Honest question about the physician shortage

[CyrilFiggis]

..


I presume that "mose" is a typo for "move". One can debate whether "routine annuals" for gyn patients are necessary at all. (the American College of Physicians says no; I'm sure that there are those with vested interests that would say yes.) Meanwhile, women in rural areas do have babies and they have complications and they need OBs (even the midwives need the supervision of an OB). Malpractice has made it almost impossible for family practitioners to deliver babies and so we do need general OB within the scope of 3 year medical schools designed to produce the docs needed to serve rural communities.

Just like Brave New World had technology producing babies that were well suited for specific roles in life, we perhaps need to select applicants to specific medical schools with the idea of filling various needs in society.

I didn't mean to say that OB as curriculum or training is unnecessary. But if you look at those in the field, esp those in residency, the need for general ob and gynecologic care is decreasing among physicians as more further refine their training with fellowship. This is more heavily weighted on the gyn side, because as you alluded, OB comes with more variability. I'm not opposed to doulas or midwives, but I would prefer NPs and PAs.

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[LizzyM]

I didn't mean to say that OB as curriculum or training is unnecessary. But if you look at those in the field, esp those in residency, the need for general ob and gynecologic care is decreasing among physicians as more further refine their training with fellowship. This is more heavily weighted on the gyn side, because as you alluded, OB comes with more variability. I'm not opposed to doulas or midwives, but I would prefer NPs and PAs.

The problem is that rural areas don't have enough volume for 5 subspecialty gynecologists but enough work for one OB-GYN.

The "need for general ob and gynecologic care is decreasing among physicians as more further refine their training with fellowships" is pure nonsense. The patient's need for generalist care does not change because a physician chooses specialty training (except for research showing that demand increases as supply increases and that utilization varies dramatically geographically despite similar demographic characteristics of populations). Can we find people who want to practice primary care in rural areas and can we admit them to medical schools that will provide them with the education necessary to fulfill their career goals and meet the needs of rural Americans?

 

[DaWeasel]

To take a different position, if you're working in the NHS you are paid a set rate to be any specific specialty. So if you're a colorectal surgeon, you get the same salary per year regardless of how many fistulotomies you do. Some would hate that. They want pay for play. Crank out 500 of those a year and buy a summer home. Some would love it. Have more standard hours, make less, but have time to relax and enjoy the other aspects of life, like family.

I don't know what this is supposed to mean with respect to the point I was making. What you've said is irrelevant.

This is where my own rant begins. First off, everyone needs to stop blurting out Econ 101 crap. Healthcare economics are way too difficult to water down to general supply/demand arguments, even dealing with just doctor supply. Healthcare is one of the least transparent markets in the US - a practice or hospital has a charge rate for a specific procedure, insurance has a negotiated rate for that procedure, and then we all have different co-pays, deductibles, and co-insurances. I had a cystectomy performed 2 weeks ago. Someone else with different insurance, done in the same hospital, with the same doc, will probably not be paying the same.

I'm not sure why you think basic economic ideas don't apply to healthcare. I do agree with you that the healthcare market lacks transparency, although I would generally argue this is a regulatory issue. As far as the differences in prices, it is pretty simple that if there are a variety of plans in existence that there will be a variety of prices paid as each plan is different. Are you arguing that economic ideas aren't relevant here, or are you making some other point?

 

[Kurk]

The AMA, the AOA, the association of hospitals, etc virtually every major medical association has come out against this bill. The AMA was powerful enough to prevent national health insurance for some 70+ years.

The psychology and power of three people, Trump, Ryan and McConnell is all that is running this. If you want to help call/email your senator

https://aamc-orange.global.ssl.fast.../2018_amcas_instruction_manual_web.pdf#page41

Will the bill drop physicians' salaries?

 

[gyngyn]

Will the bill drop physicians' salaries?

Will it harm patients without benefiting doctors?

 

[JJRousseau]

Will it harm patients without benefiting doctors?

