Interesting review of Sicko

[Dr JPH]

That's JayneCobb D.O, I'm not some pre-med ***** who has no clue. and I'm not sure why half of this rant was seemingly directed at me.

It wasnt directed at you. Go back and read again.

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[CatsandCradles]

Average annual income of all physicians in the US, compared to countries with a socialized medical system:

1996 Data:

Germany: $105,000

UK: $53,000

105K sounds little high. I have relatives living in Germany. German physicians do not make a US equivalent of $105,000 - I was told that the number was around $57,000 US.

Many physicians work only 35 hours a week - causing there to be huge waiting list -so other physicians seeing the huge wait list work well over 80 hours because they don't want to see patients waiting for critical procedures - yet these physicians still only make the same $57,000.

There was a huge national strike several years ago, but my relatives didn't participate cause they were afraid of public scrutiny.



In the UK physicians make around 100,000. That's UK £ not US $. I think this coverts into a little under 200,000 US dollars for the UK family practioner. That's quite a bit more than what a lot of US FPs make.

See here:
http://news.bbc.co.uk/2/hi/health/4373519.stm


Pretty huge disparity between the German system and the UK system.

 

[CatsandCradles]

As for doctors making less income in those countries, (mentioned much earlier in the thread) I wonder how much student loan debt they have? I would trade my student loan debt, out of pocket insurance expenses and child care expenses for a good socialized medical system any day.

I can't say about Canada or UK.

But in Germany, school education is paid for - but the physician salaries are just really really low. But I guess that's what socialism entails.

 

[eon462]

Average annual income of all physicians in the US, compared to countries with a socialized medical system:

1996 Data:

United States: $199,000
Germany: $105,000
Canada: $101,000
Japan: $63,000
France: $62,000
Denmark: $59,000
Australia: $55,000
UK: $53,000
Sweden: $41,000

source?

 

[Dr JPH]

source?

Google

 

[Kappy1]

Kappy1,
I think that what you're proposing is what is in place in most socialized/universal healthcare models: basic coverage for all while those that can afford superior service can opt for private insurance. Kind of like basic education for all while those that can afford superior schooling can opt for private education.
Obviously, the devil is in the details but we can continue to make progress by having a public dialogue that starts by affirming that the goal is for every American to have accessible and adequate healthcare. If we have this goal and the will to achieve it then we will find a way.
Namaste.

I may be wrong but I thought in a socialized system everyone is covered for all care including specialties? My suggestion was a hybrid. Where some level of care is covered while another level of care isn't covered and would require an HMO or private insurance. What the levels are is up for debate.

Just my opinion don't have to jump down my throat. In the US, I think the problem lies with the lower middle class. People who make too much and are not able to be part of medicaid and don't make enough to be able to afford private insurance. This is the group I think that needs to be targeted. All other groups in our society are basically covered by medicare, medicaid or, private insurance.

 

[JonnyG]

Google

There you go again JP, confusing the masses with your FACTS. now why do you have to be so underhanded.

 

[eon462]

Google

you can't post your source? I tried to google it but I guess I didn't search for the right thing.

 

[JayneCobb]

you can't post your source? I tried to google it but I guess I didn't search for the right thing.

2000 OECD Health Data.

 

[Xoynx]

Okay, my turn. Please bear in mind when reading my following ideas that I won't start med school for another three weeks, so I'm pretty much talking out of my butt. These are just some ideas that I'd like to hear physicians and physicians-to-be comment on.

1. Health Insurance: I suspect that health insurance inflates the cost of health care. What if all health insurance were to be banned? What effect would that have on costs? If only a small fraction of the general population could afford access to the Machine That Goes Ping, fewer hospitals would buy them, which would consequently force the manufacturer to cut its price.
   
2. Malpractice: Let's get rid of malpractice insurance too. Until every other profession is vulnerable to such suits, I don't see why ours should be so targeted. But sorry, guys--our salaries would have to be cut accordingly, passing along the savings to consumers (patients).
   
3. Big Pharm: Overhaul intellectual-property laws, allowing pharm companies exclusive rights to a drug they've patented for X years, then royalties to be paid to the pharm by competitors who copy the drug. Such royalties would be structured so that the percentage would gradually dwindle to zero over time.

I'll spare you the keystrokes and freely admit that, like all other ideas for significant healthcare reform, mine haven't a chance of ever being implemented.

 

[eon462]

2000 OECD Health Data.

He said "1996 data" in his post.

 

[JayneCobb]

He said "1996 data" in his post.

The numbers may be 1996 numbers, but the report was put out in 2000. Shockingly, the 2006 report uses 2000 data. Happy hunting.

 

[JayneCobb]

Health Insurance: I suspect that health insurance inflates the cost of health care. What if all health insurance were to be banned? What effect would that have on costs? If only a small fraction of the general population could afford access to the Machine That Goes Ping, fewer hospitals would buy them, which would consequently force the manufacturer to cut its price.

You can only lower a price so much, and if you remove the incentive to advance technology (i.e. being payed and making money) you remove all incentive to advance technology. Necessity may be the mother of invention, but money is what necessity breast feeds invention to allow it to thrive.

Malpractice: Let's get rid of malpractice insurance too. Until every other profession is vulnerable to such suits, I don't see why ours should be so targeted.

You're wrong on this point. Pretty well every profession has malpractice/liability insurance of some sort. Our problem with malpractice insurance is that (a) any ***** can sue us for any reason (b) any lawsuit, no matter how frivolous will cause an increase in our malpractice insurance and (c) there is a major incentive for lawyers to pursue these cases as they make a percentage of the rewards and suffer no consequences for continued filing of frivolous law suits.

