Health Care Reform

[UNMC2006]

I am curious what my future colleagues think with regard to the future of health care reform. I haven't really taken a serious apporach to this topic in the midst of so much book study, but a summer off has provided me the time to contemplate other areas of medicine, especially the financial portion as a summer without work renders one nearly broke very quickly!

I have had this discussion with a few doctors, and one suggested that the first step towards universal medical care would start with programs designed to cover all the children in America. Fundamentally speaking, this seems a good idea to me, it would be difficult for any political party to take a stand which denies children the right to medical care, despite their financial situation. My question, as would be many reading this forum, is how can we ideally structure the health care system in a manner which provides quality medical care to all who need it, and maintain a suitable salary for physicians, who work their entire lives to provide quality, compassionate care and deserve to be compensated in a fashion reflective of that hard work?

I know this is a can of worms that has been opened many times, but it seems that our system is on the brink of either disaster or reform, and I am curious as to what it is that we should be lobbying for to ensure our continued financial success . So, let the debates and arguments begin, I think it will be interesting to hear the ideas of fellow future docs.

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[MacGyver]

Originally posted by UNMC2006
programs designed to cover all the children in America. Fundamentally speaking, this seems a good idea to me, it would be difficult for any political party to take a stand which denies children the right to medical care, despite their financial situation.

I dont understand this logic. According to this logic, the USA currently DENIES the following:

1. The right of children to eat a good breakfast
2. The right of kids to have a playground in their neighborhood
3. The right of kids to have summer schools
4. The right of senior citizens to have free medical care
5. The right of adults

Just because something is attractive doesnt make it a RIGHT, and therefore to be provided by govt. If you go down this path, there are a whole slew of things that govt will have to provide, in addition to the thousands of social services already available.

The closer America moves towards socialism, the further our superpower status will decline and our GDP/productivity will fall off.

My question, as would be many reading this forum, is how can we ideally structure the health care system in a manner which provides quality medical care to all who need it, and maintain a suitable salary for physicians, who work their entire lives to provide quality, compassionate care and deserve to be compensated in a fashion reflective of that hard work?

This is impossible. No country which offers universal health care to all also offers attractive salary for doctors. If you are happy making 50k per year as a neurosurgeon, then universal care is great.

When you say medical care is a RIGHT, that means you have to provide it for EVERYBODY AT ZERO COST. When that happens, its impossible to support doctors salaries at a high level.

 

[asharma11]

Perhaps it wouldn't be such a bad idea to socialize health care. That way, only those who are interested in the humanistic aspect of medicine rather than the financial benefits would seek to become doctors.

Of course, socializing health care would also require mitigating the cost of medical education, since paying off a 100 grand debt would be a bit more difficult with only a 50 grand salary...

 

[TT0]

Hi UNMC 2006, I?m glad to hear of another concerned future physician thinking about the issue of providing affordable health care. I have thought about the problem several times before, and the more I think about it, the more monstrous and far reaching the problem seems to be. I?ll tell you what I?ve learned so far and offer some suggestions to solve the problem.

First I think we need to establish why our healthcare system is so darn expensive and difficult to change (a non-comprehensive list).

1. It is very fragmented and exists in an imperfect market; thus very easy for prices to be jacked up because comparison shopping and informed buying decision are difficult to come by if not impossible to determine by the consumers.

2. It is composed of several entities with conflicting interests: drug companies, medical supplies and instrument companies, insurance companies, the government (as a regulatory body and an insurer), physician groups, nurses and allied health professionals, and consumers. Each group has some clout with the two major political parties and the Congress; some have more than others.

3. There is an UNLIMITED demand. People will almost always get sick, and eventually sicker, at some point in their lives. And there?s almost always room for health to improve. Thus, if a person has been cured of one disease, it is likely that person will die of another disease that is chronic or incurable at the time. I?ve heard that a disproportional part of health care expenditure goes to a relatively small percentage of people who needs very intensive care and people who are dying. The medical profession will always do everything they can to save people?s lives, and likely spare no cost.

Some possible consequences:
1. Fragmentation of market makes institutional efficiency difficult to achieve. Even with HMOs squeezing doctors and drug companies for lower prices, there are still ways for people to waste money. For example, drug companies provide financial incentive for physicians to prefer their drugs (from the freebies we get as medical students, to free wine and dine and other the marketing ploys). Unnecessary medical tests/procedures because doctors are defensive about lawsuits (not a consequence of market fragmentation, but still an inefficient way for the society to spend their money). Further, consumers have no way of knowing what products they really need to buy and may be induced into bad purchase decision.

2. Entities involved in medical care will seek to maximize their profit for debatable reasons. All of them are in one way or another major donors to PACs (political action committee), parties, Senators and Congressmen. Should drug companies be rewarded a huge % revenue as profits (I think this industry has the highest % rev as profit of ALL industries) because they make drugs that cure the incurable? And why do Americans pay one of the highest drug prices of all the countries in the world? Should insurance company/HMO charge the premium they are charging now? Do their CEOs deserve multi-million dollar packages while premium rises as fast as ever? Are they charging a fair rate for their administrative work? Are physicians paid well enough or too well for their sacrifices? Should the educational costs be lowered to make physicians less in debt and perhaps ultimately lowering the physician salary? If so, who?s going to pick up the tab for educating the doctors? The tax-payers? We hate taxes enough as it is. And who among the payer can afford to pick up the tab? People in the higher income brackets will ultimately be the ones paying more for any attempt in increasing coverage. But they are the group that votes the most and likely to already have very good coverage themselves, thus likely to be resistant to the tax-hike. Universal Health Care in US? That?s going to need an act of God! On a natinal level, you?re asking ppl from the rich states, such as CA or NY to pay for the poor states like Mississippi or Arkansas. Clinton, with a Democratic House AND Senate (it rarely happens that one party controls the White House and both Houses of Congress), failed miserably with his universal healthcare plan. Who knows when the next time a unified government is going to try its hand at universal health care?

3. Even if prices and fees for all procedures, drugs, insurance policies, physician service, etc., are at its optimal point, maximum efficiency still doesn?t guarantee that our national healthcare expenditure will stabilize because ppl will use more medical care as more newly discovered drugs become available. And they will become available because companies have invested heavily in biotech in hope of future recovery of profits (more of a reason for them to charge sky-high prices for drugs).

Thus, I think it?d be safe to say that healthcare will remain very expensive for a long time to come, if not getting more costly by the minute as people are able to live longer and to be treated for previously untreatable diseases. It would also be very difficult for enough of us Americans (enough to pass a law) to swallow the pill of a huge tax-hike in exchange for a universal healthcare system that treats everyone the same way. It?d be too socialist, and those paying the bulk of the bill (the richer) would be getting a lower quality of health care than if they had just paid only for their own insurance or had theirs paid for by their employers. This is not even mentioning a number of industries that will see their profit dwindle if universal healthcare happens (with the US government as the only buyer, thus having extreme bargaining power), and they will do everything they can to stop it from happening.

Here are some of the short term things for us to do.
1. Provide free care in urban clinics, once a week, a month?
2. Organize educational campaigns that target those without sufficient health knowledge, and hope that they take up healthy habits and don?t get sick from preventable causes. However, ppl don?t always do what?s good for them even if they know it?s bad (smoking, fatty food, tanning, etc).
3. Vote, and educate others on the health policy positions of major political candidates and urge them to vote.
4. Start a charity organization, or donate to a charity organization.
5. Political campaign for free or discounted drugs that are badly needed.. It has been done in the 80s with gay activists when drug companies first found AZT treatment of AIDS.

In the long term, we need to find a politically and economically feasible healthcare system. And campaign furiously for it.

I like a 2-tierd healthcare system featuring a basic, ?minimal acceptable care? system, and a luxury, ?spend every single cent to make sure I stay alive? system. (With the possibility of having multiple tiers in between depending on how much care you want/are willing to spend). The point of the ?minimal acceptable care? system is to provide everyone with basic health screening, health education, and low intensity types of care so that easily treatable or preventable diseases can be taken care of before they get worse (and thus more expensive) to treat. This system is much more likely to gain acceptance because it is less expensive. Then, at people?s option, they can elected to have additional coverage with private insurance companies. Thus, people can still elect to buy expensive policies and drugs and keep the respective companies in business. The main point of this system is that everyone will have some care, however minimal, which is better than nothing at all. The hard thing is to determine how minimal is acceptable ethically and financially, and does this mean withdrawing care once a patient requires expensive treatment? This question will have to be answered at some point no matter how painful it is to do so. (Or we can go to the 3rd option, that is to buy everything we want and have our national debt grow so high that we have problem paying down the dividend).

