into psychiatry, as you'd be doing every single one of your patients a disservice.

Please keep the personal attacks to yourself. No need for them in this forum.

 

[787593]

Because I was raised in a society that told me "sharing is care-ing"

you were raised in the Soviet Union?

 

[GoldenFish]

I've never at all claimed that charity would completely replace every aspect of a huge govt program like medicare/medicaid. I think it would pick up more of the slack than people give credit for, I think it would force some people to consider making better decisions, and I think some folks would simply fall through the cracks. I've openly admitted it does mean some people might die sooner.

What I am still saying, is that despite all that, me having a need doesn't mean my neighbor has an obligation.

Your assertion that the poor could seek charity care if gov't wasn't taking people's money is simply out of touch with reality - no way would that ever do any substantive good on a large-scale. As someone who not so fondly remembers their intern year in IM, I definitely would like to see my patients who had been continuously admitted for overdoses, noncompliance etc make better decisions. But there has got to be a better way than letting some folks "fall through the cracks" - we owe it to ourselves as a society. I would hope that someone set on becoming a doctor could agree with that.

 

[Trogghunter]

I feel like everything is progressing to a point where non payers will be subverted and EMTALA is essentially repealed. Anyone feeling that?

 

[intubesteak]

I feel like everything is progressing to a point where non payers will be subverted and EMTALA is essentially repealed. Anyone feeling that?

In this thread? Yes
In real life? No

 

[deleted480308]

Your assertion that the poor could seek charity care if gov't wasn't taking people's money is simply out of touch with reality - no way would that ever do any substantive good on a large-scale. As someone who not so fondly remembers their intern year in IM, I definitely would like to see my patients who had been continuously admitted for overdoses, noncompliance etc make better decisions. But there has got to be a better way than letting some folks "fall through the cracks" - we owe it to ourselves as a society. I would hope that someone set on becoming a doctor could agree with that.

nope

 

[VA Hopeful Dr]

Your assertion that the poor could seek charity care if gov't wasn't taking people's money is simply out of touch with reality - no way would that ever do any substantive good on a large-scale. As someone who not so fondly remembers their intern year in IM, I definitely would like to see my patients who had been continuously admitted for overdoses, noncompliance etc make better decisions. But there has got to be a better way than letting some folks "fall through the cracks" - we owe it to ourselves as a society. I would hope that someone set on becoming a doctor could agree with that.

Yeah as a doctor, I sometimes wish more people would fall through the cracks.

Like the guy my hospitalist wife admitted 57 times in 3 years. Obese, weeping edematous legs, let his dog lick them clean, get cellulitis, get admitted. Discharged with referral to wound care and PCP, did neither, rinse and repeat. At some point we should be allowed to say "No, you've made your bed and we're done trying to fix you".

Or the guy I had that had 3 strokes in 18 months. Diabetic who refused to take insulin (but dutifully recorded his glucoses of 400+) or a statin (hey I'm sure that LDL of 190 and triglycerides of 300 aren't hurting you) or aspirin (didn't like the arm bruising). Every admission and rehab stay cost the state probably close to 100k.

 

[masaraksh]

nope

Once you’re in practice just go out and don’t take Medicare or Medicaid, donate/don’t accept your residency stipend since that is also taken from your “neighbors”.

Something tells me you won’t practice what you preach

 

[LongDucDong]

Your assertion that the poor could seek charity care if gov't wasn't taking people's money is simply out of touch with reality - no way would that ever do any substantive good on a large-scale. As someone who not so fondly remembers their intern year in IM, I definitely would like to see my patients who had been continuously admitted for overdoses, noncompliance etc make better decisions. But there has got to be a better way than letting some folks "fall through the cracks" - we owe it to ourselves as a society. I would hope that someone set on becoming a doctor could agree with that.

For me, all of this comes back to freedom. Its a hard truth, but a truth nonetheless, that people should be free to wreck their own lives. That may sound crass, cold-hearted, disconnected, or whatever adjective you may think of. But, I honestly believe that if someone is not free to fail, then he/she is not free to succeed. We don't owe it to "society" (which is already an issue to say, because you aren't thinking about these people as individuals, you are thinking about them as groups) to protect people from themselves. That is not the job of the government, rather it is the job of the family and of the surrounding immediate community (whether that be family, friends, churches, whatever). Also, I think you underestimate the willingness of people to give for the good of their communities. I absolutely would give more if the government wasn't already taking so much. We slowly made the decision that we shouldn't be responsible for each other, instead we should just make the government responsible for all of us. I can't stomach that paternalistic view of the government to take care of the poor for us. The government has demonstrated itself at every turn to be exceedingly inept and wildly inefficient. I agree that this is not a change that could happen overnight, if a law were to be passed that cut taxes to 5% across the board, then people would not immediately begin giving to charities in the necessary amounts. However, if we cultivated a culture of giving, then I think you'd be surprised how many of us actually are willing to give (especially when we aren't being forced by a massive, corrupt institution with goals that may or may not align with our own). Wouldn't you give more if the government took less? I certainly would, and I think most people would, too, because there is a real need for it.

