Medicare for all and physician salaries

[deleted480308]

what’s surprising is that the AMA for medical students (AMSA I think) endorsed M4A

They are a bunch of dumb activists, tons of medical students actively hate mfa (and the aca too)

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[jambro]

Stupid activists who want everyone to have healthcare. haven’t they heard of Venezuela?

i for one can say that if Tens of thousands of people need to die every year so I can earn a 99th percentile salary instead of 95th percentile, well by gosh that’s the way it has to be. Now I’ll be quick to say that physician salaries aren’t the reason healthcare costs are so high, but also complain that guaranteeing everyone healthcare necessitates a drop in my income for some reason. I will also defend to the death the hospitals and insurance bureaucrats and private equity that destroy medicine every day.

Stupid activists should get a big brain like me, resident libertarian who thinks taxes are theft. Live free or die bitches (except dying cuz you don’t have healthcare is also freedom so don’t be free that way)

 

[deleted480308]

Stupid activists who want everyone to have healthcare. haven’t they heard of Venezuela?

i for one can say that if Tens of thousands of people need to die every year so I can earn a 99th percentile salary instead of 95th percentile, well by gosh that’s the way it has to be. Now I’ll be quick to say that physician salaries aren’t the reason healthcare costs are so high, but also complain that guaranteeing everyone healthcare necessitates a drop in my income for some reason. I will also defend to the death the hospitals and insurance bureaucrats and private equity that destroy medicine every day.

Stupid activists should get a big brain like me, resident libertarian who thinks taxes are theft. Live free or die bitches (except dying cuz you don’t have healthcare is also freedom so don’t be free that way)

Live free because we all die anyway. And I'll mention that I think a true return to no govt in healthcare at all actually probably drops a lot of doctor's salaries and that's ok

 

[readmypostsMD]

Stupid activists who want everyone to have healthcare. haven’t they heard of Venezuela?

i for one can say that if Tens of thousands of people need to die every year so I can earn a 99th percentile salary instead of 95th percentile, well by gosh that’s the way it has to be. Now I’ll be quick to say that physician salaries aren’t the reason healthcare costs are so high, but also complain that guaranteeing everyone healthcare necessitates a drop in my income for some reason. I will also defend to the death the hospitals and insurance bureaucrats and private equity that destroy medicine every day.

Stupid activists should get a big brain like me, resident libertarian who thinks taxes are theft. Live free or die bitches (except dying cuz you don’t have healthcare is also freedom so don’t be free that way)

other considerations w mfa:

1) stifled innovation. us pharma makes ~60% new drugs, prices are high in US bc other countries can’t afford to pay high prices bc they’re largely socialized, so us consumer bears higher cost. Stifling innovation (Bc gov would set drug prices) could mean more suffering/death in the future.

2) moral tax issue. eg why should healthy, hard working low class bear tax burden of middle class who makes personal decision to eat unhealthy, smoke, and drink and develops costly chronic issues. Especially true in light of body positivity movement and legalization of weed

3) incentives. making it free may cause unneeded utilization of healthcare. look what happens on Black Friday when TVs are on sale, or how people act at a buffet. This may backfire because care would have to be rationed, meaning that consumer has less control over the product/service. Above 70 in need of cardiac surgery? Get in line.

4) healthcare is a right? Ideally, it should be. Just like police, firemen, k-12. Socialized healthcare is far more expensive and complex than these services, and you’d end up with “a right to waiting in line for healthcare”

5) brain drain. Fewer highly qualified applicants to med school bc government control and reduced salary. Quality of care overall might take a hit

6) waiting lines. Canada has long wait times for healthcare. Just google it. tens of thousands of Canadians come here to receive care

7) $32,000,000,000 price tag

8) both congressional bills provide free healthcare to illegal immigrants and tourists. No comment

9) I believe both bills allow for free nursing home care, acupuncture, therapy, alternative medicine. No comment