 

[MacGyver]

Originally posted by flindophile
McGuyver --

I am as much a free marketeer as anyone -- but you seem to be quite concerned about the "right" for physicians to make a high income. If you were a truly a free market conservative, then you would advocate opening more med school slots and residency slots so that physician supply and demand would find a true equilibrium. At present, physician salaries are artificially inflated by protectionsim. You are right that salaries will fall -- but so be it -- let the "magic hand" of the market determine what a doctor is really worth.

1. I question the supply/demand scheme you apply to doctors. Doctors and lawyers set their own demand, so it doesnt follow a simple supply-demand scheme. If you open more med schools, there are more people diagnosing illness, there are more people using fancy technology. Health care costs would INCREASE, not decrease, if you add more doctors.

2. If you are truly a free marketer, then you would demand that govt have NO ROLE in healthcare whatsoever. Medicare/Medicaid basically dictate doctors salaries. Thats certainly not a "free market" model

3. I never said that doctors have a RIGHT to high income.

 

[MacGyver]

Originally posted by asharma11
Perhaps it wouldn't be such a bad idea to socialize health care. That way, only those who are interested in the humanistic aspect of medicine rather than the financial benefits would seek to become doctors.

Of course, socializing health care would also require mitigating the cost of medical education, since paying off a 100 grand debt would be a bit more difficult with only a 50 grand salary...

Thats a reasonable position to take.

What is NOT REASONABLE is to somehow suggest that you could have a socialist medical system and that doctors would continue to make high salaries. Those 2 things are mutually exclusive

 

[MacGyver]

Originally posted by TT0 I like a 2-tierd healthcare system featuring a basic, ?minimal acceptable care? system, and a luxury, ?spend every single cent to make sure I stay alive? system. (With the possibility of having multiple tiers in between depending on how much care you want/are willing to spend). The point of the ?minimal acceptable care? system is to provide everyone with basic health screening, health education, and low intensity types of care so that easily treatable or preventable diseases can be taken care of before they get worse (and thus more expensive) to treat. This system is much more likely to gain acceptance because it is less expensive. Then, at people?s option, they can elected to have additional coverage with private insurance companies. Thus, people can still elect to buy expensive policies and drugs and keep the respective companies in business. The main point of this system is that everyone will have some care, however minimal, which is better than nothing at all. The hard thing is to determine how minimal is acceptable ethically and financially, and does this mean withdrawing care once a patient requires expensive treatment? This question will have to be answered at some point no matter how painful it is to do so. (Or we can go to the 3rd option, that is to buy everything we want and have our national debt grow so high that we have problem paying down the dividend). [/B]

I dont particularly have a problem with this idea, but keep in mind tha that the liberal socialist politicians who want universal health care will find this unappealing.

Socialist-leaning politicians demand that everybody is treated the same, regardless of whether you have money or not.

Liberals would be screaming about how the poor dont have the same medical care as rich people, and any new healthcare system they devise would try to strip that away.

 

[kreno]

Regarding flindophile's comment about physician salaries being artificially inflated: "At present, physician salaries are artificially inflated by protectionsim" and Macgyver's response "If you open more med schools, there are more people diagnosing illness, there are more people using fancy technology. Health care costs would INCREASE, not decrease, if you add more doctors" I have a few comments.

First and foremost... and this should be obvious, but the healthcare economy hardly represents the prototypical supply/demand type of market for a variety of reasons.

Nonetheless, Flindophile's comment about physicial salaries being artificially inflated is absolutely true. But Macgyver, your reponse was skewed. In particular you say "health care costs increase" not decrease. Well, Flindophile was saying PHYSICIAN SALARIES would decrease with the introduction of more physicians (i.e. a greater supply of doctors)... NOT overall healthcare money spent as a percentage of the GDP (which is how your comment, written in the way it is, is interpreted). HOWEVER, it should be noted that even if our country spent more money on healthcare because of greater access this is in NO WAY A BAD THING because the loss of overall productivity (i.e. GDP growth) outweigh the benefits of the cost of healthcare. this is obvious.... if the poor guy can't get healthcare, how's he gonna continue working at the same level? But if the poor guy HAS access to healthcare, of course he spends money on it (i.e. the country spends more money on healthcare) his productivity in the long-run will be greater. Get it?

This is VERY simplistic and of course there is a lot more to it.

Of course, just "opening up more medical schools" to fullfill market demand for physicians is not so simple... one interesting thing to note is that in countries such as Greece, because physician's have such a high social prestige, and the supply is not regulated so easily (people that do not make it in the state-owned medical schools that still wanna be doctors travel to italy or serbia or romania to get medical training and then come back with minimal exams, etc).. you end up with a LOWER QUALITY of physician. Indeed, the MORE MEDICAL school slots open up, the LESS competitive it is to become a doctor and the lower caliber of physician you end up with.

kreno

 

[....]

If you told the people in medical school that health care was going to be socialized and they would make 50K a year i bet 50% would drop out, 40% would be to stupid to drop out and the other 10% truly on some crazy calling for medicine. You would have like....10 doctors in the country.

Im not going to pretend for one second that I would go through all of the traning to be poor.

 

[Fermi]

Originally posted by flindophile
If you were a truly a free market conservative, then you would advocate opening more med school slots and residency slots so that physician supply and demand would find a true equilibrium... You are right that salaries will fall -- but so be it -- let the "magic hand" of the market determine what a doctor is really worth.

Physician supply cannot simply work on a supply-demand basis. If you let all qualified applicants into med school and let them loose in a free market, you would find a) incomes driving way down, and b) a lot of physicians out of jobs. Who could afford to give up 7-10 years to med school and residency, and six-figure loan burdens, if you wouldn't even be ensured a job at the end of it? That risk would only really be justified for people who have the means to pay for med school, because they would be able to get by if they had to start out making $30,000 at age 30 or had to find a different low-level job altogether.

The other problem is that you are assuming the main financial cause of health care disparities is physician income. I don't know if you have sources saying this is true, but it doesn't seem to agree with what I've read. You have to consider other material health care costs that have skyrocketed like pharmaceuticals, expensive diagnostic tests, medical devices, and such. People with good insurance (definitely not just wealthy people) can sometimes have virtually unlimited access to these health care benefits. Is this right? No, but in a "free market" it would be. So how can you suggest free-market physician supply in a universal "socialist" health care delivery system?

 

[funkless]

Originally posted by asharma11
Perhaps it wouldn't be such a bad idea to socialize health care. That way, only those who are interested in the humanistic aspect of medicine rather than the financial benefits would seek to become doctors...

It would certainly put specialists in short supply. I honestly don't believe that ANYONE is so generous as to devote the 'best years of their life' to the study of, say, neurosurgery without the promise of financial kickback. The huge toll that medicine takes on your personal life simply must be compensated for.

I imagine that anyone who argues otherwise would change their tune during or after internship. A relatively short spin into primary care would look much better all of a sudden, when compared to a long and grueling neuro residency. Even if there are still some big-hearted nerds out there who need a neuro fix, where's the incentive to sub-specialize?


--Funkless

 

[UNMC2006]

This has been an interesting post thus far... I guess I was not implying that I am in favor of a universal health care system, my wording may have been a bit deceiving. I do, however, have a real problem with the level of authority that insurance companies have on the quality of health in America, for example...

My uncle recently opened up, in conjunction with other partners, the first specialty hospital in NE, a heart hospital. They are known in NE as the elite group of cardiologists and CT surgeons. Thus, it would be in a critical patient's best interest to be treated at such an institution. In an effort to get funding by various companies, they pitched to accept 70 cents on the dollar to begin with. HOWEVER... the fact that they are a specialty hospital restrcits them to treating only cardiac patients. The catch is this, it is far more profitable for an insurance company to continue to send their patients to a regular hospital who accept 80 cents on the dollar, but provide all aspects of a patient's care.... Therefore, other hospitals continue to be the choice of the insurance companies. This is but one shining example of how insurance companies are compromising the lives of patients who might otherwise live, giving the opportunity to see a more specialized and distinguished group of physicians.