Yes.

 

[JJRousseau]

The market, alone, doesn't work for medicine, because citizens' needs exceed the capital that they have available to finance the labor to meet those needs. If you want a free market to solve medicine, you must accept individuals being denied care. It must be made an excludable good. I, and to my knowledge most US citizens, don't believe that healthcare, at least basic care (yearly doctor's visits, diabetes management, childbirth, etc.), should be excludable. Indeed, most of us, including myself, would be unhappy for someone with a gunshot wound to be turned away. As soon as we make healthcare all inclusive, we need something more complicated than "the almighty invisible hand".

 

[Matthew9Thirtyfive]

The market, alone, doesn't work for medicine, because citizens' needs exceed the capital that they have available to finance the labor to meet those needs. If you want a free market to solve medicine, you must accept individuals being denied care. It must be made an excludable good. I, and to my knowledge most US citizens, don't believe that healthcare, at least basic care (yearly doctor's visits, diabetes management, childbirth, etc.), should be excludable. Indeed, most of us, including myself, would be unhappy for someone with a gunshot wound to be turned away. As soon as we make healthcare all inclusive, we need something more complicated than "the almighty invisible hand".

Tell that to Miss USA.

 

[DaWeasel]

The market, alone, doesn't work for medicine, because citizens' needs exceed the capital that they have available to finance the labor to meet those needs. If you want a free market to solve medicine, you must accept individuals being denied care. It must be made an excludable good. I, and to my knowledge most US citizens, don't believe that healthcare, at least basic care (yearly doctor's visits, diabetes management, childbirth, etc.), should be excludable. Indeed, most of us, including myself, would be unhappy for someone with a gunshot wound to be turned away. As soon as we make healthcare all inclusive, we need something more complicated than "the almighty invisible hand".

It isn't about what anyone wants though. I, too, wish that everyone could satisfy 100% of their healthcare needs. But we live in a world of scarcity, and there are limited healthcare resources available to satisfy potentially unlimited needs. We can debate the best system for allocating healthcare, but there has to be an underlying agreement that it is not possible to satisfy every need.

You say that you don't want people denied care under a free market with the implication that a government managed system could provide endless care. That isn't true. Even the biggest government can't escape basic economics. Markets are the best system society has developed for coping with scarcity and the economic reality isn't any different when it comes to healthcare.

 

[LizzyM]

It isn't about what anyone wants though. I, too, wish that everyone could satisfy 100% of their healthcare needs. But we live in a world of scarcity, and there are limited healthcare resources available to satisfy potentially unlimited needs. We can debate the best system for allocating healthcare, but there has to be an underlying agreement that it is not possible to satisfy every need.

You say that you don't want people denied care under a free market with the implication that a government managed system could provide endless care. That isn't true. Even the biggest government can't escape basic economics. Markets are the best system society has developed for coping with scarcity and the economic reality isn't any different when it comes to healthcare.

Markets are not necessarily the best method for allocating essential services. Currently we don't treat health care services as essential except, perhaps, for renal dialysis which is federally funded for everyone who needs it. (Crazy, and due to to a policy decision >40 years ago). While we can't provide "endless care" to everyone, other countries have adopted policies that provide essential services to everyone. What we run up against in the US is the head butting of those who want the "every man for himself" American rugged individualism, versus those who believe that we should pool our money to provide for the good of all. We run up against those who don't want to pay for other people's problems, particularly diseases that are related to "bad" behaviors and there would be a huge issue with abortion and birth control as essential services (as we've seen with Obama Care).

There is a difference between "satisfying every need" and saying that at a minimum we will provide health care coverage for maternity services, newborn care, immunizations, and .... (what would be on your list of essential services).

 

[kopftonmd]

It isn't about what anyone wants though. I, too, wish that everyone could satisfy 100% of their healthcare needs. But we live in a world of scarcity, and there are limited healthcare resources available to satisfy potentially unlimited needs. We can debate the best system for allocating healthcare, but there has to be an underlying agreement that it is not possible to satisfy every need.

