Physician Salaries - below 100K

[45408]

This is my favorite one. Over the past ten years, when Medicare spending doubled, private insurance costs were rising faster than Medicare’s. Why should I trust the private sector to tackle this problem when they have done a much worse job than Medicare, and they get the healthy profitable patients to play with?!

If you've been reading anything that I've been posting, it's to take things FROM the government and FROM the private sector into YOUR OWN HANDS. I trust myself more than the government or private insurance, which is why I want control. DON'T trust them. I'm certainly not saying you should. Here's what I always expect governments and corporations to always try to get more of: money and power. I have no delusions that either entity will ever turn down money or power.

We spend 21% on defense. We spend trillions on an illegal war and an impossible war. We spend tens of billions on the drug war and prisons and other horrible policies. And you’re really wondering if we can afford healthcare for everybody? Of course we can, we just have to grow a pair of balls and not be such a whiny little bitch country about defense. We are such chicken-hawks it’s disgusting. The cold war is over and we are not the TEAM AMERICA WORLD POLICE, so can we just slash the defense budget already?

I'm not sure who you're arguing with. I already said I'm pretty libertarian, so it's not like I agree with any of those policies. If we got rid of all of them and shifted our money to a single payer system, we'd still save money, and I could support that from a financial standpoint. BUT THAT WON'T HAPPEN. The government will go for MORE money and MORE power.

Simultaneously, we get worse outcomes on all but the most expensive treatments that have dubious efficacy and are only afforded to those with excellent insurance or rich people.

Source?

Your alternative, for OOP spending up to a certain limit until catastrophic coverage would kick in does nothing to address the fact that millions of families would not be able to cover those bills for routine visits and most likely would end up not getting preventive care.

Nope, wrong. Read it again. A REQUIRED "health savings account" plan that people would use for their primary care and couldn't use for anything else. I even said that the government could subsidize it for those who couldn't afford it. Of course, everyone in the country has a cell phone, and people will still walk into your clinic/ER reeking of cigarettes and alcohol, but telling you they can't afford their $8 of anti-seizure meds. Personal responsibility. If it doesn't matter to them, it doesn't matter to me.

Regardless, you fail to realize that people take out a second mortgage to pay medical bills. How would that not happen under your OOP-expense proposal? And then they can’t work and WHOOPS bankruptcy, just like now. Under Medicare for everybody, you don’t have to double your mortgage payment just to pay some Wall Street executive’s insane salary. You get hurt, your medical bills are not your primary concern, you try to get better and you have a much easier time keeping your house. See how easy that is?

So fine, your medical bills were paid. You're still out of a job, and nobody's paying your mortgage. You still go bankrupt because of a medical problem. See how that's a misleading statistic?

If you’re truly worried about your future salary it seems that that system ought to scare you just as much as any other UHC system!

Another straw man. I'm not too concerned about my salary.

And yes, I'm well aware of how Singapore does it, which is why I posted that link with that information right in it.

Why involve them at all? Why do they get to skim off the top, as you say? How is that efficient or necessary? What do private corporations provide?! The answer is that they offer nothing at all except bloated inefficiency and million dollar salaries for thousands of rich white men.

And the government isn't chock-full of bloated inefficiency? This comes down to a pretty straightforward principle for me: the federal government DOES NOT HAVE THE AUTHORITY. Nowhere in the Constitution does it say that they can open up a health insurance program for the whole country. I don't see why a country like the USA - the third largest geographically and the third largest in population - would think that it needs ONE gigantic system to cover all of our health care needs. People call down accolades on the wonderful system that Canada has. Great. Canada is smaller than California. Why don't we try this in smaller steps? It's clear that Massachusetts bit off more than they could chew, so now Connecticut or Virginia could try their own program. Make a few changes, adjust it based on your population demographics, and give it a soft launch.

I'm just curious - what's wrong with profit? And what is your threshold for what should be government-run and what should be private? How about government-run grocery stores so that people can afford healthier food. It's a well-known fact that poor people can't afford things like nice fresh produce and good cuts of meat. Let's take away grocery store profit so they can join in too.