10) government control. If government “captures” largest economic industry, it sets precedent to take over more. Is that socialism I smell

11) cost to consumer. Emory physician found that 70% of ppl will pay more overall for healthcare

-Alternative solutions-

1) Defensive medicine. reduce litigation against doctors to help reduce costly defensive medicine

2) unhealthy Americans. Address the obesity, smoking, alcohol that are a big source of high healthcare costs

3) keeping grandma alive. Address our cultural/social issue about wanting to keep the very, very elderly who don’t even know what is going on alive with extremely expensive healthcare. Foster a culture that see death at very old age as natural and not something to be fought

4) socialize emergency care. Allow free emergency care to people, eg so that if they get in car crash, they can get free care. This would be like firemen and police, protecting you from imminent life threatening danger

5)restructure trade policies to increase drug prices for other countries

 

[jambro]

Read the thread over again if you want to see my rebuttal to most of those points. Not worth rehashing over and over again.

 

[readmypostsMD]

Read the thread over again if you want to see my rebuttal to most of those points. Not worth rehashing over and over again.

overall (and truly overall, all costs and benefits taken into account for all stake holders), m4a might be marginally more effective than our current system. It may be marginally worse. It seems like the effectiveness can be argued in either direction. We can only speculate because we can’t experimentally test m4a against a control.

My thought is that instead of spending $32 trillion on something that may or may not be more effective overall, why don’t we first shovel a small fraction of that $ into trying to fix the underlying health problems in our country that jack up healthcare costs, ie defensive medicine, obesity, smoking, alcohol, end of life care, poor mental health

if the Hoover dam started to crack and water was really starting to leak, would you try to patch up the holes with glue or mop up the downstream flood with gold?

lol this is like those chemistry energy rxn diagrams with the energy of the transition state. M4a has an insanely high transition state, but leads to the same products as another rxn w a lower transition state

 

[deleted941485]

what’s surprising is that the AMA for medical students (AMSA I think) endorsed M4A

So did the ACP if I remember correctly. It doesnt surprise e that the students have been totally indoctrinated but I think the reason the ACP did it at the time was because Bernie had just won a few primary states and endorsed it in a pathetic attempt to score points.

 

[deleted941485]

necrobump lmao, but Khrushchev apparently said:

"We cannot expect the Americans to jump from capitalism to communism, but we can assist their elected leaders in giving Americans small doses of socialism, until they suddenly awake to find they have communism."

This has been the game plan for as long as I can remember. Candidates pushing public option, medicare at 60 (was 55 last election), UBI to large swaths of the population. Get em nice and used to it.

 

[Gyuji]

You guys dislike the thought of people paying for medical services becoming obsolete.

 

[readmypostsMD]

You guys dislike the thought of people paying for medical services becoming obsolete.

I don’t dislike the idea. I understand the struggle that a certain fraction of people go through with paying for health insurance, surprise billing, etc.

There are pros and cons to what we have now and socialized healthcare

 

[deleted480308]

You guys dislike the thought of people paying for medical services becoming obsolete.

Of course I do because it’s inappropriate for someone to assume they can make others buy them things. It’s bad policy

 

[VA Hopeful Dr]

Of course I do because it’s inappropriate for someone to assume they can make others buy them things. It’s bad policy

And beyond the libertarian view, if you spend your own money on something you're likely to value it more.

 

[readmypostsMD]

Of course I do because it’s inappropriate for someone to assume they can make others buy them things. It’s bad policy

to be fair, one can consider healthcare like police and firefighters, which protect people from imminent threats (or maybe now they do the opposite...). Taxes pay for these services, so why not for healthcare too?

not that I agree w socialized medicine, but there’s legit arguments on both sides

 

[sliceofbread136]

I mean tax payers already pay out the rear with emtala. Instead of paying for Lipitor and losartan we get to pay for an emergency STEMI or stroke. This leads to our bloated costs and poor outcomes.