You say that you don't want people denied care under a free market with the implication that a government managed system could provide endless care. That isn't true. Even the biggest government can't escape basic economics. Markets are the best system society has developed for coping with scarcity and the economic reality isn't any different when it comes to healthcare.

Markets are not necessarily the best method for allocating essential services. Currently we don't treat health care services as essential except, perhaps, for renal dialysis which is federally funded for everyone who needs it. (Crazy, and due to to a policy decision >40 years ago). While we can't provide "endless care" to everyone, other countries have adopted policies that provide essential services to everyone. What we run up against in the US is the head butting of those who want the "every man for himself" American rugged individualism, versus those who believe that we should pool our money to provide for the good of all. We run up against those who don't want to pay for other people's problems, particularly diseases that are related to "bad" behaviors and there would be a huge issue with abortion and birth control as essential services (as we've seen with Obama Care).

There is a difference between "satisfying every need" and saying that at a minimum we will provide health care coverage for maternity services, newborn care, immunizations, and .... (what would be on your list of essential services).

It seems like you're talking past each other a bit. @DaWeasel notes that we can't provide everyone with every treatment that could possibly be dreamed up for them, whereas @LizzyM argues that we need to (should?) provide essential services for everyone. But there's a huge amount of space between the two, and, to me, that's where the ethically difficult part comes in: who gets to decide what is necessary? A line has to be drawn, but how do you do that without making people mad and being shouted at about "death panels?" It's a choice that needs to be made, but no one wants to make it (or so it seems to me) and so we have this mess of public/private health care that other countries (the UK, Canada, etc.) don't have because they've decided what is necessary and what is not. Whether their decisions are correct, of course, is above my pay grade.

 

[DaWeasel]

Markets are not necessarily the best method for allocating essential services. Currently we don't treat health care services as essential except, perhaps, for renal dialysis which is federally funded for everyone who needs it. (Crazy, and due to to a policy decision >40 years ago). While we can't provide "endless care" to everyone, other countries have adopted policies that provide essential services to everyone. What we run up against in the US is the head butting of those who want the "every man for himself" American rugged individualism, versus those who believe that we should pool our money to provide for the good of all. We run up against those who don't want to pay for other people's problems, particularly diseases that are related to "bad" behaviors and there would be a huge issue with abortion and birth control as essential services (as we've seen with Obama Care).

There is a difference between "satisfying every need" and saying that at a minimum we will provide health care coverage for maternity services, newborn care, immunizations, and .... (what would be on your list of essential services).

I don't believe the government has any role in providing healthcare at all, but with that said, I could accept a compromise for the sake of having something workable. A major issue with "essential services" is, as you've pointed out, there is wide disagreement on what that means. I'm not a physician and I won't take a position on what is or isn't medically necessary, but I will argue the government certainly shouldn't subsidize bad behaviors. My question with respect to essential services is, where would you be willing to draw the line and say no to a hurting patient? If you're going to take the position of only providing select services, at some point you will encounter someone marginally outside the "essential services," and you must tell them no and that their problem isn't the burden of the taxpayer.

If you aren't willing to say no, then I hope you can understand why those who advocate market-based systems are so against any form of government involvement and prefer more rugged individualism. Government programs tend to only expand over time because it is not in the self-interest of politicians to draw a line in the sand and say no.

 

[LizzyM]

I don't believe the government has any role in providing healthcare at all, but with that said, I could accept a compromise for the sake of having something workable. A major issue with "essential services" is, as you've pointed out, there is wide disagreement on what that means. I'm not a physician and I won't take a position on what is or isn't medically necessary, but I will argue the government certainly shouldn't subsidize bad behaviors. My question with respect to essential services is, where would you be willing to draw the line and say no to a hurting patient? If you're going to take the position of only providing select services, at some point you will encounter someone marginally outside the "essential services," and you must tell them no and that their problem isn't the burden of the taxpayer.