So, my point is simply that serious reform needs to be made to place more power in the hands of patients and doctors and less on the companies reeping the profits of thousands of dead patients as a result of their careless malice and greed. Is universal health care the answer? Probably not, but a certain level of control needs to exist to ensure 1)The safety of patients and 2) quality doctors pursue and remain in our profession so we can continue to ensure quality care.

 

[asharma11]

While a socialistic health care system is bound to have problems, it may be wise to consider the many ways that a perfectly competitive health care system is impossible given today's conditions.

*Disclaimer: this analysis is by no estimate comprehensive.

The criteria of a perfectly competitive market are:
1) Firm sells a standardized good/service. This means that the quality of a specific good produced by one firm is exactly the same as that produced at another firm.

2) Firms have free entry to and exit from the market. This condition has the benefit of evening out economic profit for all firms in the market in the long run. For example, if a current market is profitable, then more firms will enter that market, which increases the supply of the good/service, and thereby lowers the equilibrium price. On the other hand, if a market is economically unprofitable, then firms will exit the market, which decreases the supply for the good/service and consequently increases the equilibrium price.

3) The market for the good/service consists of a large number of small firms. This condition forces the firms to be price takers--they cannot set the price for the good/service. The price is instead dictated by the point at which the demand for the good equals the supply. By having a large number of small firms, if a single firm tries to change the price at which it sells the produced good without good reason, the change will not affect the equilibrium price for the good in the market.

4) The market must provide perfect information about the good/service to consumers. Thus, consumers must know precisely the different alternatives available for a specific good and they know the exact prices for the good determined by the overall market equilibrium.

Now let's see why health care cannot match these criteria given today's conditions...

First, let's assume that the firms are hospitals, the workers are primarily physicians and surgeons, and the consumers are patients. The service provided is the healing of a specific ailment or disease.

1) Firm sells a standardized good/service.

This is impossible, seeing as how the quality of medical education differs through the wide spectrum of medical schools and residencies. Let's say that the qualities of a physician are cognitive and motor training. Cognitive training refers to the way a doctor emotionally responds to a patient as well as the knowledge of medicine that the doctor has gained. Motor skills primarily describe the dexterity with which a doctor performs a medical operation.

I think it's safe to conclude that not all doctors receive the same education and develop equal dexterity. Some doctors are more knowledgeable and some surgeons are more skilled. Thus, some hospitals will provide better service than others. We must also take into account that a medical service from one hospital can't be returned and exchanged for the same service from another hospital. Standardizing medical service is not realistic.

2) Firms have free entry to and exit from the market.

I would imagine that the cost of building a hospital is enormous. The larger fixed costs include the rent for the property and the purchasing of relevant medical equipment. If these fixed costs are enormous, then an unprofitable hospital will continue to operate as long as its average revenue equals its average fixed costs. For a similar reason, an economically profitable hospital in one area will remain profitable since the large fixed cost of entering the market dissuade competitors from building a second hospital in that same area. This high fixed cost of starting a hospital or clinic is a barrier to free entry and exit, and thus hinder perfect competition.

3) The market for the good/service consists of a large number of small firms.

Impossible, as a consequence of the reasoning in 2. Large hospitals provide the best medical service, not clinics. The system also deals with the additional problem of insurance companies, which define the prices for medical services, not the "invisible hand" of a free, perfectly competitive market.

4) The market must provide perfect information about the good/service to consumers.

This clearly cannot be, since there is no way that the overwhelming majority of consumers will be able to spend the resources needed to be fully informed about all the medical procedures and services available to them. Furthermore, I doubt that many patients are fully aware of the price of a specific medical service, and whether or not that price differs among hospitals.


So, in order to have a perfectly competitive health care market, medical education would have to be completely standardized so that doctors would develop exactly the same cognitive and motor skills, the fixed costs of building and operating health care facilities would need to substantially decrease in order to allow free entry and exit, the market would need to be saturated with hospitals so that the price of medical services would be guided by the natural forces of a free market equilibrium (which also would lower the salaries of health care workers) , and potential patients would need complete understanding of information about all medical procedures.

I don?t think a perfectly competitive health care system is possible.

 

[USeF]

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Check out it here Please bookmark and pass it on to friends who are interested back in your school. I really liked the Alice in wonderland story

Just finished the AMSA Washington Health Policy Fellowship last week and must say it was the best choice I could've made for the summer between MS1,2. 7 weeks of true immersion in the politics of medicine and livin it up in the great town of D.C. It solidified my ambition to do something in the 'big picture' be it International Medicine (USAID, WHO) or State, county Dept. of Health or be a Health Analyst on the hill or a dozen other fun things. Fire questions about the program to me anytime.

 

[SticknRudder]

You know, I've only begun to really read about proposed National Health Plans (http://www.amsa.org/hp/uhcres.cfm) so I doubt I have the whole story (so take this with a grain of salt), but these are my impressions:

This is in reaction to the article on the above website, "Alice in Universal Health-Care Plan".

First, I get the feeling that there is too much focus on the reduction in hassle for the doctor and the patient - a rosey idealized practice of medicine for the doctor and a readily available means of healthcare for patients - and not enough focus on the real added costs of managing such a system. Sure, getting rid of the "skimming-off-the-top" that HMOs take would free up some money, but I don't think it would be on the scale that this article thinks it would be. I say this because the article refers to a system where the goverance of medical treatment would be, top to bottom, Uncle-Sam - Payor, State Board - governing the practice of doctor's monetary allocation of treatment, and finally doctor - who sees the patient. It's hard for me to swallow that the government, with its endless levels of bureaucracy in everything it does, would be as nonchalant as the article proposes in terms of allowing the doctor to order exams without having to check with an authority first - just as it is now with HMOs. In my view, the cost of administrating this system would be monstrous because of the checks and balances a goverment run healthplan would require. There would have to be a middle-man between doctors and the exam-approving bureaucrat, an endless workforce in charge of sifiting through the mountain of claims sent to Uncle-Sam to be paid (within 30-days of receipt the article claims), a board of doctors for each state, making sure that the front-line physicians are doing their job effeciently, etc. The point is, there are a lot of people to pay to do this.

It may not be as much as the cost of HMOs to do business, but it would be a helluva lot.

And this says nothing of the disaster that would ensue upon first implementation of the system.

Don't take this as my gospel or anything - I am more than anything just venting my immediate reactions. Maybe it will make sense after I think about it.


Any comments?

 

[Lux Aeterna]

Originally posted by TT0

I like a 2-tierd healthcare system featuring a basic, ?minimal acceptable care? system, and a luxury, ?spend every single cent to make sure I stay alive? system. (With the possibility of having multiple tiers in between depending on how much care you want/are willing to spend). The point of the ?minimal acceptable care? system is to provide everyone with basic health screening, health education, and low intensity types of care so that easily treatable or preventable diseases can be taken care of before they get worse (and thus more expensive) to treat.

TT0 you had some really good insights. What do you think about Howard Dean's plan to have the federal gov't take care of the seniors, the states take care of everyone up to 23, and from 23 to 65 yrs private insurance (maybe defined contribution?)--with tax credits for wellness programs, incentives for employers to offer insurance....? ( I'm not sure if that changes much except for the children being insured. )

How do we target the working poor, the people employed by small business?

Do people believe this patchwork mix of public and private work, IF properly reformed?

Or should the government mandate that everyone needs health insurance, like the way you need car insurance...? Although I'm sure there are a bunch of people out there who just DON'T want to be insured. But when they roll into an ER, the onus is on everyone else.

Sorry if some of these questions sound dumb, I'm trying to wrap my head around all these issues....if I'm going down the wrong path in understanding these issues, please correct me! I watched Dr Angell and the other NHI advocates on CSPAN the other day. If we were building the system from scratch, then sure I would be for some form of NHI in the form they advocate. But I just don't think it would pass today, we are too entrenched in a big business mindset. (Look at all the lobbies the pols cater to., I unfortunately don't see that changing).

 

[Lux Aeterna]

Also...

In a medical economics class at Wharton, the key item the prof (who is some bigshot in this field) stressed was "Some good must be left undone" when it comes to maximizing MB=MC. This may be a very unsentimental approach to healthcare, since we are talking about something as delicate as people's lives. But I think it is important to remember in face of the need for proper resource allocation of medical resources.