Maybe someone can convince me that I am wrong, but the only two solutions seems to be either dump EMTALA and let the poor die or we can further subsidize health care.

 

[sliceofbread136]

And beyond the libertarian view, if you spend your own money on something you're likely to value it more.

I’m not so sure about that one. I’ve never noticed any difference in motivation between those with Medicaid or those with private insurance. In fact I often see the opposite (poor Hispanic moms seem to hang on a doctor’s every word)

 

[VA Hopeful Dr]

I’m not so sure about that one. I’ve never noticed any difference in motivation between those with Medicaid or those with private insurance. In fact I often see the opposite (poor Hispanic moms seem to hang on a doctor’s every word)

Am I recalling correctly that you're a pediatrician?

 

[deleted480308]

to be fair, one can consider healthcare like police and firefighters, which protect people from imminent threats (or maybe now they do the opposite...). Taxes pay for these services, so why not for healthcare too?

not that I agree w socialized medicine, but there’s legit arguments on both sides

I’m gonna disagree that someone can make a logical claim that “arrest the guy who tried to murder me” is the same as “you have to buy me dialysis and bariatric surgery”

 

[deleted480308]

I mean tax payers already pay out the rear with emtala. Instead of paying for Lipitor and losartan we get to pay for an emergency STEMI or stroke. This leads to our bloated costs and poor outcomes.

Maybe someone can convince me that I am wrong, but the only two solutions seems to be either dump EMTALA and let the poor die or we can further subsidize health care.

You seem to think it’s either/or, what adding m4a would mean is you just have to buy everyone their lipitor AND pay for their eventual stemi/dialysis/etc. We could just stop pretending that everyone has a right to everything

 

[readmypostsMD]

I’m gonna disagree that someone can make a logical claim that “arrest the guy who tried to murder me” is the same as “you have to buy me dialysis and bariatric surgery”

Yeah you’re right, it sort of depends on the exact healthcare service

Case 1: hey some dude just crashed his car into me while I was walking down the sidewalk and there’s a metal pole lunged into my gut

case 2: I eat McDonald’s for every meal and am 370 lbs, so I have heart issues now

I feel like ER visits could be socialized, and that would be similar to police/firefighters because its life threatening. Just need to put regulations as to what qualifies as a life threatening problem. Does cancer? I don’t know

 

[NotAProgDirector]

I mean tax payers already pay out the rear with emtala. Instead of paying for Lipitor and losartan we get to pay for an emergency STEMI or stroke. This leads to our bloated costs and poor outcomes.

This is often talked about when discussing M4A or any other broad based health care system. It's almost certainly not true. Sure, for a single patient you can say that if they got better treatment earlier, it might have been cheaper. But you have to treat large numbers of people with statins to prevent an MI, so in the end it's not cost savings. The real discussion is whether spending the additional money to treat everyone is worth the better outcomes.

I feel like ER visits could be socialized, and that would be similar to police/firefighters because its life threatening. Just need to put regulations as to what qualifies as a life threatening problem. Does cancer? I don’t know

Problem is, if I have a headache, can I go to the ED? Could be a brain bleed.

That's the problem -- everything could be an emergency in the right setting, or with a rare enough cause. It's impossible to put limits on whom can come to an ED for an evaluation. So there is no regulation that would work, and charging people afterwards for things that are not emergencies is going to make people avoid ED's even if it is something serious.

The overall problem is that you can't have it all. We could give people more healthcare but it will cost more money (there may be some savings in efficiencies but not enough to offset the additional cost). We could save money by limiting what care people get, but that's rationing and we will never agree on what shouldn't be included. Or we could save money by decreasing costs -- but that means that everyone's salary in medicine goes down. Any combination of those options, but they all cause pain/problems for someone.

 

[readmypostsMD]

This is often talked about when discussing M4A or any other broad based health care system. It's almost certainly not true. Sure, for a single patient you can say that if they got better treatment earlier, it might have been cheaper. But you have to treat large numbers of people with statins to prevent an MI, so in the end it's not cost savings. The real discussion is whether spending the additional money to treat everyone is worth the better outcomes.