If you aren't willing to say no, then I hope you can understand why those who advocate market-based systems are so against any form of government involvement and prefer more rugged individualism. Government programs tend to only expand over time because it is not in the self-interest of politicians to draw a line in the sand and say no.

If the government should not provide any health services, would you advocate for the closing of all VA hospitals and clinics? What would you do with the ~50% of all births in America currently covered by Medicaid? What about the profoundly physically and mentally disabled? Should they be thrown in the streets or euthanized?

If the government should not subsidize bad behavior how will be define "bad behavior". Should we begin by saying that anyone who has an STI likely got it through sex outside of marriage and that no public dollars will be spent on his treatment even if leaving it untreated will harm those to whom the disease is spread?

You can be a rugged individual but the morality of our society is measured in how we care for those who are incapable of helping themselves.

I'm a bit foggy on the details but in the early 90s the state of Oregon, IIRC, tried to come up with a list of essential services by engaging the public in a sorting and ranking exercise. It can be done but it does involve hard choices.

 

[hungrybox]

If the government should not provide any health services, would you advocate for the closing of all VA hospitals and clinics? What would you do with the ~50% of all births in America currently covered by Medicaid? What about the profoundly physically and mentally disabled? Should they be thrown in the streets or euthanized?

Strawman. Nobody is saying that.

You can be a rugged individual but the morality of our society is measured in how we care for those who are incapable of helping themselves.

That's your measure of the morality of a society, not mine.

 

[LizzyM]

Strawman. Nobody is saying that.

Someone is saying that:

I don't believe the government has any role in providing healthcare at all,

That's your measure of the morality of a society, not mine.

Me and Hubert Humphrey.
famous misquotations | Bookshelf
Speaking at the Hubert Humphrey Building dedication in Washington, D.C. on November 1, 1977, former U.S. Vice President (1965-69) Hubert Humphrey spoke about the treatment of the weakest members of society as a reflection of a government: “the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped.”

 

[DaWeasel]

If the government should not provide any health services, would you advocate for the closing of all VA hospitals and clinics? What would you do with the ~50% of all births in America currently covered by Medicaid? What about the profoundly physically and mentally disabled? Should they be thrown in the streets or euthanized?

If the government should not subsidize bad behavior how will be define "bad behavior". Should we begin by saying that anyone who has an STI likely got it through sex outside of marriage and that no public dollars will be spent on his treatment even if leaving it untreated will harm those to whom the disease is spread?

You can be a rugged individual but the morality of our society is measured in how we care for those who are incapable of helping themselves.

I'm a bit foggy on the details but in the early 90s the state of Oregon, IIRC, tried to come up with a list of essential services by engaging the public in a sorting and ranking exercise. It can be done but it does involve hard choices.

I wouldn't necessarily close the VA, I would ensure there's a system that does help take care of veterans, whether that is the VA or a different institution.

The euthanasia comment is over the top. I'm arguing from a good faith position here, don't insult me by saying I want people to die. As far as births covered by Medicaid, no I would not advocate for those to be covered. Pregnancy doesn't happen by accident. As you posted, hard choices have to be made at times and I would choose to hold people accountable for the choices they make. This includes not covering STIs in your example. There's at least one highly effective way to avoid getting an STI.

I specifically agree with you about taking care of the severely mentally and physically handicapped. I think there are plenty of charity based ideas that would be effective, but this is an area that the government does have justification in helping.

I agree with you that we have an obligation to help those not as fortunate as us. I enjoy my volunteer work now, and I fully intend one day to provide some portion of healthcare as charity. One of the best experiences in life is helping another individual who can't do anything in return for you. I feel the same need to help the less fortunate as most people here do. However, government mandated compassion is not the practical or moral equivalent of genuine acts of kindness toward those in need of our help.