And also, correct me if I am wrong.... if the gov't is the single payer, that means that doctors are basically a slave to whatever the non-profit board of directors decides for reimbursements correct? Whereas now, if enough docs balk at an HMO's reimbursement plan they have the option of shifting to another group, which gives some power to the doctors. .... RIght?

And what's the deal with IPA's? Are they making their bottom line or are they falling under? Do many docs join them anymore?

sorry for all the questions!

 

[MacGyver]

Originally posted by Lux Aeterna
And also, correct me if I am wrong.... if the gov't is the single payer, that means that doctors are basically a slave to whatever the non-profit board of directors decides for reimbursements correct? Whereas now, if enough docs balk at an HMO's reimbursement plan they have the option of shifting to another group, which gives some power to the doctors. .... RIght?

Under a socialized/single payer model, all doctors are basically employees of the federal government.

As such, they have to accept whatever the bureaucrats decide. If the bureaucrats want to cut the docs pay by 50%, they have no recourse but to accept it or quit.

Doctors have ZERO power and ZERO flexibility under a single payer system.

Thats how a single payer system cuts costs, by using its massive bargaining power and a monopoly to dictate the rules. There is no competition from the private sector so doctors have no choice but to take whatever scraps the federal govt decides to throw their way.

 

[carrigallen]

i would say one of the key issues is insurance, namely, third-party payers (ie employers). I believe that health insurance needs to be paid for directly by the patient, not the employer. This would promote healthcare rationing at the consumer level, rather than the provider level. Even the poor would be required to carry basic healthcare (like motor vehicles), and those who qualify below the poverty level would receive stipends to cover some of the expenses.

 

[winstonm]

How do you define a "socialized" health system? Please give an example and explain it.

What is your idea of a "high salary"? That's a pretty general statement.

I'm interested in finding out what "socialized" health system the US system is being compared to in this thread.

 

[jenni4476]

I find myself of two minds on this....

The idealistic side of me thinks that medicine should not be regarded as a business. Period. People's lives are not something for someone to make a profit off of and there shouldn't be a debate between paying for services for a patient and making the shareholders happy. That creates an inherent conflict of interest, and unfortunately, American society seems to be tipping more towards the business side and making a mockery of medicine.

Using this rationale, I would say that the most immediate impact would be realized by making health insurers, drug companies, biotech companies, hospital chains, etc, nonprofit organizations. This needn't result in a reduction of doctors' salaries, since I too believe that there needs to be good compensation for what physicians give up to do this. Not to mention the knowledge that the patients won't get anywhere else. What needs to be cut is administrative overhead.

Then the realistic side of me kicks in and I realize that this is not likely to happen. For one, there would be an enormous amount of capitalization needed for these companies to buy out the stockholders and where would that come from? I don't know the answer. Two, like a previous poster said, business is so entrenched in medicine that it would be next to impossible to get everyone to change their perspective. I could go on and on....

What it comes down to is that there is no one solution to it all. I'm firmly against socialized healthcare b/c that would just make the current bureaucratic/red tape situation worse. And I'm not an elitist who believes that only those who pay should receive care, I simply believe that patient care would suffer greatly under such a system, and that's my primary concern. I also have a problem with people thinking they have a RIGHT to healthcare no matter what. Personal responsibility needs to be a factor here, and people need to stop expecting the government to fix everything and take some action themselves.

OK, here's an idea I just had...it's very simplistic so forgive me, but how about forcing all the health insurers to standardize their claims forms and streamline processes-have it all done electronically over a central system. Have a standardized list of procedures that require preauthorization that all companies must adhere to. That alone should reduce time and money spent on billing....one small step. Not much, but a start...

 

[GeddyLee]

Hello all, good to see the altruism is still intact.
First of all, drug companies that are non-profit organizations? Why on earth do you think that would work? Face facts, the country is a capitalist society, which is precisely why we have some of the best medical care, drugs, and technology in the world, and a country like, Russia, doesn't. Investors want profits from their investment, and drug companies will not exist without investors! This is the most idiotic idea I've ever heard. Same goes for health insurance.
Secondly, face it that doctors are the lowest on the totem pole. If you want to go after the fat cows, look at hospital management and government beaurocracy. Cutting doctor salaries doesn't seem quite fair.
Universal health care is a disaster waiting to happen. Physicians are already so disgruntled about the falling reimbursements and increasing expenses that many are retiring early. Do you honestly think that cutting salaries even more, and pushing larger numbers of physicians out of practice will help with health care access? For universal health care to even be considered possible, I would think the government would need to pay medical school tuitions for those who will evetually practice within the system. Otherwise it wouldn't be feasible.
Some of you have mentioned adding spots for more med students and residents. This won't work! Residency programs are subsidized by the government, so how could they possibly increase spending on training? And it will only lead to increased competitiveness in the desireable practice locations without any effect on access in rural areas.
The government is not here to provide medical care! This is the physician's responsibility. Keep your high salary! Keep control over your own practice and your own right to make policies for the business you own! Universal health care would require that physicians accept the system's pathetically low reimbursements or be out of practice. This is not freedom, it is not capitalism. It is a terrifying step in the direction of socialism and the downfall of a country that is great because of capitalism. What right does a government who did not pay for you training and education have to dictate how you practice medicine and how much you should make?
The responsibility to provide care to the needy is YOURS. If every doctor out there would volunteer 1-2 nights a week in free clinics, think what an impact there would be! Stop looking to the government as if they are mommy and daddy giving hand-outs to their bastard children. You wanted to help people - so do it. But universal health care is not the way. I did not become a physician simply to make a high salary. But if the salaries were significantly lower, you better bet I'd find easier ways to help people. Make no mistake but this would be a common attitiude amongst would-be doctors with all the options in the world that are available to them. As salaries decrease, so will the caliber of people that enter medicine.
However, I would certainly entertain the idea if the government were willing to pay for my education and set work hours that are in line with other government employs. Weekends off, 30 days vacation, holidays off, 40 hours per week. If you are going to be a government employ, you should be treated like one. Universal health care is a disguise that makes doctors think they are independent, but make no mistake, you work for them. And this government is one that won't even advocate for medical malpractice reform. How will you pay your premiums on your government salary? I don't think you all are seeing the total picture. It seems easy enough to just give every american free health care, but it's just no feasible.
Geddy

 

[jenni4476]

Geddy-I fully agree with about 90% of what you said.

However, let me clarify my rationalization regarding the non-profit thing. First, I said that that was the idealistic side of me saying that and I know it wouldn't work realistically. I simply said it to illustrate the serious conflict of interest that is present.

I could give you so many examples, but I'll stick with astronomical drug prices for now. If these companies weren't pressured to show profits, they could plow the rest of that money back into research. Also, I believe the economic total revenue curve comes into play here. There are many patients out there that can't afford expensive medications, so they don't get them. I think if the drug companies would reduce their prices, their total revenue may well grow. This is very simplistic, I'll admit, but if you take it further....

My point is that medicine should not be run as a business. Health insurers and drug companies are effectively pitting patient lives against share prices, and unfortunately, this is America, so the bottom line wins out...

Just a thought on physician salaries...malpractice lawsuits often assign a value to a life in the multimillion dollar range. Why, then, is the value of each life a physician saves so much less, and further declining under cost-cutting pressure? All profits in the system should go to the physicians, IMO. Technology is great, but if you don't know how to use it and interpret the results, it's worthless.

 

[Goofyone]

I'm feeling the urge to make a lot of people angry with me.

Random thoughts from your average Joe Blow medical student.

Why do people seem to think they have the "right" to healthcare? Because it keeps us alive, and life is the most precious thing? Then why don't we have the "right" to go to a grocery store and get food without money? We would die much faster without food.

TRULY Altruistic people are wonderful gifts to this earth, and equally rare. We should not EXPECT physicians to ALL be this way (of course we should expect compassion and kindness).

If your only desire is to help people, I dare you to train in Neurosurgery, pay off your loans, and work for $20,000 a year. Hippocrit.

Socialized medicine?
Let's see: good healthcare for a few or crappy healthcare for all? I just can't decide!
Liberals don't want this anymore than anyone else. Liberal campaigns are all based on promises, especially the empty ones (but the votes sure come in handy). You think Tom Daschle is going to waiting in line for six months for an MRI with us mortals? Dream on.