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[45408]

Here's a good editorial from KevinMD's blog about cutting health care costs by doing the unthinkable: http://www.kevinmd.com/blog/2009/09/cutting-health-care-costs-means-reducing-utilization.html

And here's a NEJM article - http://content.nejm.org/cgi/content/full/360/9/849 - that points out regional differences in Medicare spending. Since people in Long Island aren't susceptible to rare diseases that people in North Carolina are immune to, the differences in cost are mostly due to differences in medical practice. Good read.

Do something good for your patients: do less.

 

[RGMSU]

If you've been reading anything that I've been posting, it's to take things FROM the government and FROM the private sector into YOUR OWN HANDS.

One of the biggest mistakes doctors ever made is letting a third party stand between them and their patients.

 

[meister]

I had originally typed a hellishly long reply but I think we can pare this down.

If you've been reading anything that I've been posting, it's to take things FROM the government and FROM the private sector into YOUR OWN HANDS. I trust myself more than the government or private insurance, which is why I want control. DON'T trust them. I'm certainly not saying you should. Here's what I always expect governments and corporations to always try to get more of: money and power. I have no delusions that either entity will ever turn down money or power.

The problem is that you think corporate and government evil are equivalent. They are certainly not. Government is necessary, corporate profit-seeking is not. Horrible, evil things have been committed by governments, I'll be the first to admit. The worst acts of mankind, even. But that does not mean it can do nothing right. In your proposed solution, poor and middle-class patients would be forced to consider whether or not your proposed treatment's benefits are outweighed by the cost burden. That's just a fact. It is a regressive scheme, just not as evil as our current set-up. Furthermore, completely eliminating corporate involvement and having government be the funding mechanism does not preclude doctor autonomy. It enhances it. There will be no government bureaucrat in the room. Government is simply the funding mechanism and would actually increase the autonomy of the doctor-patient relationship.

Nope, wrong. Read it again. A REQUIRED "health savings account" plan that people would use for their primary care and couldn't use for anything else.

So you would subsidize the HSA for the poor, jobless, disabled, children, and elderly? What is the point in your HSA?

You are only suggesting this because you feel that people spending their own money is the only way to curb spending, correct? But you admit single-payer would be easy to administrate. You admit it would be more fiscally responsible than our current system. You even admit that strict government control on prices and other market regulation is necessary to achieve true long-term solvency. How does a 100% government-financed single-payer system not achieve all of these goals? And how is it not much easier to implement than your HSA plan with subsidies for certain groups. (Determined on what basis I don't know, but I smell a new government agency a la the IRS).

It all just seems like extra work with no real point. I think I have shown that the feds can do some things right (like the VA, or SSI, or TRICARE). Thus, I have some confidence in their ability to redistribute money to the 50 states and enact reasonable cost control legislation. I don't think it'll ever happen, though, because our Congress is 95% bought by lobbyists and corporate donations. But there's no reason it wouldn't work if done right.

And the government isn't chock-full of bloated inefficiency? This comes down to a pretty straightforward principle for me: the federal government DOES NOT HAVE THE AUTHORITY. Nowhere in the Constitution does it say that they can open up a health insurance program for the whole country.

I don't see why a country like the USA - the third largest geographically and the third largest in population - would think that it needs ONE gigantic system to cover all of our health care needs.

So now you're backpedalling to a constitutional discussion? Interstate commerce clause and the General Welfare clause cover this pretty nicely. Additionally, the federal government could enact the necessary revenue streams, appropriate the funds to the 50 states, and preclude federal monies for XYZ programs contingent on the establishment of state-level healthcare administrations that would run the programs.

I'm just curious - what's wrong with profit?

You mean greed? Avarice? Well that is a complicated question, but personally the profit motive of cell phone companies, or car manufacturers, or video game companies doesn't bother me any more than many of the other things that we take for granted in our first world privileged societies. What bothers me is when that motive precludes the just and ethical appropriation of resources that I feel are the inalienable right of any person within the boundaries of our tremendously wealthy democratic nation. All human beings within our borders are entitled to food, water, basic shelter and healthcare. Does everyone get a Benz? No. Does everyone get to eat steak every day? No. Does everyone get a HiB vaccine or PCN for syphilis? Mother f*cking yes.