 

[LizzyM]

As far as births covered by Medicaid, no I would not advocate for those to be covered. Pregnancy doesn't happen by accident.

Yes, and every method of birth control is 100% effective. Welcome to Utopia.

 

[Med Ed]

They couldn't get a public option through because TEd Kennedy died in office and they lost their majority.

Not quite. The public option was removed because Joe Lieberman was opposed to it, and his was the 60th vote needed to avoid a filibuster. Ted Kennedy's death, or rather Scott Brown's election, resulted in the House passing the Senate version intact. This was followed by the passage of a smaller reconciliation bill that made House-initiated tweaks to what the Senate had put together. Since it was a reconciliation process it was not subject to filibuster and only need 50 votes to pass. People often confuse the passage of the ACA proper with the later reconciliation bill.

 

[Med Ed]

don't insult me by saying I want people to die.

It's not an insult if you are arguing a position that would result in more people dying.

As far as births covered by Medicaid, no I would not advocate for those to be covered.

Yeah, let's pull the plug on pregnancy coverage and let's see what happens!

 

[DaWeasel]

It's not an insult if you are arguing a position that would result in more people dying.



Yeah, let's pull the plug on pregnancy coverage and let's see what happens!

I'm not arguing a position that will result in anyone dying. No action I am advocating would be responsible for any negative consequences. The responsibility for this has to fall on those who choose to get pregnant. The responsibility for consequences of a pregnancy have to fall on the parents. I hope you'll be consistent enough to acknowledge the moral hazard involved when the individuals involved in risky behavior aren't responsible for the entirety of the consequences of their actions.

So yes, personal responsibility should be the cornerstone of our society and there shouldn't be any subsidizing of bad decisions.

Saying personal responsibility is important isn't as emotionally satisfying as saying that "every essential need will be covered, " but my position is actually consistent. You can define "essential services" however you'd like, but the ultimate result is an arbitrary line created by government.

 

[Med Ed]

I'm not arguing a position that will result in anyone dying.

You favor having Medicaid not cover pregnancy. Medicaid current covers almost half of all births. Being pregnant without insurance increases risk of mortality for both mother and baby. Logic therefore dictates that you are, in fact, in favor of a change that would result in higher mortality.

It sounds like you just finished Atlas Shrugged.

 

[Iz_FtB]

I'm not arguing a position that will result in anyone dying. No action I am advocating would be responsible for any negative consequences. The responsibility for this has to fall on those who choose to get pregnant. The responsibility for consequences of a pregnancy have to fall on the parents. I hope you'll be consistent enough to acknowledge the moral hazard involved when the individuals involved in risky behavior aren't responsible for the entirety of the consequences of their actions.

So yes, personal responsibility should be the cornerstone of our society and there shouldn't be any subsidizing of bad decisions.

Saying personal responsibility is important isn't as emotionally satisfying as saying that "every essential need will be covered, " but my position is actually consistent. You can define "essential services" however you'd like, but the ultimate result is an arbitrary line created by government.

Read this as "poor people need to know their place and not get pregnant."

How much better off would American society be with millions denied pre-natal, partum, and post-partum care?

 

[Med Ed]

Read this as "poor people need to know their place and not get pregnant."

More generally, "people need to stop being human." Something that has yet to occur in the history of our species. That said, medicine does seem to attract a subset with paternalistic tendencies.

 

[DaWeasel]

You favor having Medicaid not cover pregnancy. Medicaid current covers almost half of all births. Being pregnant without insurance increases risk of mortality for both mother and baby. Logic therefore dictates that you are, in fact, in favor of a change that would result in higher mortality.

It sounds like you just finished Atlas Shrugged.

No, I just disagree with your premise that the government has a role to play. I think those involved in the pregnancy are responsible for it, not the tax payers.

More generally, "people need to stop being human." Something that has yet to occur in the history of our species.