IMHO, if you wish to decrease this area, force lawyers to work on an hourly basis to remove the element of greed from their end. Allow physicians to sue people who cost us money with these frivolous suits, and then mandate that a "trial by my peers" actually includes a few of my peers on the jury.

But sorry, guys--our salaries would have to be cut accordingly, passing along the savings to consumers (patients)

You say this now as a pre-med, but once you've finished your 4 years, are $200k in debt, and will be making $40k for the next 3-5 years and then have a bunch of hillbilly drunks threatening to sue you every damn day if you do not do exactly what they want, when they want when you're trying to help them, you might feel differently. It may not be about the money, but at some point, this job isn't worth the pile of flaming crap we put up with on a daily basis.

Big Pharm: Overhaul intellectual-property laws, allowing pharm companies exclusive rights to a drug they've patented for X years, then royalties to be paid to the pharm by competitors who copy the drug. Such royalties would be structured so that the percentage would gradually dwindle to zero over time.

The only problem here is the number of years they maintain the property rights would continually need to be expanded with the FDA's continued expansion on requirements to approve a drug. The countdown to generics should not start until the day the drug has been approved, not from the date of the patent.

 

[Dr JPH]

you can't post your source? I tried to google it but I guess I didn't search for the right thing.

I dont know the source. Dont you think its a bit unrealistic to expect me to remember the website of something that I searched more than 2 weeks ago?

Try a search for yourself. The data is available, you just need to find it.

Ive been a little busy the last few weeks.

 

[Ilikescience]

I'm not sure if anyone has mentioned this, but in many countries with socialized medicine, like Europe, education is free. Although, it doesn't account for the discrepancies between physician salaries of the US and Europe at least European doctors don't come out of medical school over $150,000 in dept. For Americans socialized medicine would make this substantial debt almost impossible to pay off with ~$70,000 per year, if one wants to own a house, car, bills, and save for retirement. Can't count on social security, it is long gone for our generation.

 

[eon462]

I dont know the source. Dont you think its a bit unrealistic to expect me to remember the website of something that I searched more than 2 weeks ago?

Try a search for yourself. The data is available, you just need to find it.

Ive been a little busy the last few weeks.

No I didn't expect you to memorize the URL. I thought maybe you had saved it or knew what you searched for to get it, and could find it again quickly. Guess not.

 

[Ilikescience]

I can't say about Canada or UK.

But in Germany, school education is paid for - but the physician salaries are just really really low. But I guess that's what socialism entails.

Yep

 

[Sartre79]

Anyone have any opinions about the Swiss sytem, where everyone is forced to buy private insurance. It seems to be a shining star in the European from what I have read.

 

[Noeljan]

I'm not sure if anyone has mentioned this, but in many countries with socialized medicine, like Europe, education is free. Although, it doesn't account for the discrepancies between physician salaries of the US and Europe at least European doctors don't come out of medical school over $150,000 in dept. For Americans socialized medicine would make this substantial debt almost impossible to pay off with ~$70,000 per year, if one wants to own a house, car, bills, and save for retirement. Can't count on social security, it is long gone for our generation.

I may be way off base with this one, but I can only speak from my experiences (from an ex boyfriend who was from europe, received his medical education in europe, and worked their first) but don't doctors in many of these countries work a lot less hours?? So comparing the salaries can't be a really good source of comparison. I remember he would always talk about people claiming how much doctors worked in america. He said he didn't know if he should believe it or not. When he came here he found it to be very very true, and very overwhleming and surprising.

 

[Noeljan]

another thing he would talk about, was the attitude towards physicians in general. He would say that doctors got more respect back home, didn't have to worry about being sued so much, and didn't get put down by patients so much. I don't know if he was exaggerating or not, but he was the one who worked in both places.

 

[It'sElectric]

I've read through this entire thread (God only knows why), and I must say thank God for people like JP. They're called realists, and I'm personally counting on them to save our country from a number of vocal idealists who are often entirely irrational.

I won't get into every little issue that has already been mentioned, because JP and others have handled them quite well. All I want to add is why is it my responsibility to pay for someone else's healthcare???? Why should I pay taxes so that others (many undeserving) can have "free" healthcare???

Yes, I know that there are a number of dead beats out there now who walk into an ED, get some cold medicine, and pass the $500 bill onto the responsible taxpayers. Obviously our healthcare system needs some sort of reform, but if you think socialized medicine is the answer, I'm truly frightened. So once again, thank God for people like JP who have enough sense to realize how misguided socialized medicine is.

 

[Sartre79]

I won't get into every little issue that has already been mentioned, because JP and others have handled them quite well. All I want to add is why is it my responsibility to pay for someone else's healthcare???? Why should I pay taxes so that others (many undeserving) can have "free" healthcare??? quote]


Same thing could be said for our public education system. Once again, I do NOT advocate socialized healthcare because there are those who will abuse the system as is evident in may socialized systems. In fact, most health economist start with the premise that healthcare is finite. But there are abuses on both side of the aisle...corporate healthcare's hands are by no means clean, so I cannot wholeheartly advocate for a purely capitalist system. I guess my bleeding heart just goes out to those middle class families, etc who do the right things (don't smoke, etc) but still struggle b/c of healthcare cost, etc.