Problem is, if I have a headache, can I go to the ED? Could be a brain bleed.

That's the problem -- everything could be an emergency in the right setting, or with a rare enough cause. It's impossible to put limits on whom can come to an ED for an evaluation. So there is no regulation that would work, and charging people afterwards for things that are not emergencies is going to make people avoid ED's even if it is something serious.

The overall problem is that you can't have it all. We could give people more healthcare but it will cost more money (there may be some savings in efficiencies but not enough to offset the additional cost). We could save money by limiting what care people get, but that's rationing and we will never agree on what shouldn't be included. Or we could save money by decreasing costs -- but that means that everyone's salary in medicine goes down. Any combination of those options, but they all cause pain/problems for someone.

yeah I totally agree about the massive difficulty of defining what’s an emergency vs not. I do think that insurance companies already have enormous sets of rules and regulations about what’s covered, so I don’t think it’s impossible to define what counts as an emergency

I think one huge issue w socialized healthcare is the precedent that it sets for nationalizing other industries, which gives the gov too much power and money, and will lead to corruption

 

[TwistedTea]

I think California would be a good guinea pig for this M4A stuff. They always brag about how big their economy is and about breaking off from the rest of america. Now is your chance. If it works I'll eat my words.


Personally as time goes on the less and less I want my tax funded dollars to pay for those who can work but do not work. Much less providing free care to those also. The system would be abused. Just ask those rioters if they would be destroying stuff if they actually paid tax dollars toward building it. (HINT: most probably do not pay any taxes) no skin in the game, what do they care? BURN BABY BURN!

 

[sliceofbread136]

Am I recalling correctly that you're a pediatrician?

Yup! I admit my insight into smelly adult medicine may be limited

You seem to think it’s either/or, what adding m4a would mean is you just have to buy everyone their lipitor AND pay for their eventual stemi/dialysis/etc. We could just stop pretending that everyone has a right to everything

Well the idea is that the cheap intervention prevents the expensive intervention in the expensive setting of care like the er.

I do think access to healthcare should be a right independent of money. Don’t think we will change each other’s views on that one

This is often talked about when discussing M4A or any other broad based health care system. It's almost certainly not true. Sure, for a single patient you can say that if they got better treatment earlier, it might have been cheaper. But you have to treat large numbers of people with statins to prevent an MI, so in the end it's not cost savings. The real discussion is whether spending the additional money to treat everyone is worth the better outcomes.

I have a tough time believing that universal access to preventative medicine and being able to go to a sick visit at a doctor’s office instead of the er would not create significant efficiencies. I also have a tough time believing that as time passes and preventative medicine advances those efficiencies won’t continue to grow.

 

[sliceofbread136]

I just find my self really frustrated with our current system. A perverse form of socialism where the public props up dinosaur companies like Boeing. If we are really going away from the free market I atleast wish the money would go to something that would help the American people like universal healthcare. I would even prefer a fully free market to the current plutocracy, at least that would be honest

 

[sliceofbread136]

I think California would be a good guinea pig for this M4A stuff. They always brag about how big their economy is and about breaking off from the rest of america. Now is your chance. If it works I'll eat my words.


Personally as time goes on the less and less I want my tax funded dollars to pay for those who can work but do not work. Much less providing free care to those also. The system would be abused. Just ask those rioters if they would be destroying stuff if they actually paid tax dollars toward building it. (HINT: most probably do not pay any taxes) no skin in the game, what do they care? BURN BABY BURN!

I mean would you rather have your money go to Boeing???