Oh they didn't have the foresight to sign up for that maternity clause or for preventive benefits? Who the hell cares. That's my answer. Yours, as you have previously stated in this thread, is that it's tough **** for them:

I completely agree. If your home insurance covers routine furnace/roof/window/door replacement, then your premiums will increase to cover the cost as well as the additional profit for the insurance company. Your choice.

 

[meister]

I'm not too concerned about my salary.

Sweet, I've always wanted to go to school for 13 years to become a surgeon, just so I can make $12/hr, while the nurses who went to school for 2 years can make $28/hr.

Any specialty that works twice as much should be much more highly reimbursed, such as surgery. It's just not comparable to a clinic-based specialty that works 9-5, Monday through Friday, with an hour for lunch.

How about no, Scott?

Lol.

Preventative care doesn't save money. It's actually more expensive. It's better for your health, but it comes at a cost.

What I think we need is more consumer involvement. People have no skin in the game, so they agree to a $2000 karyotype that has no bearing on their treatment. I've seen it done. If they had to pay for it, they would ask "Is this really necessary? No? Then I don't want it." I just shelled out $1400 for car repairs, and I was asking specific questions about what was going to be done and why.

People curb their spending when they spend their own money.

So your basic argument against single-payer is:

1. Medicare-for-all would increase the profit motive for doctors (I have no idea how you think this, considering private insurance costs have outpaced Medicare costs, as I have previously demonstrated.)

and

2. People spend less when it’s their own money

I think your premise in 1 is inherently flawed because it does not consider the increased government regulation that would simultaneously occur, such as in Canada, the UK, or Singapore. Regulation which you would be in favor of. Your second premise is flawed not because it’s not true, but because it would have dramatic consequences and be detrimental to the doctor-patient relationship. You yourself even argue that we could potentially lower costs by decreasing preventive care since it’s so expensive and the cost benefits of it are dubious, allegedly. I mean, do you really want doctors to be seen as car mechanics are? Really?

 

[Concubine]

All human beings within our borders are entitled to food, water, basic shelter and healthcare. Does everyone get a Benz? No. Does everyone get to eat steak every day? No. Does everyone get a HiB vaccine or PCN for syphilis? Mother f*cking yes.

This is where I fundamentally disagree with you. I don't believe healthcare is a right, but a service.

 

[45408]

So you would subsidize the HSA for the poor, jobless, disabled, children, and elderly? What is the point in your HSA?

You are only suggesting this because you feel that people spending their own money is the only way to curb spending, correct? But you admit single-payer would be easy to administrate. You admit it would be more fiscally responsible than our current system. You even admit that strict government control on prices and other market regulation is necessary to achieve true long-term solvency. How does a 100% government-financed single-payer system not achieve all of these goals? And how is it not much easier to implement than your HSA plan with subsidies for certain groups. (Determined on what basis I don't know, but I smell a new government agency a la the IRS).

It all just seems like extra work with no real point. I think I have shown that the feds can do some things right (like the VA, or SSI, or TRICARE). Thus, I have some confidence in their ability to redistribute money to the 50 states and enact reasonable cost control legislation. I don't think it'll ever happen, though, because our Congress is 95% bought by lobbyists and corporate donations. But there's no reason it wouldn't work if done right.

So now you’re backpedalling to a constitutional discussion? Interstate commerce clause and the General Welfare clause cover this pretty nicely. Additionally, the federal government could enact the necessary revenue streams, appropriate the funds to the 50 states, and preclude federal monies for XYZ programs contingent on the establishment of state-level healthcare administrations that would run the programs.

I'm not backpedaling at all. It's just that I know that most people aren't libertarian, and I've got a strong enough sense of realism to know that I should try to meet people in the middle. I could adamantly refuse any system that wasn't constitutional, but I would never get what I want. If we find something in the middle that suits more people than not, then I'll take it.

As for a system like HSAs, I have no specific attachment to THAT particular idea. I was suggesting it as an alternative that would place the patient/consumer in the driver's seat as opposed to continually being taken for a ride.

You are only suggesting this because you feel that people spending their own money is the only way to curb spending, correct? But you admit single-payer would be easy to administrate. You admit it would be more fiscally responsible than our current system. You even admit that strict government control on prices and other market regulation is necessary to achieve true long-term solvency. How does a 100% government-financed single-payer system not achieve all of these goals?