 

[It'sElectric]

I won't get into every little issue that has already been mentioned, because JP and others have handled them quite well. All I want to add is why is it my responsibility to pay for someone else's healthcare???? Why should I pay taxes so that others (many undeserving) can have "free" healthcare??? quote]


Same thing could be said for our public education system. Once again, I do NOT advocate socialized healthcare because there are those who will abuse the system as is evident in may socialized systems. In fact, most health economist start with the premise that healthcare is finite. But there are abuses on both side of the aisle...corporate healthcare's hands are by no means clean, so I cannot wholeheartly advocate for a purely capitalist system. I guess my bleeding heart just goes out to those middle class families, etc who do the right things (don't smoke, etc) but still struggle b/c of healthcare cost, etc.

Just to clarify, I was in no way calling you out, Sartre.

I don't pay taxes for every kid's education. The same people that would lead you to believe that health care is a right are the same people that want everyone's taxes to pay for every student's education. Thus, if you live and work in suburban Chicago and pay really high taxes, your money should also fund the educations of "poorer" communities where their residents pay next to nothing in taxes for their own kids' educations. That's socialism, and I don't want that BS. It's one thing to be charitable, kind, compassionate, giving, etc. It's a whole other thing to live under a government that mandates you provide for people you have no connection with. Many of these people will bleed the country to death, since they have no personal investment (thanks to your "mandatory charity").

 

[Dr JPH]

and I must say thank God for people like JP.

I hear this quite often but it never gets old.

 

[Sartre79]

Just to clarify, I was in no way calling you out, Sartre.

I don't pay taxes for every kid's education. The same people that would lead you to believe that health care is a right are the same people that want everyone's taxes to pay for every student's education. Thus, if you live and work in suburban Chicago and pay really high taxes, your money should also fund the educations of "poorer" communities where their residents pay next to nothing in taxes for their own kids' educations. That's socialism, and I don't want that BS. It's one thing to be charitable, kind, compassionate, giving, etc. It's a whole other thing to live under a government that mandates you provide for people you have no connection with. Many of these people will bleed the country to death, since they have no personal investment (thanks to your "mandatory charity").

I'm confused by your argument (honestly). We all pay state and federal incometax (state depending on location), as well as property/auto taxes and then the gov't doles out the money from the yearly budget. Every kid can go to any public school if they want. Even those parents who send their child to a private school are still paying taxes that go to public schools. Sales tax, etc. is different, but still goes more toward infrastructure which is why you pay more in urban areas. I think I lost something in translation....could you clarify???

 

[sawoobley]

(This is a rant off the top of my head. Take it with a grain of salt.)

Here is the way I look at it.

With capitalism people choose who they go to and pay for it. We have gotten away from this somewhat so we get plans from HMOs/PPOs and they keep our prices down but limit our choices.

If we go to socialized medicine then we hire loads of people to make our choices for us. I mean levels and levels of oversight and regulations and paperwork. Anything has to be better than this. I always here people say look what they are doing in Canada, we should be like them? My one friend lives in Canada and she loves it. We should be like them. Well, I am looking and I can't see Canada or any other country from here. Show me the data from an unbiased source. The truth is that we live in the most successful country in the world. Why do we always look to the example of lesser countries to see how we should act? We did not get to be the greatest country with the most opportunities for our citizens by acting like Canadians. We can find a better way than socialized medicine as it exists in Canada or any other country.

Everybody deserves health care, everybody deserves food and water, everybody deserves housing, everybody deserves a car, everybody deserves clothes, everybody deserves to have a TV and DVD player, everyone deserves to have a family if they want, everyone deserved to be happy...Where does it end...

It seems like we have a broken system because not enough people are paying into the system. When doctors and/or hospitals don't get their money they find other ways like sticking it to insurance companies. The worst of all the people who sue at the drop of a hat and the lawyers that support them.

Well, time for bed...

 

[novado]

I see abuse of the system down here all the time. I once used to believe in a socialized health care system, until I lived down here. If you do not make enough of an income, the county landowner's pay a large tax in order to help these patients out with health expenses through the county hospital system. Patients often do not show up for their appointments and are non compliant even though they often get their medications for free through these programs. They complain about cheap $5 to $20 co-pays, then go out and do their illegal drugs and smoke their cigarettes. Canada is not perfect. I have had several patients come from Canada with cancer with mets. Canada refused to treat them any further other than palliative care. One mother in her 30's just had a baby and found that her GERD and weight loss after the baby was not all post-pregancy. She had gastric carcinoma with mets to her lungs and liver. Canada stopped paying for her care, other than for pain meds. She wants to see her child grow up to at least 2 years old. She came to Florida for further care so that she can live longer. There are multiple cases like that. Needless to say, I see socialized medicine as the VA here in the US. Go work at the VA, and you will see the lines are so long to see certain specialists. It is inefficient often and patients are scheduled without being called or asked their preference. They get a letter in the mail a few days before they are supposed to come in saying they were scheduled. We waste are time with no-shows, because patients get no notice. The VA often does not approve of many drugs that are necessary. Their standard of care is much different than what other organizations recommend. I was appalled to find out that they accept a Hba1c of 9.0% as their standard. If you want approval for other meds than metformin or glyburide, you often cannot get them approved if their Hba1c is less than 9.0%. I will not even go into their cholesterol guidelines. Socialized medicine is not the answer to everything. Has anyone thought about the fact that in other countries they do not have to pay as much for their medical education. Many countries have free medical schools. I have essentially 2 mortgages of debt right now: my house, and my medical education. I know Michael Moore references Cuba. Well, Cuba often does not follow patent laws. They just manufacture meds with no quality standards and copy drugs with patents with no regard to how much it cost to research and make that drug.