"people have always made irresponsible decisions" is not a defense of irresponsible decisions.

 

[Toutie]

No, I just disagree with your premise that the government has a role to play. I think those involved in the pregnancy are responsible for it, not the tax payers.

So only those people with children should pay taxes for schools? Only those with a drivers licence should pay taxes for roads? Only those who actually use public parks/lands should pay taxes for them?

 

[JJRousseau]

Yes, and every method of birth control is 100% effective. Welcome to Utopia.

And 100% accessible.

 

[JJRousseau]

It is appealing to think that all of life's problems will be solved by the market. It's similarly appealing to think that they will be solve by holding hands and sharing everything. Who knows maybe God will fix it. IMHO, complex problems will actually be solved by careful analysis of social institutions and behaviors, market economies, moral belief systems, etc. followed by a social discourse on how to react to the resulting data. Or we can just keep burning strawmen and feel good about our own magical fixer-upper of a purist ideology, all the while no real nuance gets acknowledged and no problem gets solved.

 

[JJRousseau]

If you want to radical, purist neoliberalism for what it really is, then healthcare is the best economy to examine. The face of social Darwinism is hard to hide there.

 

[DaWeasel]

It is appealing to think that all of life's problems will be solved by the market. It's similarly appealing to think that they will be solve by holding hands and sharing everything. Who knows maybe God will fix it. IMHO, complex problems will actually be solved by careful analysis of social institutions and behaviors, market economies, moral belief systems, etc. followed by a social discourse on how to react to the resulting data. Or we can just keep burning strawmen and feel good about our own magical fixer-upper of a purist ideology, all the while no real nuance gets acknowledged and no problem gets solved.

A market-based system is the best way to make use of diverse perspectives and knowledge.

 

[JJRousseau]

A market-based system is the best way to make use of diverse perspectives and knowledge.

Indeed, no solution for healthcare I would ever dare to suggest would eliminate market forces - totally planned economies are vastly inferior, and in most cases a total disaster. However, there is a difference between relying on market forces to leverage some form of utilitarian outcome (like the Affordable Care Act), and simply casting a prayer that the invisible hand will magically solve all of the unpleasant outcomes of the healthcare economy as it stood (or stands). As appealing as it is to believe that by doing nothing and letting everyone keep as much of their own income as they want, society will achieve it's optimum prosperity - I think it's a bit more complicated than that. It sure works well for wheat and coal, but when it comes to patients and prisoners - well, I'm not buying it.

 

[DaWeasel]

Indeed, no solution for healthcare I would ever dare to suggest would eliminate market forces - totally planned economies are vastly inferior, and in most cases a total disaster. However, there is a difference between relying on market forces to leverage some form of utilitarian outcome (like the Affordable Care Act), and simply casting a prayer that the invisible hand will magically solve all of the unpleasant outcomes of the healthcare economy as it stood (or stands). As appealing as it is to believe that by doing nothing and letting everyone keep as much of their own income as they want, society will achieve it's optimum prosperity - I think it's a bit more complicated than that. It sure works well for wheat and coal, but when it comes to patients and prisoners - well, I'm not buying it.

I would argue that the market system delivers the best health care we can hope to achieve. But I don't think that's the important part of this discussion. What do you see as fundamentally different between the market for food, which I think is a more urgent need than medical care, and the healthcare market?

 

[hungrybox]

Me and Hubert Humphrey.
famous misquotations | Bookshelf
Speaking at the Hubert Humphrey Building dedication in Washington, D.C. on November 1, 1977, former U.S. Vice President (1965-69) Hubert Humphrey spoke about the treatment of the weakest members of society as a reflection of a government: “the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life; the sick, the needy and the handicapped.”

How is Hubert relevant to this? Sounds like an appeal to authority, except I don't even know who that is.

 

[Med Ed]

No, I just disagree with your premise that the government has a role to play. I think those involved in the pregnancy are responsible for it, not the tax payers.