 

[VA Hopeful Dr]

Once you’re in practice just go out and don’t take Medicare or Medicaid, donate/don’t accept your residency stipend since that is also taken from your “neighbors”.

Something tells me you won’t practice what you preach

Its not a residency stipend, its a salary. You're being paid for the work you do.

 

[masaraksh]

Its not a residency stipend, its a salary. You're being paid for the work you do.

It’s more of a stipend since the money is coming from government GME funding not the patients who you work for.

But sure, salary. Doesn’t change my point

 

[Giovanotto]

Once you’re in practice just go out and don’t take Medicare or Medicaid, donate/don’t accept your residency stipend since that is also taken from your “neighbors”.

Something tells me you won’t practice what you preach

Why even bother replying to him? I've known a few individuals like him, and I honestly think "they" are frightened with everyday living to an extreme extent and as a result, latch on to the most logical political philosophy and don't let go. There is a lot of comfort in logic. Never mind the fact that as a specie we are hardly logical. He is legitimately not going to change his mind, because it would mean a great loss of comfort for him. It's a coping mechanism. Keep living the dream I guess, to each his own.

 

[deleted407021]

Y’all, @sb247 didnt just pop out of nowhere, he’s batted these ideas around the SPF for years and been challenged way more than y’all are doing here. He’s done a lot of thinking about his positions. Just for context.

 

[jw3600]

Usually I find some of SB’s libertarian principles a little too far out there but I’m shocked he’s getting flak for this. People are actually against the idea of being fully responsible for the money you borrow?
I do think it’s bull**** that they can pull the rug out from under the current participants because that opens a whole other can of worms about contract law.

 

[deleted480308]

Once you’re in practice just go out and don’t take Medicare or Medicaid, donate/don’t accept your residency stipend since that is also taken from your “neighbors”.

Something tells me you won’t practice what you preach

You don’t get to seize my income to pay for a program that then captures a huge portion of my customer base, essentially monopolize the training, and capturw a huge portion of the jobs then call me a jerk for getting stuck interacting with the program.

The program should never have been started

 

[Perrotfish]

Its not a residency stipend, its a salary. You're being paid for the work you do.

No you're not. It's a government stipend that is not tied in any way to the amount of work you do and is taken from someone else's tax dollars. That's why the ratio of actual work you do as a resident (ward and clinic rotations) to non value added education (research time and subspecialists rotations) doesn't affect your salary.

 

[VA Hopeful Dr]

No you're not. It's a government stipend that is not tied in any way to the amount of work you do and is taken from someone else's tax dollars. That's why the ratio of actual work you do as a resident (ward and clinic rotations) to non value added education (research time and subspecialists rotations) doesn't affect your salary.

Umm, no? My current job is salary but is not tied to clinical versus nonclinical time either. I'm paid whether I'm seeing patients or sitting in meetings.

Or am I on a stipend now as well?

 

[VA Hopeful Dr]

It’s more of a stipend since the money is coming from government GME funding not the patients who you work for.

But sure, salary. Doesn’t change my point

Your point was a bad one and I'm pointing that out.

 

[deleted480308]

Umm, no? My current job is salary but is not tied to clinical versus nonclinical time either. I'm paid whether I'm seeing patients or sitting in meetings.

Or am I on a stipend now as well?

The irs sure thinks it’s salary

 

[Perrotfish]

Umm, no? My current job is salary but is not tied to clinical versus nonclinical time either. I'm paid whether I'm seeing patients or sitting in meetings.

You might not be paid by the RVU but your job is absolutely basing their salary on the amount of income you generate, and if you chose to wither reduce your PPH or to take more.meetings in place of clinic they would either cut your salary or cut you.

As far as the government is concerned Residency is just another school, for which they pay your tuition (about 70K/year paid directly to your program) and a stipend (about 50K/year of your salary which is reimbursed by the government). A salary is something that an employer pays. Unless you do a mitary residency your employer isn't paying you anything.

If you are a libertarian you should take out 120K of loans per year of residency and pay for yourself, rather than demanding someone else's money for your training

 

[deleted480308]

You might not be paid by the RVU but your job is absolutely basing their salary on the amount of income you generate, and if you chose to wither reduce your PPH or to take more.meetings in place of clinic they would wither cut your salary or cut you.