 

[white_n_nerdy]

I keep hearing how Michael Moore proclaimed Cuba’s socialized medical system is better than the U.S. system. It seems to have been lost on some that Cuba is a dictatorship. The citizens are not free, the government decides their fates. No thanks.

 

[It'sElectric]

I'm confused by your argument (honestly). We all pay state and federal incometax (state depending on location), as well as property/auto taxes and then the gov't doles out the money from the yearly budget. Every kid can go to any public school if they want. Even those parents who send their child to a private school are still paying taxes that go to public schools. Sales tax, etc. is different, but still goes more toward infrastructure which is why you pay more in urban areas. I think I lost something in translation....could you clarify???

I apologize for the confusion, but you need to break it down further. If you do a cursory search, you'll see that 35-45% of public school budgets are derived from local taxes, which is one of the major reasons that we have a so-called education disparity in the U.S. I for one do not want my local taxes to pay for anyone else's education, other than the school district that I live in (the same one my future kids will attend).

Hopefully this clarifies what I was arguing previously.

 

[group_theory]

There is an interesting article in the WallStreet Journal.

http://online.wsj.com/article/SB118480165648770935.html?mod=todays_us_page_one

On a recent day, 22 out of the 37 patients were on Medicaid, and another 12 had Medicare or other government-sponsored insurance. Only three had commercial health coverage. Dr. Tynes tries to make ends meet with a bare-bones staff. He has also cultivated a loyal patient base by offering specialty services such as sexual-dysfunction treatment and marriage counseling. Depending on how good business is, he tries to pay himself an after-tax salary of $500 to $750 a week to support his family of five children.

But three times so far this year, he's forgone his biweekly paycheck to keep the practice out of the red. Last year, he cut his office staff from seven to four people. "We [primary-care physicians] are the ones keeping this Medicaid system together, but we're the ones getting killed," he says.
​

​

 

[Chulito]

There is an interesting article in the WallStreet Journal.

Most of the article is only available to subscribers. Would you mind cutting and pasting the whole thing here?

Here's one line that was accessible.

To get to the bottom of her symptoms, Jada needed to see a rheumatologist. But the local one listed in her Medicaid plan's network wouldn't see her in his office. The wait to get into a clinic was more than three months. ...

I thought that there weren't any waits here in the States.

 

[Dr JPH]

I thought that there weren't any waits here in the States.

You will wait months in Philly to see a Rheumatologist.

If you want to see a Urologist for a non-emergent issue...good luck.

But thats how things work. Supply & demand. Its all business.

 

[group_theory]

Most of the article is only available to subscribers. Would you mind cutting and pasting the whole thing here?

Doing so would violate copyright rules. However, I can give you snippits under the fair use doctrine (and if you are really interested OR think i'm biased in my selection, you can either access it through your school's electronic library resources, your local public library, or just buy a copy at a newstand. (don't blame me, i didn't write the copyright rules and WSJ have lots of lawyers - and even this is pushing the limit of fair use)

I'm gonna select text from the article that will try to explain the reason behind the long wait for medicaid patients. The rest of the text mainly talks about personal plights of patients trying to finding specialists, some comments by State-sponsored private plans (patients on HMO paid for by the state medicaid), and a history on how it got this bad in the particular area of Michigan (Benton Harbor).


Note to Medicaid Patients:
The Doctor Won't See You
As Program Cuts Fees,
MDs Drop Out; Hurdle
For Expansion of Care
By VANESSA FUHRMANS
July 19, 2007; Page A1
The Wall Street Journal

In a 2006 report from the Center for Studying Health System Change, a nonprofit research group based in Washington, nearly half of all doctors polled said they had stopped accepting or limited the number of new Medicaid patients.

That's because many Medicaid programs, straining under surging costs, are balancing their budgets by freezing or reducing payments to doctors. That in turn is driving many doctors, particularly specialists, out of the program.

...

In Michigan, the number of doctors who will see Medicaid patients has fallen from 88% in 1999 to 64% in 2005. Many of those doctors tightly cap how many they'll see or refuse to take on new Medicaid patients. At the same time, enrollment in the program in Michigan has risen more than 50% to nearly 1.6 million since 1999.

...

"At this point, I have to pay money out of my own pocket to take care of that [Medicaid] patient, and it's only going to get worse," says AppaRao Mukkamala, president of the Michigan State Medical Society and a radiologist in Flint, Mich.
...
For every chest X-ray Dr. Mukkamala performs, for instance, Medicaid pays him $20. Commercial insurers such as Blue Cross pay about $33 and Medicare pays $30. But with technicians, film and other equipment, his costs are about $29 per X-ray, he estimates. Medicaid patients he sees at Hurley Medical Center in Flint make up 28% of his work there.

...

When he started his practice in the early 1990s, Dr. Ward says he placed no limits and Medicaid patients flocked to his practice. Medicaid patients soon ballooned to 35% of his roster.
"It was a rookie mistake," says Dr. Ward, one of only two full-time neurologists in the tri-county area.
Commercial health plans such as Blue Cross pay him between $72 and $85 for a typical neurological exam. He receives about $31 from the Medicaid plans. Now, 12% of his patients are on Medicaid.

...