 

[sliceofbread136]

yeah I totally agree about the massive difficulty of defining what’s an emergency vs not. I do think that insurance companies already have enormous sets of rules and regulations about what’s covered, so I don’t think it’s impossible to define what counts as an emergency

I think one huge issue w socialized healthcare is the precedent that it sets for nationalizing other industries, which gives the gov too much power and money, and will lead to corruption

I mean the government is already corrupt. I for one would prefer leaning toward socialism over fascism

 

[VA Hopeful Dr]

Yup! I admit my insight into smelly adult medicine may be limited

My experience with adult (and peds) is that people who have zero/very low copays are the ones who come in because they had a rash 3 weeks ago that's gone now but they really want to know what it was.

Or don't bother to take their meds ever.

Or go to the ER with a UTI.

 

[readmypostsMD]

I mean the government is already corrupt. I for one would prefer leaning toward socialism over fascism

to me, that gives the gov too much power. imagine if a tyrannical leader came into power (which seems surely possible given that we elected trump) and he controlled large facets of our economy like healthcare

I personally don’t want anyone have that much power and money (“absolute power corrupts absolutely” and control the military/police.... I mean, imagine if Bezos controlled the military

 

[readmypostsMD]

I think California would be a good guinea pig for this M4A stuff. They always brag about how big their economy is and about breaking off from the rest of america. Now is your chance. If it works I'll eat my words.


Personally as time goes on the less and less I want my tax funded dollars to pay for those who can work but do not work. Much less providing free care to those also. The system would be abused. Just ask those rioters if they would be destroying stuff if they actually paid tax dollars toward building it. (HINT: most probably do not pay any taxes) no skin in the game, what do they care? BURN BABY BURN!

Preach. You get the system you incentivize

 

[deleted480308]

Yup! I admit my insight into smelly adult medicine may be limited



Well the idea is that the cheap intervention prevents the expensive intervention in the expensive setting of care like the er.

I do think access to healthcare should be a right independent of money. Don’t think we will change each other’s views on that one



I have a tough time believing that universal access to preventative medicine and being able to go to a sick visit at a doctor’s office instead of the er would not create significant efficiencies. I also have a tough time believing that as time passes and preventative medicine advances those efficiencies won’t continue to grow.

We definitely don’t agree on philosophy. We also disagree on the notion that preventative always saves money as all it does (if it works) is delay those big events and create more expense now before you get to the big events

we 100% agree that adults are more smelly.

#unitedwestand

 

[deleted480308]

I mean the government is already corrupt. I for one would prefer leaning toward socialism over fascism

We could just do less govt

 

[VA Hopeful Dr]

We definitely don’t agree on philosophy. We also disagree on the notion that preventative always saves money as all it does (if it works) is delay those big events and create more expense now before you get to the big events

we 100% agree that adults are more smelly.

#unitedwestand

Yeah the data is very clear that preventative care doesn't save money.

It saves lives, but not money.

 

[TwistedTea]

I mean would you rather have your money go to Boeing???

We could just keep our money

 

[TwistedTea]

Essentially:

If you value your own life you will take care of yourself and save money to pay for healthcare.

If you value your kids life you won't have kids until you can afford them, and will by all means do your best to support them on your own.

It is not the government or the taxpayers responsibility to take care of your family, even if the liberal crowd calls you a terrible person for letting someone else or their kid die since you didn't hand over your tax dollars to their newest government pet project.


We would then have more money left over to donate to deserving people, and not letting the skanks of the United States get away with indirect theft.

 

[sliceofbread136]

We could just do less govt

We could just keep our money

I would be more on board with that than our current system. Anything but the current system

 

[sliceofbread136]

Yeah the data is very clear that preventative care doesn't save money.

It saves lives, but not money.

mind posting some?

 

[VA Hopeful Dr]

mind posting some?

Cost Savings and Cost-Effectiveness of Clinical Preventive Care

A framework for evaluating the cost-effectiveness of investment in clinical preventive care.

www.rwjf.org

Basically childhood vaccinations save money and usually counseling does too because it's super cheap. Nothing else really does.