As far as the government is concerned Residency is just another school, for which they pay your tuition (about 70K/year paid directly to your program) and a stipend (about 50K/year of your salary which is reimbursed by the government). A salary is something that an employer pays. Unless you do a mitary residency your employer isn't paying you anything.

If you are a libertarian you should take out 120K of loans per year of residency and pay for yourself, rather than demanding someone else's money for your training

After they warp the market and will still take my money forever to fund that warping?

I’ll stick with calling for them to just close down

 

[masaraksh]

You might not be paid by the RVU but your job is absolutely basing their salary on the amount of income you generate, and if you chose to wither reduce your PPH or to take more.meetings in place of clinic they would wither cut your salary or cut you.

As far as the government is concerned Residency is just another school, for which they pay your tuition (about 70K/year paid directly to your program) and a stipend (about 50K/year of your salary which is reimbursed by the government). A salary is something that an employer pays. Unless you do a mitary residency your employer isn't paying you anything.

If you are a libertarian you should take out 120K of loans per year of residency and pay for yourself, rather than demanding someone else's money for your training

Exactly what I’m saying.

I mean you definitely should be paying your residency 70k+/yr for the privilege of training you, for training you get, for the resources (sim centers etc) that you will use to get good at your craft. I mean you surely don’t want your “neighbor” paying for your residency training and surely you wouldn’t want to contribute to their education since that is on them.

 

[Perrotfish]

After they warp the market and will still take my money forever to fund that warping?

Yes. You're the one with the principles, right? You are calling for sick children, born into poverty, to die uncared for in the name of your principles. You don't seem to care about the various ways that the market is warped to put them at a disadvantage. You don't seem to feel that the world needs to be perfect.before you take the first step if throwing them out on the street to die. Aren't your principles worth some of your own salary as well? Lead by example?

Why should your neighbor have to pay for residency training that is going to make you one of the wealthiest individuals in the country when you're done? How can you possibly be opposed to the government funding healthcare for the desperate and dying but be for them funding healthcare training for the wealthy and well connected?

 

[VA Hopeful Dr]

You might not be paid by the RVU but your job is absolutely basing their salary on the amount of income you generate, and if you chose to wither reduce your PPH or to take more.meetings in place of clinic they would either cut your salary or cut you.

As far as the government is concerned Residency is just another school, for which they pay your tuition (about 70K/year paid directly to your program) and a stipend (about 50K/year of your salary which is reimbursed by the government). A salary is something that an employer pays. Unless you do a mitary residency your employer isn't paying you anything.

If you are a libertarian you should take out 120K of loans per year of residency and pay for yourself, rather than demanding someone else's money for your training

For someone often involved in discussions about the business aspect of medicine, you truly have no idea how so much of it works.

I can absolutely guarantee that my salary is based in no way at all on the income I generate as I generate precisely zero money.

 

[Perrotfish]

I can absolutely guarantee that my salary is based in no way at all on the income I generate as I generate precisely zero money.

Do you think your salary would stay the same if you stopped providing patient care? You really don't think that your employer (whoever they are) hired you to provide patient care and is basing your salary on your providing it?

 

[deleted480308]

Yes. You're the one with the principles, right? You are calling for sick children, born into poverty, to die uncared for in the name of your principles. You don't seem to care about the various ways that the market is warped to put them at a disadvantage. You don't seem to feel that the world needs to be perfect.before you take the first step if throwing them out on the street to die. Aren't your principles worth some of your own salary as well? Lead by example?

Why should your neighbor have to pay for residency training that is going to make you one of the wealthiest individuals in the country when you're done? How can you possibly be opposed to funding healthcare for the deaperate and dying but be for finding healthcare training for the wealthy and we'll connected?

I don’t want medicare involved in funding residency. I think training should cost what it costs. I think availability of medicare funds inflates the sense of what is necessary to train and we would see a truer market reflection in terms of cost/ time without medicare

I think mddicare costs us (docs and upper income earners) money and it’s silly to claim that I can’t point that out without taking an even bigger loss

And you can relax with the self righteous virtue signalling, I love voluntary charity which is far different than forced redistribution

 

[deleted407021]

While I disagree and agree with SB on various things (for instance, I do think we have obligations to give more as people with more) I do think going after him when his visions are far from realized in the real world is sort of silly, i.e. demanding that someone with a certain ideal live as if that ideal exists when it doesn’t.

It’s like telling a socialist they’re hypocritical if they have an iPhone when that wouldn’t even make sense in an ideal world.

 

[jhamaican]

You are responsible for your own actions and choices. Life is not fair and handouts can end at any time. Try to see reality for how it really is. Liberals either cannot or refuse to understand these basic truths.