I'm going to quit working and eat nothing but cholesterol poppers for the next 30 years. Will you be the one to give me a free CABG, Dr. Nice Guy/Gal? Did I mention if you screw it up I'm taking you for everything you own? Muhahahahaha.

Gee wiz, now that the CEOs and insurance companies blew their wads in the stock market and the democrats lost government control it's obvious that we need to promise the poor some more money that doesn't exist, cut physician's salaries, and blame the pharm companies for making a buck (since they should be altruistic like all the physicians).

When it comes down to it, WE'RE ALL COMPETING FOR THE SAME BUCK.

Medical supply companies want to shaft pharmaceutical companies and hospitals.

Pharm companies want to shaft patients, and they want us doctors to help.

Insurance companies and hospitals want to shaft patients, insurance companies, and doctors.

Uncle sam wants to shaft everyone, without anyone knowing it.

Patients don't care who's shafting who, as long as they're not paying for it.


Pre-emtive responses to your thoughts:

No, I'm not a pessimist, I'm a realist.
Yes, it's been a rough week.
I'm only a jerk if you're an ex-girlfriend of mine.
I only said what everyone else is thinking, hippocrit.

I just want to help people!



PS If this upset you, I apologize. I was only half-serious.

 

[gramcracker]

Originally posted by MacGyver
Under a socialized/single payer model, all doctors are basically employees of the federal government.

As such, they have to accept whatever the bureaucrats decide. If the bureaucrats want to cut the docs pay by 50%, they have no recourse but to accept it or quit.

Doctors have ZERO power and ZERO flexibility under a single payer system.

Thats how a single payer system cuts costs, by using its massive bargaining power and a monopoly to dictate the rules. There is no competition from the private sector so doctors have no choice but to take whatever scraps the federal govt decides to throw their way.

I believe you're confusing "socialized medicine" (Britain) with "socialized insurance"/single-payer (Canada).

The system is still privately run in single-payer countries, but publicly administered and financed. Doctors negotiate with the government for reimbursement rates, they are not dictated by the government.

And, no, that's not how a single-payer system cuts costs. It cuts costs by removing the ~$200 BILLION (yes, BILLION) of administrative waste and profits in our current health care system.

 

[gramcracker]

Originally posted by Goofyone
Why do people seem to think they have the "right" to healthcare? Because it keeps us alive, and life is the most precious thing? Then why don't we have the "right" to go to a grocery store and get food without money? We would die much faster without food.

We should not EXPECT physicians to ALL be this way (of course we should expect compassion and kindness).

Liberals don't want this anymore than anyone else. Liberal campaigns are all based on promises, especially the empty ones (but the votes sure come in handy). You think Tom Daschle is going to waiting in line for six months for an MRI with us mortals? Dream on.

I'm going to quit working and eat nothing but cholesterol poppers for the next 30 years. Will you be the one to give me a free CABG, Dr. Nice Guy/Gal? Did I mention if you screw it up I'm taking you for everything you own? Muhahahahaha.

Gee wiz, now that the CEOs and insurance companies blew their wads in the stock market and the democrats lost government control it's obvious that we need to promise the poor some more money that doesn't exist, cut physician's salaries, and blame the pharm companies for making a buck (since they should be altruistic like all the physicians).

1) People know they need to eat and drink to survive, and the possess the ability to do this. We are the priveleged few in this society who have been chosen to learn how to cure disease and heal the sick. The "survival" comparison isn't the same, IMHO.

2) We shouldn't expect physicians to be altruistic? Part of the profession is healing the ill. There's a social contract: physicians are given a great number of priveleges due to our (future) knowledge and profession, in exchange for the understanding that we will care for the public. And if you don't buy that argument, our education is greatly funded by PUBLIC taxpayer dollars, we learn anatomy from citizens who have chosen to give their bodies so that we may learn from them, and most hospitals do at least some residencies at public hospitals or VAs. We use the public to gain knowledge for our practice.

3) I'd recommend doing a little reading on technological investment at the US's percentage of GDP and see if you still believe MRIs will take that long.

4) Then we've got to work harder to make changes in the diet of Americans.

5) A lot of pharmaceutical companies develop drugs that were, in large part, discovered from publicly financed, taxpayer funded, NIH dollars. I don't have a problem with making a buck, but I do have one with charging exhorbitant prices in the United States when my money helped you to create the product you now sell.

 

[pxz]

As a person who actually lived a country with socialized medicine and non-profit drug companies, I feel obligated to provide some facts.

1) Medical schools are a lot less attractive. Do you want to be a scientist/engineerer making 50K after 4 years or a doctor making 50K after 8 years? Medical schools are the second class of colleges. heck, none of the top ten universties in China had medical school before 2000.

2) The quality of patient care is ....bad. When physicians make as much as a bus driver and work 80 hours a week, there is no way they care very much about patients. You can cut your leg off in front of a hospital and nobody pay any attention to you unless you can drag yourself into doctor's office.

3) Almost anyone can be a doctor. Sure, there are some medical graduates in hosptial, but a lot of "doctors" are not. They are the relatives of hosptial officials or graduates from some three-month medical program. What can you expect when you want a lot of physicians and you do not want to pay them?

4) If you want to receive good care, you'd better be wealthy. How do you make those low-paying doctors happy and treat you according? Pay them! (yes, even in a socialized medicine country). For example, If you have a loved one for a surgery (precedure costs $50), you have to give money to the surgeon ($300), nurses($200), etc. If you do not have money, well, a fourth-year medical student will be the one who makes the cut.

5)Non-profit drug companies just do not do a thing. How many new drugs have China discovered in the last 50 years? Five! Of course, we can manifacture any drugs cuz we do not have any brand-right/copy-right/patent protection in China.

You know the ultimate goal of communism is that "everyone gets what s/he needs....because everyone is altruism and works as hard as s/he can". It simply doesn't work this way in real life.

 

[Goofyone]

Originally posted by gramcracker
1) People know they need to eat and drink to survive, and the possess the ability to do this. We are the priveleged few in this society who have been chosen to learn how to cure disease and heal the sick. The "survival" comparison isn't the same, IMHO.

2) We shouldn't expect physicians to be altruistic? Part of the profession is healing the ill. There's a social contract: physicians are given a great number of priveleges due to our (future) knowledge and profession, in exchange for the understanding that we will care for the public. And if you don't buy that argument, our education is greatly funded by PUBLIC taxpayer dollars, we learn anatomy from citizens who have chosen to give their bodies so that we may learn from them, and most hospitals do at least some residencies at public hospitals or VAs. We use the public to gain knowledge for our practice.

3) I'd recommend doing a little reading on technological investment at the US's percentage of GDP and see if you still believe MRIs will take that long.

4) Then we've got to work harder to make changes in the diet of Americans.

5) A lot of pharmaceutical companies develop drugs that were, in large part, discovered from publicly financed, taxpayer funded, NIH dollars. I don't have a problem with making a buck, but I do have one with charging exhorbitant prices in the United States when my money helped you to create the product you now sell.

1. IF it were up to me, I would personally make sure that everyone had basic health care AND food. Unfortunately, its not. My point was that some (not ALL, of course) people don't think they should have to pay ANYTHING for healthcare. They think its a God-given right. They don't contribute to society but expect everyone else to foot the bill (of course im not talking about disabled people, or financially helpless people through no fault of their own), yet they don't think anything about paying for other of life's necessities, including cellular phone service. I think this is a VERY valid point. So, while they're sitting on their duffs shagging like rabbits and having babies, and getting every penny of their health, dental, and visioin paid for, grandma Jane can't afford her inhaler that the insurance company won't pay for. I grew up in a poor neiborhood and know what I'm talking about.

2. OK maybe I shouldn't have used the word altruistic. We should be altruistic. And of course nobody should get into medical school if they have totally selfish reasons. My POINT, is that there is a reason why there are a small number of saints. We are HUMAN, and therefore, have other agendas than just "helping people." Work for free if you really want to prove me wrong. You're a better person than me. By the way, maybe your education is funded by the public, but I am at a private school and making a bank very happy by borrowing a vast amount of money, which I will have to pay back with interest. By the way, I am grateful to all those who have donated their physical bodies for the good of others. I also mean no disrespect to the good people out there who are exceptions to everything im saying here.