In Benton Harbor, more than 300 patients lost access to counseling services after the main provider of Medicaid mental-health services, Riverwood Center, stopped accepting payments from Medicaid HMOs. Riverwood says the reimbursements it was receiving from the Medicaid HMOs for outpatient sessions didn't cover their costs.
Payment delays and other administrative hassles compounded the crunch, says Riverwood's president, Allen Edlefson. The center lost $350,000 in 2003, the year before it decided to quit its Medicaid HMO contracts. "It was a painful decision, but we just couldn't make it work financially," he says.

 

[Renwick6]

How about providing everyone with a high deductible healthplan ($3000-$5000) and only providing 100% payment for people with legitimate chronic conditions and disability? It would discourage people from coming to the ER if they have a cold but still provide care for people with cancer, organ failure, etc.

 

[group_theory]

How about providing everyone with a high deductible healthplan ($3000-$5000) and only providing 100% payment for people with legitimate chronic conditions and disability? It would discourage people from coming to the ER if they have a cold but still provide care for people with cancer, organ failure, etc.

It's a good start but that option is available already ... there are HMO/PPO with high deductible.

It will not cover low-income (and even some portion of middle-income) segments of the population because the high deductible is out-of-reach for them. There are a lot of people that are living paycheck by paycheck.

Another issue is those with health problems. If you have cancer, or a chronic disease ... a $3k-$5k deductible is a good bargin ... but in the big picture who will pay for the cost of treatment and healthcare. The basic premise of insurance is to pass the cost around. So if you have a disease that will cost around $5k/month to treat, you need a lot of other healthy people who are paying premiums and are not getting any healthcare services to help with the cost of your care. In the auto insurance industry, this works because auto insurance is mandated by law and also the ratio of people needing to use their insurance versus people who have it, are paying for it, but not using it - is favorable.

In healthcare, insurance isn't mandatory (and recent efforts to make it mandatory in some states have been decried as taking away freedom of choice). Also, everyone will eventually need healthcare. Also the cost is more staggering. You total a car and the damage may be $10-$30k (for simplicity, will ignore medical benefits that comes with auto insurance). A 89 year old male with cancer that has spread throughout his body, in the ICU, with pressors, vents, etc. will cost the plan 6-7 figures in cost. You will need a lot of healthy paying members to cover that cost.

Which brings me to point #3 - wanna guess which segment takes up 33-50% (depending on which report) of those uninsured? It's healthy people in their 20s and early 30s (and working but don't get healthcare benefits from their employer). In this segment of the population, they have relatively few healthcare issues, and don't really think long term (very few save for retirement let alone save money in their bank account). If they decide to get individual plans ... their monthly premiums will probably far greater than what services they get out of it (and the rest goes to subsidize the cost of the elderly).

Healthcare isn't free - the money has to come from somewhere. Any proposal for universal coverage must have a way to fund it. It is also a good idea to look at any consequences of any changes.

In other countries, the revenue comes from income taxes, high luxary tax, and probably sales tax. They restrict expenditure by limiting payout (what insurance/medicaid/medicare does) AND also on a government level set guidelines to restrict utilization of certain costly resources (MRI, dialysis, non-emergent CT scans, elective surgery), etc. But healthcare cost is rising in these countries and the government doesn't want to raise taxes any higher - so there are talks about further restrictions - denying services to people with unhealthy lifestyle, etc.

 

[Dr JPH]

How about providing everyone with a high deductible healthplan ($3000-$5000) and only providing 100% payment for people with legitimate chronic conditions and disability? It would discourage people from coming to the ER if they have a cold but still provide care for people with cancer, organ failure, etc.

So now youre asking patients to diagnose themselves prior to seeking medical treatment. For fear of their visit not being covered they dont seek a professional opinion until its too late to render appropriate treatment.

That "flu like syndrome" or "indigestion" could be something as serious as leukemia or an MI.

Now you have serious conditions going undiagnosed, except by the county Medical Examiner.

Talk about feed for another Michael Moore film.

Just the other day we admitted a gentleman who was diagnosed with AML...his only symptoms (and reason for coming to the ER) was fatigue.

Everyone who works in medicine has story about the patient who was having an MI whose only complain was dizziness, abdominal pain or headache.

We need to put the resources in a cheaper, more streamlined place. Having patient suck up an ER bed just doesnt make sense. Nor does having these people make appointments with their PCP. The cost doesnt equate. A PCP who keeps their doors open an extra half hour to see the mother with their sick child loses money...whereas the ER is already open and not incurring and additional cost.

BUT with the latter the cost is placed on the taxpayers.

I dont think there is an easy answer to this.

The patients dont want to pay for their healthcare. I sure as hell dont want to pay for them to have $500 worth of ER bills for a poison ivy rash...but thats what is happening...I AM paying that.

We need more government sponsored free clinics. Once they are in place THEN you can start billing patients who abuse the system. Once their is a cheaper alternative then you can use the threat of high medical bills to divert these people to the appropriate place.

We need cheap clinics that are open and staffed with liberal hours. We need resources that would allow these clinics to make a reasonably accurate diagnosis and then transfer patients with a need for higher level of care to the ER. Almost like a distant triage center.

Will it work? Probably not. There is already a similar system with these "mini clinics" popping up in some pharmacies around the country.

But at least its an idea. And it a whole lot more feasible than universal healthcare.

With the number of people going into medicine for the money and lifestyle (which still does exist, dont listen to people who tell you otherwise) youre going to get a lesser quality physician. Youre going to get people entering medicine for the altruistic reasons only...which is fine, but let be honest about who makes up the majority of medical school classes. Sure, medicine has a higher purpose, but if you told me that I needed to spend 15 years in training to make $75,000 I would laugh at you and be off to law school in a heartbeat.