Tell that to the OB's and L&D departments that would be working for free if Medicaid were ended. Besides, most people on Medicaid work, and 80% of them live in working households. In other words, they are taxpayers.

Out of curiosity, how removed from healthcare would you like the government to be?

"people have always made irresponsible decisions" is not a defense of irresponsible decisions.

Not defending, merely pointing out that wishful thinking has a 0.0000% success rate at stopping people from acting like people.

 

[Matthew9Thirtyfive]

"people have always made irresponsible decisions" is not a defense of irresponsible decisions.

Your position is so naive and immature, it's almost not funny. In what world do you live where pregnancies due to rape and birth control failures don't occur, or in which poor people just don't get to have sex or reproduce because they aren't affluent enough?

 

[DaWeasel]

Tell that to the OB's and L&D departments that would be working for free if Medicaid were ended. Besides, most people on Medicaid work, and 80% of them live in working households. In other words, they are taxpayers.

Out of curiosity, how removed from healthcare would you like the government to be?



Not defending, merely pointing out that wishful thinking has a 0.0000% success rate at stopping people from acting like people.

The point of discussion isn't about how those physicians get paid. Yes, anyone subsidized by the current insurance institutions may be hurt if conditions changed to reflect market demand. I'm not saying this is good or bad, it's just the reality. It's also a possibility they could be more appropriately compensated in the long run as the situation changed to reflect their true value, so my position isn't adverse in the long run to any department reliant on Medicaid.

Back to the individuals, my position is simply that each individual is responsible for their actions, and any system that separates consequences from action introduces moral hazard and subsizes bad decisions. I'm not calling anyone lazy or anything like that. I'm not commenting on the people in the government system, only the incentives that they face.

Your position is so naive and immature, it's almost not funny. In what world do you live where pregnancies due to rape and birth control failures don't occur, or in which poor people just don't get to have sex or reproduce because they aren't affluent enough?

Pregnancy resulting from rape is outside the scope of this discussion. I'm only talking about consensual pregnancy.

My response otherwise is that risky actions can have consequences, and that using the health care system to have children is expensive. I don't understand why being willing to say this is immature and naive.

 

[Matthew9Thirtyfive]

Pregnancy resulting from rape is outside the scope of this discussion. I'm only talking about consensual pregnancy.

But you said:

As far as births covered by Medicaid, no I would not advocate for those to be covered. Pregnancy doesn't happen by accident.

You then a few posts later mentioned "choosing to get pregnant," but not everyone who gets pregnant chose to do so. You can't tell them to **** off because they can't afford the pregnancy or abortion they didn't plan on in the first place (and in some cases, didn't want).

If you're saying you're just talking about irresponsible pregnancies by people who have no business having children, then you are arbitrarily narrowing the discussion. What about the rest? Are you okay with the government covering pregnancies 2/2 rape? Where do you draw the line?

 

[jcorpsmanMD]

@DaWeasel you must be a real pleasure at parties, that is all

 

[Toutie]

@DaWeasel you must be a real pleasure at parties, that is all

Yep, he only serves beer to his guests who can afford it.

 

[DaWeasel]

@DaWeasel you must be a real pleasure at parties, that is all

Yes, all four of us free market people sit in the corner and compete to give the most thanks for Ann Rand.

No, I'm just trying to advocate for free markets in healthcare. I don't mind being in the minority doing so.

 

[Med Ed]

You then a few posts later mentioned "choosing to get pregnant," but not everyone who gets pregnant chose to do so. You can't tell them to **** off because they can't afford the pregnancy or abortion they didn't plan on in the first place (and in some cases, didn't want).

If you're saying you're just talking about irresponsible pregnancies by people who have no business having children, then you are arbitrarily narrowing the discussion. What about the rest? Are you okay with the government covering pregnancies 2/2 rape? Where do you draw the line?