3. OK, maybe an MRI will only take 5 months My POINT is that politicians are mostly interested in votes, not really helping people (of course there are exceptions -- i shouldn't have to keep pointing these out, you're smart enough to read between the lines, but i must be pre-emtive for my critics :smile: ) and no politician (or other wealthy person) is going to stand for the same treatment as the public. What's good for the good isn't good enough for the gander.

4. Maybe if you want to go live with a patient and monitor their dietary habits, you'll have more success at changing them. But unless you're REALLY fast, I'll bet you can't do it with more than one. People generally know what's good for them and what's not. My POINT, is that people are also responsible for their own health. All we can do as physicians is educate and encourage good habits.

5. The pharm industry is a whole other topic. Let's not go there. My POINT, is that ALL OF US HAVE SOMETHING AT STAKE HERE. And don't kid yourself, we're all chasing the same buck. It's called CAPITALISM. You can't have it both ways.

PS: People with ridiculous lawsuits should have to pay a penalty to the court for wasting time and money, as should their attorneys. These people are making it worse for everybody. If you think about it, we kinda have socialized medicine indirectly because of things like this. Maybe this is one reason why my ill father has to pay more money than his mortgage every month for basic health coverage.

PS Insurance companies suk. I remember when I had my tonsils taken out a couple years ago. I had complications after the operation and my mom was on the phone trying to get the weekend ER visit approved. I was standing over the sink with a 4" swollen uvula hanging out of my mouth and epiglottitis trying to keep my airway patent so I could live to be an altruistic physician and thereby save the lives of hundreds (maybe thousands) over the course of my career. The snotty little wench on the other end insisted on speaking with ME to find out "why I felt it was necessary to go to the hospital". I gave her my best Helen Keller impression. If you think about it, she almost caused hundreds (maybe thousands) to die, which would have resulted in less members and revenue for the insurance company.

I love a good argument, don't hold it against me.

Thanks for entertaining my thoughts! Even if you totally disagree with me, I'm just glad someone's reading this!

 

[Goofyone]

Originally posted by pxz
5)Non-profit drug companies just do not do a thing. How many new drugs have China discovered in the last 50 years? Five! Of course, we can manifacture any drugs cuz we do not have any brand-right/copy-right/patent protection in China.

Is this why on infomercials for herbs and other "natural" remedies, they always say "Ancient cultures like china have been using the same drugs for 2,000 years, so they must be good." ?

 

[SportsAndSpine]

This is a copy of the letter I just mailed to the Senate and the President:



It is possible to revise healthcare in the United States without totally changing its infrastructure and entirely rewriting policies. Over the past few months we have gained, first hand, insight into the effects of government deregulation of a large industry: the housing market. The lesson taught from the housing market crash is basic – you cannot deregulate something once it is regulated. Simply put: a national healthcare plan is something we cannot reverse once it has taken effect. When thinking about such deregulation my mind becomes filled with all too vivid memories of government bail-out dollars and government corporation control. The current system of care is not without its faults with regard to spending. The inefficiencies can be corrected, the access of care can be increased across a significantly greater income spectrum, and the quality of care can be improved. A modification of the current system of healthcare is the best approach to the healthcare crisis of the United States.


The analysis of the healthcare financial arena which includes, but is not limited to, spending, inefficiency, reimbursements, and profits is a complicated machine whose understanding is limited by many factors including investigator bias, lack of clinical knowledge by many investigators, and the lack of a systems based practice that promotes monetary efficiency by healthcare professionals. One thing is certain, however, the cost of care is increasing. Several major factors have contributed to this increase.



PROBLEM: Innovations and breakthroughs require research, and research requires time, manpower, and money. The new wonder drug or the fast noninvasive tests that roll out of the current capitalistic system and enhance the quality of care in this country cost money to develop. Pharmaceutical companies and technology companies need to recover these losses in the form of profit. A government run health care plan where compensations and ultimately profits of these corporations are dictated by the government will ultimately halt or significantly slow the innovations in medicine, most of which have come from the private sector. It would then become the government’s responsibility to finance and promote such advances since many of these corporations would then have little incentive to do so. There is a solution, however, to diminish the cost generated in this aspect of healthcare.
SOLUTION: By applying Nash’s theory of equilibrium, if all pharmaceutical and technology companies were restricted from spending the billions of dollars they currently utilize for marketing purposes, the profit distributions of these companies would not alter significantly from their current percentages, and corporations would lose less money in the form of advertising. These products would, as a result, cost less – enhancing the delivery of care. Moreover, clinicians would make selections on products based on data and not which product was more effectively marketed toward them.


PROBLEM: People are living longer due to enhanced medical care, increased nutritional awareness, and engaging in safe practices, amongst a number of other things. As a result, however, people live significantly longer with chronic conditions that debilitate their victims over time, after long periods of pharmacotherapy, a number of procedures, and significant pain and suffering. It is the diabetic with coronary artery disease, as an example, that costs the system money-not the person hit by a bus. Also, as a result of the enhancement of age, there is an increasing population of the elderly which is disparate to the ratios of the past. Medicare has enough difficulty paying for the elderly with these debilitating conditions.
SOLUTION: Compliant patients with regular follow up should pay relatively lower premiums compared to that of noncompliant patients with poor follow-up. The basis for this is that the practice of preventive medicine decreases the overall cost of their care, which rises exponentially with age. There is another benefit to this measure-it rewards people for living healthier lives.


PROBLEM: Another and more easily controllable factor contributing to the rising cost of increased healthcare is malpractice. Doctors practice defensive medicine. As a result, they order excessive tests and procedures to rule out what is very unlikely, though it has a very small possibility. Increased numbers of tests, unnecessary admissions, and needless prolongation of a hospital admission raises the costs of a hospital stay, increasing the reimbursements paid by insurance companies, which in turn amplifies insurance premiums, and, as a result, healthcare becomes inaccessible to a tremendous number of families.
SOLUTION: The auto insurance industry utilizes a system of full and partial tort options when insuring a vehicle. Tort refers to the victim’s ability to sue for pain and suffering. Individuals with partial tort pay less in premiums, but sacrifice the ability to sue for pain and suffering in more minor situations. Individuals can choose health insurance plans based on their desires and the amount of money they have available to pay their premiums. This addresses the issue of lowering malpractice limits, but allowing it to remain the choice of the individual-not the government.


On its surface, a national healthcare plan is a wonderful idea. The thought of each and every American being able to go to the doctor provides a vibrant image of a healthy United States. This notion is furthered by all the remarks made about how great the national healthcare plans of other first world countries are-promoting the “grass is greener on the other side of the fence” mentality. The reality of the situation is that national healthcare results in rationing of care, restriction of care in certain conditions, and waiting for necessary visits, tests, or procedures. A ninety five year old woman with inoperable and incurable lung carcinoma with a prognosis of three months survival will not receive the millions of dollars in care required to extend her life one additional month. In the few scenarios where examples of national healthcare at work are seemingly effective, the populations are small and there are few socioeconomic and ethnic barriers to care. The foundations of the current system of care can be enhanced and the availability of care can be broadened significantly. Many small steps can ultimately lead to a giant leap forward for all Americans, but a blind giant leap can throw us over the edge.

 

[Claudia Shauna]

I think the choice is fairly obvious: The House should keep working until they pass a health reform bill - health care is more important than vacation.What say you?

 

[apple1357]

When 1,400 physicians were polled by LocumTenens.com about future health care reform, more than 20% said they'd stop practicing medicine if health care reform is implemented. Out of those 20% a vast majority were anesthesiologists, surgeons or radiologists. These specialists are already in short supply in many areas of the country so research shows there will be greater shortages if government-run universal health insurance is implemented. Read more about the research here:

LocumTenens.com Health Care Reform Whitepaper

 

[meister]

When 1,400 physicians were polled by LocumTenens.com about future health care reform, more than 20% said they'd stop practicing medicine if health care reform is implemented. Out of those 20% a vast majority were anesthesiologists, surgeons or radiologists. These specialists are already in short supply in many areas of the country so research shows there will be greater shortages if government-run universal health insurance is implemented. Read more about the research here:

LocumTenens.com Health Care Reform Whitepaper

What terrible assumptions and polling, I'm shocked that misinformation is being spread by the right. Shocked!

 

[RabbMD]

What terrible assumptions and polling, I'm shocked that misinformation is being spread by the right. Shocked!