1. Yes.
2. A single-payer health care system might be more straight forward to administrate, but wouldn't a single-payer college tuition program be more straight forward too? What about single payer mortgages?
3. No, I don't think it would be more fiscally responsible than our current system. Health care expenses will continue expanding until we hit the source - we do too much. Great article in Newsweek last week - http://www.newsweek.com/id/215291 - that talks about how the US has more health care than any other country in the world. It's not better, but it's more. We need to slash our costs like our nation's livelihood depends on it.
4. No, I don't think government control on prices is NECESSARY. I think that Singapore has pulled it off in a good system, but that doesn't mean it's the only way at all.

You mean greed? Avarice? Well that is a complicated question, but personally the profit motive of cell phone companies, or car manufacturers, or video game companies doesn’t bother me any more than many of the other things that we take for granted in our first world privileged societies. What bothers me is when that motive precludes the just and ethical appropriation of resources that I feel are the inalienable right of any person within the boundaries of our tremendously wealthy democratic nation. All human beings within our borders are entitled to food, water, basic shelter and healthcare. Does everyone get a Benz? No. Does everyone get to eat steak every day? No. Does everyone get a HiB vaccine or PCN for syphilis? Mother f*cking yes.

Everyone gets food? What about those greedy grocery companies? The water company demands that I pay them too. My landlord doesn't cut me any slack either on my rent in my opulent 1BR apartment.

 

[45408]

Lol.

"Not too concerned" doesn't mean I have no concern. I'm pretty clearly pointing out that I think that you should get paid more if you work harder and longer than other people. And no, I wouldn't be a surgeon working 70 hours a week if I were only going to get paid $100K/year. I'd be a nurse putting in PICC lines to the tune of $120 apiece, because that's what they get paid.

You yourself even argue that we could potentially lower costs by decreasing preventive care since it’s so expensive and the cost benefits of it are dubious, allegedly. I mean, do you really want doctors to be seen as car mechanics are? Really?

Well, yes, I do think we should cast a critical eye on screening tests. I'm sure that you, of all people, realize that there are people behind the scenes pushing this on us. A colonoscopy on everyone over 50? I'm sure the companies making colonoscopes have no vested interested there. A PSA on every man? There's an assay somewhere in there. Mammograms? PAP smears?

Obviously there is enough benefit to most of the screening that we do it, but there's a reason we don't screen for everything. There's no screening test for pancreas cancer or lung cancer, even though those two are far more deadly than colon/breast/prostate cancer.

Don't you think the cost/benefit of screening for pancreas cancer is dubious? I don't know why you threw that "allegedly" on there.

 

[Dwindlin]

3. No, I don't think it would be more fiscally responsible than our current system. Health care expenses will continue expanding until we hit the source - we do too much. Great article in Newsweek last week - http://www.newsweek.com/id/215291 - that talks about how the US has more health care than any other country in the world. It's not better, but it's more. We need to slash our costs like our nation's livelihood depends on it.

I'm really glad you mentioned this. Increasing access and cutting costs are 2 entirely separate issues. I could be simply misunderstanding him, but the way meister is arguing his points it makes it seem as if he believes moving to a single-payor or universal system is going to address both these. When in reality unless something changes about the way medicine is practiced all increasing access is going to do is increase the amount of spending (assuming current reimbursement which is a bad assumption I admit but I think this shows how they are in reality separate issues).

 

[meister]

This is where I fundamentally disagree with you. I don't believe healthcare is a right, but a service.

Yes, it is easy to say “fundamental disagreement.” But I have a couple simple questions for you: are you going to let a poor homeless man die of syphilis because he can't afford penicillin? A poor child die of viral diarrhea because his mom can't afford an IV?

I'm not backpedaling at all. It's just that I know that most people aren't libertarian, and I've got a strong enough sense of realism to know that I should try to meet people in the middle. I could adamantly refuse any system that wasn't constitutional, but I would never get what I want. If we find something in the middle that suits more people than not, then I'll take it.

Well I was responding to your claim that the feds don’t have the authority to set up national coverage; if you admit that this is an irrelevant discussion since the Constitution means whatever the party in power says it means barring relevant Supreme Court precedent then I guess there’s nothing to discuss.

1. Yes.

What about the fact that other countries have UHC that is government-administered with much lower per capita expense? To what do you attribute this?