Look, it's very simple. All we have to do is convert a $3.2 trillion system to an anarcho-feudal-mercantile model and, after all the deaths, things will smooth into a state of self-correcting perfection.

 

[LizzyM]

I would argue that the market system delivers the best health care we can hope to achieve. But I don't think that's the important part of this discussion. What do you see as fundamentally different between the market for food, which I think is a more urgent need than medical care, and the healthcare market?

Do you realize that the federal government spent over $66 billion dollars last year on "food stamps" for Americans through the supplemental nutrition assistance program (that's not including the cost of administering the program, just the cost of the food itself.) The federal government also provides food to kids through the School Breakfast and School Lunch programs, and through WIC, for women (who are pregnant or breastfeeding), infants and children who are at nutritional risk. There is also government funding for lunches for elderly folks through "Meals on Wheels" and senior center dining rooms.

 

[deleted407021]

Yep, he only serves beer to his guests who can afford it.

No, he gets the beer, they get what trickles down out of the mostly empty bottles

 

[deleted407021]

I would argue that the market system delivers the best health care we can hope to achieve.

This doesn't appear to be the case in the real world. The US spends much more per capita on health care than any other comparable Western nation and we're behind on number of people covered, infant mortality from 1-12 months, life expectancy for cystic fibrosis (~40 yrs in US, ~50 in Canada) and many other metrics you could care to look at.

I guess if all the uninsured (and people with PEC) died then those numbers would look more favorable

 

[LizzyM]

How is Hubert relevant to this? Sounds like an appeal to authority, except I don't even know who that is.

Maybe you should have studied history as well as philosophy. Come back when you have a more liberal education (and pardon the pun).

 

[deleted407021]

My prediction -- the US will have nationwide legalization of recreational marijuana before it has a nationwide single-payer system.

The reverse of pretty much every other country.

 

[hungrybox]

Maybe you should have studied history as well as philosophy. Come back when you have a more liberal education (and pardon the pun).

Oh, an ad hominem to follow up your appeal to authority?

What is a logical fallacy? That's a rhetorical question for you.

Real arguments aren't built on namedropping dead, irrelevant white people and your own insecurities.

 

[DaWeasel]

This doesn't appear to be the case in the real world. The US spends much more per capita on health care than any other comparable Western nation and we're behind on number of people covered, infant mortality from 1-12 months, life expectancy for cystic fibrosis (~40 yrs in US, ~50 in Canada) and many other metrics you could care to look at.

I guess if all the uninsured (and people with PEC) died then those numbers would look more favorable

Yes, except those statistics might not be worth taking at face value. My source for this is "In Excellent Health" by Scott Atlas. The tl;dr is that the United States has significantly better health outcomes than any other country.

 

[deleted407021]

Yes, except those statistics might not be worth taking at face value. My source for this is "In Excellent Health" by Scott Atlas. The tl;dr is that the United States has significantly better health outcomes than any other country.

If you only look at white people ... or what? Some detail on this would be appreciated.

 

[LizzyM]

Oh, an ad hominem to follow up your appeal to authority?

What is a logical fallacy? That's a rhetorical question for you.

Real arguments aren't built on namedropping dead, irrelevant white people and your own insecurities.

It's no appeal to authority; only to say that I am not alone in the opinion that we have an obligation as a society to care for the most vulnerable, those who are incapable of helping themselves. I am deeply ashamed that my generation has failed yours in the teaching of American history broadly defined.

I hope I meet you on the interview trail... it would be fun to have a chat.

 

[vrazzles]

Yes, except those statistics might not be worth taking at face value. My source for this is "In Excellent Health" by Scott Atlas. The tl;dr is that the United States has significantly better health outcomes than any other country.

What do you mean by "significantly better health outcomes"?

The US spends quite a bit more on direct health care (per capita) than does the runner up on that list (Norway). However, virtually every health care metric on the list below is in the favor of Norway. This trend repeats for many European countries.

Norway vs United States: Health Facts and Stats