Any medicare based national health plan would result in an over 50% revenue cut before my expenses as an anesthesiologist. I would definitely quit if the government did that to me with no change in my ever increasing liability.

 

[meister]

Any medicare based national health plan would result in an over 50% revenue cut before my expenses as an anesthesiologist. I would definitely quit if the government did that to me with no change in my ever increasing liability.

Luckily in my infinite wisdom as benevolent dictator I would also take care of malpractice liability for all practitioners and fully subsidize medical education as well as cancel all remaining medical student loans.

The problem is you are just assuming everything would stay the same except Medicare reimbursements would replace your private reimbursements. Just for a second, consider what life would be like if we just eliminated all these wasteful and inefficient private blood-suckers from the equation. Hrm....


Nope better not think about it, just reflexively deny any reform because you irrationally fear a 50% salary cut.

 

[MOHS_01]

Luckily in my infinite wisdom as benevolent dictator I would also take care of malpractice liability for all practitioners and fully subsidize medical education as well as cancel all remaining medical student loans.

The problem is you are just assuming everything would stay the same except Medicare reimbursements would replace your private reimbursements. Just for a second, consider what life would be like if we just eliminated all these wasteful and inefficient private blood-suckers from the equation. Hrm....


Nope better not think about it, just reflexively deny any reform because you irrationally fear a 50% salary cut.

Does anyone like you? Anyone? Anyone?

 

[gloriacollins]

Nice thread....

 

[zut212]

Perhaps it wouldn't be such a bad idea to socialize health care. That way, only those who are interested in the humanistic aspect of medicine rather than the financial benefits would seek to become doctors.

Of course, socializing health care would also require mitigating the cost of medical education, since paying off a 100 grand debt would be a bit more difficult with only a 50 grand salary...

I agree with you here. Moreover, to another poster here, I *DO* believe that healthcare is a social right to the extent that I believe that the individual taking care of himself is a *SOCIAL* duty.

 

[horselover1991]

This is a topic that is a very touch topic. However, I do believe that healthcare does need reform, but not reform to a universal system, as that is not cost-effective for an already overburdened country. We must reduce our debt, not get into more debt, and a universal option is not going to help us reduce our debt.

I am not saying maintain the status quo. I have been misinterpreted in the past to want to maintain the status quo, and that is not what I am proposing that happens in healthcare. Here is what I propose for health care reform.

1. Government needs to take less of a role in health care. Rather than running the system, they need to allow the private sector to take control. Government involvement only proves to raise the costs associated with something and lower the payments out to people. For example, very little of the state-run Medicaid program is actually used for medical costs. On top of it, Medicaid and Medicare are the lowest paying when it comes to reimbursement for doctors, which is why so few doctors accept these patients. Let's look at the private sector on the other hand, private health insurance. Sure health insurance does bargain down the price that the doctor originally proposes, but at least they don't stiff the doctor. Private insurance gives the doctor enough money for what they do, and that is why many doctors prefer private insurance over Medicaid or Medicare. The private sector pays them better for what they do.

2. There needs to be innovation in health care. I got the privilege several years ago as a part of my FFA group going to the national convention to tour a drug company's campus. What they told us is that testing for a drug through all of its phases is a 10 year, multibillion dollar venture. Most drugs never make it out on the market, as they don't pass the stringent testing. While drugs manufactured in the US should go through this stringent testing, I believe that drugs outside of the US, if proven safe and effective in other countries, should be allowed in the US. When I say foreign countries, I am referring to industrialized nations with health care systems similar to ours. There also needs to be allowed new technology to the realm of health care. Technology is evolving faster than we know it, as the laptop you own may already be outdated, even though you bought it just a few months prior. We need to allow this kind of innovation into health care.

3. Malpractice suits should be capped. I hate the fact that this nation can be filled with so many people who are looking for someone to mess up so that they can win easy money via malpractice suits. I have heard what a malpractice suit does to a doctor emotionally and how it impacts the kind of care for the rest of their patients. Often people talk about unnecessary tests being run and they don't like the fact that they are being run. However, they don't take into mind why the doctor does it. Often it's to protect them from a malpractice suit. Another thing that people don't bear in mind is that each malpractice suit goes onto the doctor's public record, where people can view it before deciding to go to this doctor. The doctor may be a very good doctor at what he does, but because of one suit, it may cost him many patients. I think that more people need to bear in mind that medicine is an imperfect science, and the doctor is as well. No one knows how someone will react to anything before it happens. We may have an idea based off of past events, which is why there are safeguards for that, as doctors do not prescribe a medication in a class of drugs in which the patient is allergic to. However, if there is no past history of adverse events, how can one predict a future event? Different people react differently to different things at different times. One may develop an allergy to a medication that they have taken in the past. While this is probably not likely, it is still possible, and there is no way that someone can predict this happening. I believe that there are things that are worthy of a lawsuit, and a simple misunderstanding or accident on the doctor's part with the attempt at remediation isn't worth going to court over. However, blatant disrespect and blatant disregard for safeguards is worthy of being sued over. While there are people out there that will get under the bonnet of doctors, it is there responsibility to not allow their feelings toward them, either anger or physical attraction, to cloud their judgment and allow them to do or say things that they would normally not say to other patients. Even with this in mind, I believe that these malpractice suits should be capped. I know that some cases may be bad, but one shouldn't get awarded $60 million for something that the doctor may or may not have been able to prevent. That is too much to expect of the doctor. When malpractice suits are capped, then they may not have to carry such high-premium malpractice insurance, which will help reduce the cost of care for all.

I'm sure that there is more that can be said on this topic, as it is one of those topics that each person has their own opinion on. While I have my own opinion on what needs to be changed, I do respect the input of others on this conversation. Each person has valuable input and with each person's input, we may be able to change the direction of health care, but it will take many people working together to facilitate this change.

 

[zut212]

This is a topic that is a very touch topic. However, I do believe that healthcare does need reform, but not reform to a universal system, as that is not cost-effective for an already overburdened country. We must reduce our debt, not get into more debt, and a universal option is not going to help us reduce our debt.

I am not saying maintain the status quo. I have been misinterpreted in the past to want to maintain the status quo, and that is not what I am proposing that happens in healthcare. Here is what I propose for health care reform.

1. Government needs to take less of a role in health care. Rather than running the system, they need to allow the private sector to take control. Government involvement only proves to raise the costs associated with something and lower the payments out to people. For example, very little of the state-run Medicaid program is actually used for medical costs. On top of it, Medicaid and Medicare are the lowest paying when it comes to reimbursement for doctors, which is why so few doctors accept these patients. Let's look at the private sector on the other hand, private health insurance. Sure health insurance does bargain down the price that the doctor originally proposes, but at least they don't stiff the doctor. Private insurance gives the doctor enough money for what they do, and that is why many doctors prefer private insurance over Medicaid or Medicare. The private sector pays them better for what they do.

2. There needs to be innovation in health care. I got the privilege several years ago as a part of my FFA group going to the national convention to tour a drug company's campus. What they told us is that testing for a drug through all of its phases is a 10 year, multibillion dollar venture. Most drugs never make it out on the market, as they don't pass the stringent testing. While drugs manufactured in the US should go through this stringent testing, I believe that drugs outside of the US, if proven safe and effective in other countries, should be allowed in the US. When I say foreign countries, I am referring to industrialized nations with health care systems similar to ours. There also needs to be allowed new technology to the realm of health care. Technology is evolving faster than we know it, as the laptop you own may already be outdated, even though you bought it just a few months prior. We need to allow this kind of innovation into health care.