Physicians work too hard for too long and for too much grief to not be well compensated. It would be a crime to pay physicians less than we currently make for the work we do. I know how hard I work now...and it comes to about $11/hour. The time I put in and the crap I have to deal with is insane. True, Im still a resident...but many attendings work just as hard and have to deal with the daily threats of being sued...and the patients who tell them that right to their face. I heard a patient the other day say "I dont come after money, I come after medical licenses"

I work twice the hours for half the salary of the nurses in the hospital. The same nurses who question my orders and wake me up in the middle of the night because a patient wants tylenol.

Socialized medicine isnt the answer. Government sponsored low cost healthcare clinics is the best first start we have.

You have an entire gaggle of midlevel practitioners who want to play doctor. Here is their chance to make a difference and help ease the burden of almost every ER in the country.

 

[Renwick6]

It's a good start but that option is available already ... there are HMO/PPO with high deductible.

It will not cover low-income (and even some portion of middle-income) segments of the population because the high deductible is out-of-reach for them. There are a lot of people that are living paycheck by paycheck.

Another issue is those with health problems. If you have cancer, or a chronic disease ... a $3k-$5k deductible is a good bargin ... but in the big picture who will pay for the cost of treatment and healthcare. The basic premise of insurance is to pass the cost around. So if you have a disease that will cost around $5k/month to treat, you need a lot of other healthy people who are paying premiums and are not getting any healthcare services to help with the cost of your care. In the auto insurance industry, this works because auto insurance is mandated by law and also the ratio of people needing to use their insurance versus people who have it, are paying for it, but not using it - is favorable.

In healthcare, insurance isn't mandatory (and recent efforts to make it mandatory in some states have been decried as taking away freedom of choice). Also, everyone will eventually need healthcare. Also the cost is more staggering. You total a car and the damage may be $10-$30k (for simplicity, will ignore medical benefits that comes with auto insurance). A 89 year old male with cancer that has spread throughout his body, in the ICU, with pressors, vents, etc. will cost the plan 6-7 figures in cost. You will need a lot of healthy paying members to cover that cost.

Which brings me to point #3 - wanna guess which segment takes up 33-50% (depending on which report) of those uninsured? It's healthy people in their 20s and early 30s (and working but don't get healthcare benefits from their employer). In this segment of the population, they have relatively few healthcare issues, and don't really think long term (very few save for retirement let alone save money in their bank account). If they decide to get individual plans ... their monthly premiums will probably far greater than what services they get out of it (and the rest goes to subsidize the cost of the elderly).

Healthcare isn't free - the money has to come from somewhere. Any proposal for universal coverage must have a way to fund it. It is also a good idea to look at any consequences of any changes.

In other countries, the revenue comes from income taxes, high luxary tax, and probably sales tax. They restrict expenditure by limiting payout (what insurance/medicaid/medicare does) AND also on a government level set guidelines to restrict utilization of certain costly resources (MRI, dialysis, non-emergent CT scans, elective surgery), etc. But healthcare cost is rising in these countries and the government doesn't want to raise taxes any higher - so there are talks about further restrictions - denying services to people with unhealthy lifestyle, etc.

Maybe I should have been more specific, as far as people who are poor and have a chronic health problems or major emergencies are concerned they should have their medical care paid for by the state. Poor people without those problems should get a job with private insurance if they want to go to the doctor when they have a cold, otherwise they should not go to the doctor because they are not sick.

I think it should be run by the government because even if somone wants to have insurance the insurance company can still deny you coverage (I know I have been denied coverage). Insurance companies will still deny payment everytime they can and cannot be trusted. People that don't want health coverage, like the people you mentioned, should still be forced to have it because,like you said, the money has to come from somewhere. Basically what I want is socialized medicine with a deductible to keep people who aren't sick away from wasting time at hospitals. Then provide fully covered care to those who really are very sick.

We could also get more money for healthcare by cutting out other useless government spending programs (like useless bridges to nowhere: http://www.heritage.org/Press/Commentary/ed011206a.cfm ).I'd suggest more specific things but that would probably drive the post off topic. If we did that taxes wouldn't increase.

Also, your mentioning of an 89 year old cancer patient makes me wonder why will our current system pay for 16 year old teenage parents that don't want to get a job and 89 year old people that are going to die anyway and aren't contributing to the economy while they let people that are of working age die without healthcare. I think we should offer more benefits to people that can contribute to society than those who don't.I think a 30 year old with cancer deserves more care than an 89 year old with cancer but the U.S. system does the opposite. Heck, if I were 89 and sick I'd rather spend my last days with my family doing meaningful things than trying to squeeze out an extra year on chemo and radiation surrounded by doctors. I'm not sure how to solve that problem. The solution I posed wouldn't solve it but at least it would help people who are of working age just as much as those that are old.

 

[Renwick6]

So now youre asking patients to diagnose themselves prior to seeking medical treatment. For fear of their visit not being covered they dont seek a professional opinion until its too late to render appropriate treatment.

That "flu like syndrome" or "indigestion" could be something as serious as leukemia or an MI.

Now you have serious conditions going undiagnosed, except by the county Medical Examiner.

Talk about feed for another Michael Moore film.

Just the other day we admitted a gentleman who was diagnosed with AML...his only symptoms (and reason for coming to the ER) was fatigue.

Everyone who works in medicine has story about the patient who was having an MI whose only complain was dizziness, abdominal pain or headache.