2. A single-payer health care system might be more straight forward to administrate, but wouldn't a single-payer college tuition program be more straight forward too? What about single payer mortgages?

Fully funded government subsidized college tuition? F*ck yes that’d be better than our current system. Our current system is only designed to spring as many traps for young financially ignorant adults as possible. It results in high profits for banks, bankrupt-proof college loans, and insane levels of lower- and middle-class debt. This is largely the same in the housing industry but I don’t think it’s wise to have government running mortgages, I would just regulate the hell out of the housing industry and prevent predatory lending.

I’ve already advocated for subsidized college eduction: fully funding medical education is a necessary component of cost control because it’s the only way we can begin to eliminate the horrible physician siege mentality. Our current system graduates physicians with hundreds of thousands in debt with no guarantees that they’ll land a high enough paying specialty to cover their debts and live comfortably. On top of that you have the largely grandiose specter of malpractice and you have a ripe environment for overtesting and CYA medicine. This is just a simple fact and cannot be ignored, though it is.

3. No, I don't think it would be more fiscally responsible than our current system. Health care expenses will continue expanding until we hit the source - we do too much. Great article in Newsweek last week - http://www.newsweek.com/id/215291 - that talks about how the US has more health care than any other country in the world. It's not better, but it's more. We need to slash our costs like our nation's livelihood depends on it.

I don’t think we need to slash costs, we need to begin to eradicate CYA medicine. Huge student loan debts + long training programs at 80+hrs/week + specter of malpractice + American consumerism + societal issues dealing with death = insane costs for end-of-life care. Your article hits that last part pretty well.

The hospital at my mother's assisted-living facility was sustained by Medicare, which pays by the procedure. I don't think the doctors were trying to be greedy by pushing more treatments on my mother. That's just the way the system works. The doctors were responding to the expectations of almost all patients. As a doctor friend of mine puts it, "Americans want the best, they want the latest, and they want it now." We expect doctors to make heroic efforts—especially to save our lives and the lives of our loved ones.

This is exactly why the “death panels” claim was so f*cking damaging and cynical: it fear-mongered and took advantage of this flaw in American society and resulted in the removal of the end-of-life counseling that was contained in the bills. Unbelievable how some uneducated hick from Alaska can single-handedly undo one of the more important aspects of cost control by a goddamn facebook status update or twitter or whatever the hell Palin used to vomit out this canard.

4. No, I don't think government control on prices is NECESSARY. I think that Singapore has pulled it off in a good system, but that doesn't mean it's the only way at all.

But heavy government regulation is the only way that decent cost control has come about, ever, in the history of the world. So why is it I’m supposed to consider other options when we have systems in every other country that have costs at acceptable levels?

Everyone gets food? What about those greedy grocery companies? The water company demands that I pay them too. My landlord doesn't cut me any slack either on my rent in my opulent 1BR apartment.

Don’t be obtuse. Providing a homeless guy with a shot of penicillin for his syphilitic ucler and some bread and water and a cot in a large gymnasium is what I’m talking about. Please don’t play the slipper slope fallacy game.

Well, yes, I do think we should cast a critical eye on screening tests. I'm sure that you, of all people, realize that there are people behind the scenes pushing this on us. A colonoscopy on everyone over 50? I'm sure the companies making colonoscopes have no vested interested there. A PSA on every man? There's an assay somewhere in there. Mammograms? PAP smears?

Any and all procedures should be evaluated based on efficacy and evidence. This is going to be impossible to change with our current physician culture, plain and simple.

 

[Dwindlin]

What about the fact that other countries have UHC that is government-administered with much lower per capita expense? To what do you attribute this?

They ration. There is no other way to say it. They have a committee to decide each year what doctors can and cannot do under the UHC system. If you want treatment outside what they approve you have to pay for it out of pocket (I think cancer treatments are the best example of this). I don't necessarily think this is a bad thing either because like many others I think we do too much sometimes.

As I said in a previous post you don't need UHC to bring down cost (it has also been stated by many others through-out this conversation). In fact if you enact some sort of UHC system without some sort of rationing (or tanking reimbursement) UHC will not lower costs, it will increase (more people accessing the same medical care). These are 2 separate issues (cost and access) that in my opinion do not have a common solution.