3. Malpractice suits should be capped. I hate the fact that this nation can be filled with so many people who are looking for someone to mess up so that they can win easy money via malpractice suits. I have heard what a malpractice suit does to a doctor emotionally and how it impacts the kind of care for the rest of their patients. Often people talk about unnecessary tests being run and they don't like the fact that they are being run. However, they don't take into mind why the doctor does it. Often it's to protect them from a malpractice suit. Another thing that people don't bear in mind is that each malpractice suit goes onto the doctor's public record, where people can view it before deciding to go to this doctor. The doctor may be a very good doctor at what he does, but because of one suit, it may cost him many patients. I think that more people need to bear in mind that medicine is an imperfect science, and the doctor is as well. No one knows how someone will react to anything before it happens. We may have an idea based off of past events, which is why there are safeguards for that, as doctors do not prescribe a medication in a class of drugs in which the patient is allergic to. However, if there is no past history of adverse events, how can one predict a future event? Different people react differently to different things at different times. One may develop an allergy to a medication that they have taken in the past. While this is probably not likely, it is still possible, and there is no way that someone can predict this happening. I believe that there are things that are worthy of a lawsuit, and a simple misunderstanding or accident on the doctor's part with the attempt at remediation isn't worth going to court over. However, blatant disrespect and blatant disregard for safeguards is worthy of being sued over. While there are people out there that will get under the bonnet of doctors, it is there responsibility to not allow their feelings toward them, either anger or physical attraction, to cloud their judgment and allow them to do or say things that they would normally not say to other patients. Even with this in mind, I believe that these malpractice suits should be capped. I know that some cases may be bad, but one shouldn't get awarded $60 million for something that the doctor may or may not have been able to prevent. That is too much to expect of the doctor. When malpractice suits are capped, then they may not have to carry such high-premium malpractice insurance, which will help reduce the cost of care for all.

I'm sure that there is more that can be said on this topic, as it is one of those topics that each person has their own opinion on. While I have my own opinion on what needs to be changed, I do respect the input of others on this conversation. Each person has valuable input and with each person's input, we may be able to change the direction of health care, but it will take many people working together to facilitate this change.

First, Medicare is much more efficient than the private sector. Medicare converts over 97% of healthcare dollars into service, but this is only 87% for the private insurance due to overheads of marketing, for profit motive, etc.

Second of all, drug development costs are hundreds of millions and not billions on average. You were off by 900%. Do you really think that Norway produces more biomedical engineers or files more medically related patents than the USA, and this explains their healthcare sector's success?

Finally, malpractice is capped from state to state, but I'm not sure if all states do this. I know for a fact that malpractice represents only 2.2% of all healthcare costs in the US. Not a big deal if you ask me.

We need more doctors.
We need to eliminate this perverse fee-for-service capitalistic model here.
We need a small tax on syrupy drinks and fast food of about 2% IN ADDITION to their current tax rates. This would generate $6B/year, but the real savings would be that it discourages consumption, and the true societal costs are saved.

 

[horselover1991]

First, Medicare is much more efficient than the private sector. Medicare converts over 97% of healthcare dollars into service, but this is only 87% for the private insurance due to overheads of marketing, for profit motive, etc.

It may seem more efficient, but the reimbursement for procedures is not what private insurance reimburses, hence why physicians often prefer patients with private insurance over those with Medicare or Medicaid

Second of all, drug development costs are hundreds of millions and not billions on average. You were off by 900%. Do you really think that Norway produces more biomedical engineers or files more medically related patents than the USA, and this explains their healthcare sector's success?

Finally, malpractice is capped from state to state, but I'm not sure if all states do this. I know for a fact that malpractice represents only 2.2% of all healthcare costs in the US. Not a big deal if you ask me.

It may not seem a big deal, but once a physician has been sued, it follows them the rest of their career. They not only care for their patients differently a lot of times out of fear of a repeat, but their premiums for their malpractice insurance also goes up, and they have to pay for it. While sometimes it is warranted, many times it is not warranted for people to sue physicians, and many times it is either settled out of court or it is ruled that this is a frivolous case. Either way, you still have the memory of that close call, and henceforth some physicians practice defensive medicine, ordering tests that are often expensive and unnecessary, in order to avoid being sued again. Malpractice may be a small percentage of costs in the US, but the costs of it are often not tangible.

We need more doctors.
We need to eliminate this perverse fee-for-service capitalistic model here.
We need a small tax on syrupy drinks and fast food of about 2% IN ADDITION to their current tax rates. This would generate $6B/year, but the real savings would be that it discourages consumption, and the true societal costs are saved.

I agree that we need more doctors. There is a vast shortage of doctors in the US and there needs to be something more done about it. What are some options to remedy this shortage that you propose?

As for the fee-for-service model, while I don't think it's all sunshine and daisies, I do think that it's not too bad. I don't think that a socialist model for health insurance, where we tell the government to foot the bill and tax us for our insurance is a good option either. There are some people out there that are perfectly healthy that do not use their health insurance because they don't need to, so being taxed the same as someone who goes to the doctor for every sniffle and sneeze would not be fair. Also, take this into consideration as well, it has been proven that this kind of system is not effective, and that it is even a violation of basic human rights (in Canada this case has been called Chaoulli vs. Quebec-look it up). Why are we wanting to try something that has been declared a violation of basic human rights?

As for taxing junk food, it would be a very good idea, but if you have the goal in mind to force people off of it, then you are taxing it for the wrong reasons. This is America, where I have the freedom to eat whatever I want to. To have government tell me what to eat is against my freedom of choice. I think another thing that we can do to increase revenue is to make medical marijuana legal and tax it like any other drug that you can get from the pharmacy. This would free up some of the space in our jails thereby reducing the cost of caring for these people while in jail. A significant percent of people are in jail because of drug-related offenses, so legalizing marijuana may help.

As for covering everyone, I think that this is not possible. There will be people that fall through the cracks, so to try to do so is unrealistic.

 

[zut212]

It may seem more efficient, but the reimbursement for procedures is not what private insurance reimburses, hence why physicians often prefer patients with private insurance over those with Medicare or Medicaid



It may not seem a big deal, but once a physician has been sued, it follows them the rest of their career. They not only care for their patients differently a lot of times out of fear of a repeat, but their premiums for their malpractice insurance also goes up, and they have to pay for it. While sometimes it is warranted, many times it is not warranted for people to sue physicians, and many times it is either settled out of court or it is ruled that this is a frivolous case. Either way, you still have the memory of that close call, and henceforth some physicians practice defensive medicine, ordering tests that are often expensive and unnecessary, in order to avoid being sued again. Malpractice may be a small percentage of costs in the US, but the costs of it are often not tangible.



I agree that we need more doctors. There is a vast shortage of doctors in the US and there needs to be something more done about it. What are some options to remedy this shortage that you propose?

As for the fee-for-service model, while I don't think it's all sunshine and daisies, I do think that it's not too bad. I don't think that a socialist model for health insurance, where we tell the government to foot the bill and tax us for our insurance is a good option either. There are some people out there that are perfectly healthy that do not use their health insurance because they don't need to, so being taxed the same as someone who goes to the doctor for every sniffle and sneeze would not be fair. Also, take this into consideration as well, it has been proven that this kind of system is not effective, and that it is even a violation of basic human rights (in Canada this case has been called Chaoulli vs. Quebec-look it up). Why are we wanting to try something that has been declared a violation of basic human rights?

As for taxing junk food, it would be a very good idea, but if you have the goal in mind to force people off of it, then you are taxing it for the wrong reasons. This is America, where I have the freedom to eat whatever I want to. To have government tell me what to eat is against my freedom of choice. I think another thing that we can do to increase revenue is to make medical marijuana legal and tax it like any other drug that you can get from the pharmacy. This would free up some of the space in our jails thereby reducing the cost of caring for these people while in jail. A significant percent of people are in jail because of drug-related offenses, so legalizing marijuana may help.

As for covering everyone, I think that this is not possible. There will be people that fall through the cracks, so to try to do so is unrealistic.

Physicians turn down medicare patients because reimbursement rates are less. This is all about money. period.

Regarding the shortage of MDs in the USA: Produce more Drs! We import 20% of our MDs. We can produce more docs here. USA! USA! USA!

I agree about marijuana legalization, and also, perhaps decriminalization of harder drugs.

Perhaps instead of a surcharge or additional tax on junk foods, I think that elimination of the $30B farm subsidy would have the same effect and less bureaucracy.

 

[John99991]

Perhaps it wouldn't be such a bad idea to socialize health care. That way, only those who are interested in the humanistic aspect of medicine rather than the financial benefits would seek to become doctors.

Of course, socializing health care would also require mitigating the cost of medical education, since paying off a 100 grand debt would be a bit more difficult with only a 50 grand salary...

Single payer or socialized healthcare is perhaps impossible to implement in America because of the huge cost. The world has changed and the challenges of healthcare cannot be overcome by a single payer system. Nations in the developed world with such systems are struggling with cost from Canada to France.

There is a new book that proffers some unique solution that i highly recommend.
It's titled "On the Principles of Social Gravity" by Tobore Tobore. Read the second chapter where healthcare is discussed.