We need to put the resources in a cheaper, more streamlined place. Having patient suck up an ER bed just doesnt make sense. Nor does having these people make appointments with their PCP. The cost doesnt equate. A PCP who keeps their doors open an extra half hour to see the mother with their sick child loses money...whereas the ER is already open and not incurring and additional cost.

BUT with the latter the cost is placed on the taxpayers.

I dont think there is an easy answer to this.

The patients dont want to pay for their healthcare. I sure as hell dont want to pay for them to have $500 worth of ER bills for a poison ivy rash...but thats what is happening...I AM paying that.

We need more government sponsored free clinics. Once they are in place THEN you can start billing patients who abuse the system. Once their is a cheaper alternative then you can use the threat of high medical bills to divert these people to the appropriate place.

We need cheap clinics that are open and staffed with liberal hours. We need resources that would allow these clinics to make a reasonably accurate diagnosis and then transfer patients with a need for higher level of care to the ER. Almost like a distant triage center.

Will it work? Probably not. There is already a similar system with these "mini clinics" popping up in some pharmacies around the country.

But at least its an idea. And it a whole lot more feasible than universal healthcare.

With the number of people going into medicine for the money and lifestyle (which still does exist, dont listen to people who tell you otherwise) youre going to get a lesser quality physician. Youre going to get people entering medicine for the altruistic reasons only...which is fine, but let be honest about who makes up the majority of medical school classes. Sure, medicine has a higher purpose, but if you told me that I needed to spend 15 years in training to make $75,000 I would laugh at you and be off to law school in a heartbeat.

Physicians work too hard for too long and for too much grief to not be well compensated. It would be a crime to pay physicians less than we currently make for the work we do. I know how hard I work now...and it comes to about $11/hour. The time I put in and the crap I have to deal with is insane. True, Im still a resident...but many attendings work just as hard and have to deal with the daily threats of being sued...and the patients who tell them that right to their face. I heard a patient the other day say "I dont come after money, I come after medical licenses"

I work twice the hours for half the salary of the nurses in the hospital. The same nurses who question my orders and wake me up in the middle of the night because a patient wants tylenol.

Socialized medicine isnt the answer. Government sponsored low cost healthcare clinics is the best first start we have.

You have an entire gaggle of midlevel practitioners who want to play doctor. Here is their chance to make a difference and help ease the burden of almost every ER in the country.

Well argued. I guess that destroys my argument. Thanks for the insight.

 

[Dr JPH]

Also, your mentioning of an 89 year old cancer patient makes me wonder why will our current system pay for 16 year old teenage parents that don't want to get a job and 89 year old people that are going to die anyway and aren't contributing to the economy while they let people that are of working age die without healthcare. I think we should offer more benefits to people that can contribute to society than those who don't.I think a 30 year old with cancer deserves more care than an 89 year old with cancer but the U.S. system does the opposite. Heck, if I were 89 and sick I'd rather spend my last days with my family doing meaningful things than trying to squeeze out an extra year on chemo and radiation surrounded by doctors. I'm not sure how to solve that problem. The solution I posed wouldn't solve it but at least it would help people who are of working age just as much as those that are old.

Youre making too many assumptions here to be taken seriously.

I understand what youre getting at and what youre trying to say...I just think you said it the wrong way.

Another way of phrasing this could have been:

"A person who is currently paying into the healthcare system, or one who has paid into the system for many years, should be entitled to a higher level of care (more resources, more time spent) than those who do not pay into the system."

This, of course, comes with all sorts of moral and ethical issues.

Similar to the poster above who blatantly said "a rich woman doesnt deserve breast implants any more than a poor woman."

To which I say: "wrong."

Boutique and specialty medicine, like cosmetic procedures are just that...special things that are available to people who can afford them.

Every american deserves the right to emergency healthcare to stabilize their acute medical needs. But we need to be more careful with the resources beyond that.

Im not saying children with leukemia or poor people who have a heart attack shouldnt be cared for. But we need a cost to benefit rationale with some patients.

Does the 85 year old near comatose nursing home patient need a $5,000 workup? I see it every day.

Should the 18 year old woman with 2 kids be able to come to the ER on a regular basis to get free treatment for things like insect bites and stuffy nose? That happens all the time too.

What about the 25 year old drug seeking patient? The same patient who threatens to sue...and shoot up the ER...if they arent given their pain meds and a box of needles.

Unfortunately medicine is an area where you need to make medical decisions and you cannot let morality factor in to what you do. We dont want doctors making moral and ethical decisions that may affect medical judgement.

BUT we have a government that seems perfectly fine with making these moral judgements when it comes to people in other countries...yet they coddle and cultivate a homegrown society where even the lowest of the low...the people who abuse and wreak havoc on our medical system feel they DESERVE top notch free healthcare...and also reserve the right to sue if they feel they didnt get what they should have. All while maintaining less than a high school education and no job. Bravo Big Brother...bravo.

 

[Renwick6]

Youre making too many assumptions here to be taken seriously.

I understand what youre getting at and what youre trying to say...I just think you said it the wrong way.

Another way of phrasing this could have been:

"A person who is currently paying into the healthcare system, or one who has paid into the system for many years, should be entitled to a higher level of care (more resources, more time spent) than those who do not pay into the system."
.

Yes,I stated that poorly. I think you summed it up well

This, of course, comes with all sorts of moral and ethical issues.

Similar to the poster above who blatantly said "a rich woman doesnt deserve breast implants any more than a poor woman."

To which I say: "wrong."