 

[VA Hopeful Dr]

Just like free needles for drug users and free narcan doesn't save anyone any money. But its SoCiAlJuStiCe

Don't misread, I am 100% behind preventative medicine (I am an FP after all). But we do it to save/improve lives, not save money.

 

[TwistedTea]

Don't misread, I am 100% behind preventative medicine (I am an FP after all). But we do it to save/improve lives, not save money.

I was agreeing with you sarcastically . <3

 

[NotAProgDirector]

I have a tough time believing that universal access to preventative medicine and being able to go to a sick visit at a doctor’s office instead of the er would not create significant efficiencies. I also have a tough time believing that as time passes and preventative medicine advances those efficiencies won’t continue to grow.

Others have beat me to the punch. But I can't help myself.

The only things that are going to be truly cost saving are really cheap and last a long time. Vaccinations fit the bill --- you'll def save money there.

But everything else we do costs money. As mentioned, you may get better outcomes which may be totally worth the extra spend, but these arguments from politicians that they can just "save money" are just crazy.

The other "problem" is that if you screen someone for cancer and prevent it, then they live longer. That's a good thing. But they will ultimately still get sick and cost money to the system - and the longer they live, the more they are likely to cost.

Before my comments get misconstrued, let me be clear: I'm all for screening and preventing disease. But it's not going to save money.

Also, smaller experiments have been done, and in general giving people insurance coverage does not decrease ED visits.

Last, advancements in preventive medicine over the last 20+ years have gotten more and more expensive, not less. It's very unlikely someone is going to discover some simple cure for diabetes that's really cheap. Those advancements may have been better than prior, but they are not cheaper. And as the margin of improvement narrows, value drops.

 

[Antynamikal]

other considerations w mfa:

1) stifled innovation. us pharma makes ~60% new drugs, prices are high in US bc other countries can’t afford to pay high prices bc they’re largely socialized, so us consumer bears higher cost. Stifling innovation (Bc gov would set drug prices) could mean more suffering/death in the future.

2) moral tax issue. eg why should healthy, hard working low class bear tax burden of middle class who makes personal decision to eat unhealthy, smoke, and drink and develops costly chronic issues. Especially true in light of body positivity movement and legalization of weed

3) incentives. making it free may cause unneeded utilization of healthcare. look what happens on Black Friday when TVs are on sale, or how people act at a buffet. This may backfire because care would have to be rationed, meaning that consumer has less control over the product/service. Above 70 in need of cardiac surgery? Get in line.

4) healthcare is a right? Ideally, it should be. Just like police, firemen, k-12. Socialized healthcare is far more expensive and complex than these services, and you’d end up with “a right to waiting in line for healthcare”

5) brain drain. Fewer highly qualified applicants to med school bc government control and reduced salary. Quality of care overall might take a hit

6) waiting lines. Canada has long wait times for healthcare. Just google it. tens of thousands of Canadians come here to receive care

7) $32,000,000,000 price tag

8) both congressional bills provide free healthcare to illegal immigrants and tourists. No comment

9) I believe both bills allow for free nursing home care, acupuncture, therapy, alternative medicine. No comment

10) government control. If government “captures” largest economic industry, it sets precedent to take over more. Is that socialism I smell

11) cost to consumer. Emory physician found that 70% of ppl will pay more overall for healthcare

-Alternative solutions-

1) Defensive medicine. reduce litigation against doctors to help reduce costly defensive medicine

2) unhealthy Americans. Address the obesity, smoking, alcohol that are a big source of high healthcare costs

3) keeping grandma alive. Address our cultural/social issue about wanting to keep the very, very elderly who don’t even know what is going on alive with extremely expensive healthcare. Foster a culture that see death at very old age as natural and not something to be fought

4) socialize emergency care. Allow free emergency care to people, eg so that if they get in car crash, they can get free care. This would be like firemen and police, protecting you from imminent life threatening danger

5)restructure trade policies to increase drug prices for other countries

Interesting...