 

[novastorm]

In the end after all the muddling exposition its just a move to have greater control over your lives. Remember they will directly own your educational loans soon, they own the second largest car company on earth, they want to control how much energy you use, they want to control all financial dealing in the us, and soon they will control your health.

Scary.

 

[Concubine]

Yes, it is easy to say "fundamental disagreement." But I have a couple simple questions for you: are you going to let a poor homeless man die of syphilis because he can't afford penicillin? A poor child die of viral diarrhea because his mom can't afford an IV?

I personally wouldn't, but I believe that decision should be based on my own morals, not the morals others project on to me. What's the value of forcing responsibility on others? What is the long term benefit? Giving the guy penicillin is the right thing to do, but who are you going to force to pay for the penicillin?

 

[45408]

Yes, it is easy to say "fundamental disagreement." But I have a couple simple questions for you: are you going to let a poor homeless man die of syphilis because he can't afford penicillin? A poor child die of viral diarrhea because his mom can't afford an IV?

First off, pretty much everyone here has said they're okay with children getting coverage. Secondly, if there is really a poor homeless man who can't afford $4 of penicillin, then I would be okay with free clinics that would provide that. I'm pretty sure I already said that too. I think that some government-run free clinics would be a reasonable thing to have.

Of course, the American people deserve nothing but the best, even if they're not paying for any of it.

What about the fact that other countries have UHC that is government-administered with much lower per capita expense? To what do you attribute this?

A vastly different mind-set in those countries, which we clearly don't have here.

Fully funded government subsidized college tuition? F*ck yes that'd be better than our current system. Our current system is only designed to spring as many traps for young financially ignorant adults as possible. It results in high profits for banks, bankrupt-proof college loans, and insane levels of lower- and middle-class debt. This is largely the same in the housing industry but I don't think it's wise to have government running mortgages, I would just regulate the hell out of the housing industry and prevent predatory lending.

I've already advocated for subsidized college eduction: fully funding medical education is a necessary component of cost control because it's the only way we can begin to eliminate the horrible physician siege mentality. Our current system graduates physicians with hundreds of thousands in debt with no guarantees that they'll land a high enough paying specialty to cover their debts and live comfortably. On top of that you have the largely grandiose specter of malpractice and you have a ripe environment for overtesting and CYA medicine. This is just a simple fact and cannot be ignored, though it is.

Is there anything that you wouldn't have the government do?

This is exactly why the "death panels" claim was so f*cking damaging and cynical: it fear-mongered and took advantage of this flaw in American society and resulted in the removal of the end-of-life counseling that was contained in the bills. Unbelievable how some uneducated hick from Alaska can single-handedly undo one of the more important aspects of cost control by a goddamn facebook status update or twitter or whatever the hell Palin used to vomit out this canard.

Agreed.

Don't be obtuse. Providing a homeless guy with a shot of penicillin for his syphilitic ucler and some bread and water and a cot in a large gymnasium is what I'm talking about. Please don't play the slipper slope fallacy game.

Don't be rude. You need to reign in those angry feelings of yours.

You're pulling out these dramatic situations in which just a few pennies would make a world of difference, in which no one would disagree. The reality is more like "providing a homeless guy with a bed in a skilled nursing facility because he has Wernicke-Korsakoff's and can't do his ADLs any more."

Any and all procedures should be evaluated based on efficacy and evidence. This is going to be impossible to change with our current physician culture, plain and simple.

Why? Physicians wouldn't order tests if people asked "Is this necessary?" and the answer was no. "Is this expensive?" Yes. "Then I don't want it."


Edit - found these interesting articles on Scalpel or Sword's blog - http://scalpelorsword.blogspot.com/

Scroll down a few entries, and he's got a series on health care reform that he actually wrote 2 years ago, but he addresses just about everything we're talking about now. Good stuff.

 

[meister]

They ration. There is no other way to say it. They have a committee to decide each year what doctors can and cannot do under the UHC system.

Come on man don't pretend we don't have rationing here, we do! It's just done in the most ancient and unethical way possible: 1-part luck 9-parts wealth.

I personally wouldn't, but I believe that decision should be based on my own morals, not the morals others project on to me. What's the value of forcing responsibility on others? What is the long term benefit? Giving the guy penicillin is the right thing to do, but who are you going to force to pay for the penicillin?