Boutique and specialty medicine, like cosmetic procedures are just that...special things that are available to people who can afford them.

Every american deserves the right to emergency healthcare to stabilize their acute medical needs. But we need to be more careful with the resources beyond that.

Im not saying children with leukemia or poor people who have a heart attack shouldnt be cared for. But we need a cost to benefit rationale with some patients.

Does the 85 year old near comatose nursing home patient need a $5,000 workup? I see it every day.

Should the 18 year old woman with 2 kids be able to come to the ER on a regular basis to get free treatment for things like insect bites and stuffy nose? That happens all the time too.

What about the 25 year old drug seeking patient? The same patient who threatens to sue...and shoot up the ER...if they arent given their pain meds and a box of needles.

Unfortunately medicine is an area where you need to make medical decisions and you cannot let morality factor in to what you do. We dont want doctors making moral and ethical decisions that may affect medical judgement.
.

I completely agree with you on this.

BUT we have a government that seems perfectly fine with making these moral judgements when it comes to people in other countries...yet they coddle and cultivate a homegrown society where even the lowest of the low...the people who abuse and wreak havoc on our medical system feel they DESERVE top notch free healthcare...and also reserve the right to sue if they feel they didnt get what they should have. All while maintaining less than a high school education and no job. Bravo Big Brother...bravo.

I agree with you. I was merely trying to think of some compromise between fully socialized healthcare and our current system that would help the situation. Both systems have their problems; there should be some alternative. I don't know enough about the system yet to think of a very good one. The high deductible healthplan has been mentioned by some politicians and I thought it seemed pretty good, but now I see that it has problems.I like your idea of more free clinics as an alternative to having people go to the ER all the time. I'd like to hear other peoples suggestions. It's more productive than just saying that socialized healthcare is bad or inurance companies are bad and not proposing an alternative.

 

[Renwick6]

Youre making too many assumptions here to be taken seriously.

I understand what youre getting at and what youre trying to say...I just think you said it the wrong way.

Another way of phrasing this could have been:

"A person who is currently paying into the healthcare system, or one who has paid into the system for many years, should be entitled to a higher level of care (more resources, more time spent) than those who do not pay into the system."
.

Yes,I stated that poorly. I think you summed it up well

This, of course, comes with all sorts of moral and ethical issues.

Similar to the poster above who blatantly said "a rich woman doesnt deserve breast implants any more than a poor woman."

To which I say: "wrong."

Boutique and specialty medicine, like cosmetic procedures are just that...special things that are available to people who can afford them.

Every american deserves the right to emergency healthcare to stabilize their acute medical needs. But we need to be more careful with the resources beyond that.

Im not saying children with leukemia or poor people who have a heart attack shouldnt be cared for. But we need a cost to benefit rationale with some patients.

Does the 85 year old near comatose nursing home patient need a $5,000 workup? I see it every day.

Should the 18 year old woman with 2 kids be able to come to the ER on a regular basis to get free treatment for things like insect bites and stuffy nose? That happens all the time too.

What about the 25 year old drug seeking patient? The same patient who threatens to sue...and shoot up the ER...if they arent given their pain meds and a box of needles.

Unfortunately medicine is an area where you need to make medical decisions and you cannot let morality factor in to what you do. We dont want doctors making moral and ethical decisions that may affect medical judgement.
.

I completely agree with you on this.

BUT we have a government that seems perfectly fine with making these moral judgements when it comes to people in other countries...yet they coddle and cultivate a homegrown society where even the lowest of the low...the people who abuse and wreak havoc on our medical system feel they DESERVE top notch free healthcare...and also reserve the right to sue if they feel they didnt get what they should have. All while maintaining less than a high school education and no job. Bravo Big Brother...bravo.

I agree with you. I was merely trying to think of some compromise between fully socialized healthcare and our current system that would help the situation. Both systems have their problems; there should be some alternative. I don't know enough about the system yet to think of a very good one. The high deductible healthplan has been mentioned by some politicians and I thought it seemed pretty good, but now I see that it has problems.I like your idea of more free clinics as an alternative to having people go to the ER all the time. I'd like to hear other peoples suggestions. It's more productive than just saying that socialized healthcare is bad or inurance companies are bad and not proposing an alternative.

 

[nerdgrrl]

Why do you think its so popular to have a baby at 16 years old?

Cash money.

said by one who's clearly never talked to a pregnant teenager.

 

[Dr JPH]

said by one who's clearly never talked to a pregnant teenager.

Clearly.

I dont have time to sit and chat with them. Im too busy seeing patients who need real medical attention. I usually just ask them "what do you want me to do for you?"...and they always have an answer.

 

[MJB]

Pharm companies spend more on Lawyers and Advertising, than they do scientists.

I'd love to see the numbers to back this claim up. As for vitamins...not even in the same league as Pharma when it comes to regulations.


I'm pretty much with JP and Harvey on this one...socializing medicine, in my experience and opinion would be a very bad idea...and HMO's are evil.

I honestly wonder how much real world experience many folks who advocate Mr. Moore's ideas actually have. It is my contention that Mr. Moore himself plays on the ignorance of many Americans and other citizens of the world. He seems to me to be the real crook...What service is he providing in return for the wealth he's made?

People bash physicians and pharma companies while paying this slob 8-15 bucks to watch what he did while being a jackass with a camera?

Color me baffled.

 

[Kappy1]

I with JP, Harvey, MJB and anyone else who doesn't want to see socialized medicine. "Just say No" to socialized medicine.