Are you one of those guys who thinks taxation is theft? Governments provide goods and services for citizens, rich and poor. They get revenue generally via taxes. I see it as a common interest, both in terms of public health and in terms of ethics/justice, that a poor dude be given PCN for his syphilis, or any number of other things. That's not forcing responsibility, it's part of being a taxpaying member of a ridiculously wealthy first-world nation that has no problem with people like Paris Hilton growing up with the biggest silver spoon in her mouth and literally contributing nothing other than being born.

First off, pretty much everyone here has said they're okay with children getting coverage. Secondly, if there is really a poor homeless man who can't afford $4 of penicillin, then I would be okay with free clinics that would provide that. I'm pretty sure I already said that too. I think that some government-run free clinics would be a reasonable thing to have.

Of course, the American people deserve nothing but the best, even if they're not paying for any of it.

Your last sentence here is rather bizarre, what precisely do you mean by that? Most people pay taxes so...?

Regardless, you've said guaranteed care for kids, free clinics for the homeless, Medicare for the elderly, so I guess you just want the working public to have a harder time getting care than the rest? I really just don't understand you're reasoning, sorry. Why have a billion different systems, it just creates confusion and higher administrative costs. Sigh.

Is there anything that you wouldn't have the government do?

Mortgages, anything consumer related, personal finances? I'm not sure what your point is here, all I've advocated is government-administered UHC and free education, not exactly earth-shattering ideas. They are done everywhere else but here.

You're pulling out these dramatic situations in which just a few pennies would make a world of difference, in which no one would disagree. The reality is more like "providing a homeless guy with a bed in a skilled nursing facility because he has Wernicke-Korsakoff's and can't do his ADLs any more."

So the homeless guy doesn't get a nursing home bed and instead gets...? Nothing? Really?

 

[meister]

By the way, Prowler, that blog is funny because he just strokes the American Medical Community as being just so obviously the highest quality in the world. Then he pokes fun at Cuba because they don't have MRIs on every corner. He also ignores Cuba's amazing public health care system that rivals the best in the world for literally pennies on the dollar. Lol, he completely misses the point that our obsession with being the BEST QUALITY is like half the problem, American Medicine is just obsessed with MRIs and CTs and Avastin-Herceptin $50k/month biodrugs. So we can treat that breast cancer so great but we f*ck everything else up.

Way to go America, you can treat the Saudi King for his prostate cancer! You may treat those with chronic conditions or the poor like total ****, and you might bankrupt thousands every year, but goddammit, the one or two foreign dudes who come here every year get the best treatment at Mayo! (Also let me ignore that Mayo doesn't have a fee-for-service payment system.)

Don't misunderstand and don't buy the baloney the frantic lefties are trying to feed you....poor people in this country still get better care than in any other country.

This pretty much throws everything he has to say into question, sorry. Talk about living in total denial. Don't listen to anything that dude has to say, because goddamn.

 

[meister]

As an aside, I'd like to point out that the British Medical Association fought against the NHS back in the 1940s and now are the staunchest defenders of the system, fighting tooth and nail against any privatization of the system. Who would want to get rid of guaranteed free care, free medical education, and guaranteed salaries starting at £100k all the way up to £200k+ for specialists?! They'd be insane!

Yet we in the US aren't even mentioning single-payer as an option, only a worthless public option. And even that is a tough sell?!

 

[Dwindlin]

Come on man don't pretend we don't have rationing here, we do! It's just done in the most ancient and unethical way possible: 1-part luck 9-parts wealth.

I disagree. While I get what you're saying that is more a problem with access to health care. Those that have access typically have access to a full workup at the drop of a hat and heroic measures if it comes to that (regardless of their true ability to pay as you've so diligently pointed out with bankruptcy rates due to medical bills). That isn't rationing.

 

[meister]

I disagree. While I get what you're saying that is more a problem with access to health care. Those that have access typically have access to a full workup at the drop of a hat and heroic measures if it comes to that (regardless of their true ability to pay as you've so diligently pointed out with bankruptcy rates due to medical bills). That isn't rationing.

How is that not rationing? Those who can afford it, get it. Those who can't, don't. It is rationed by the capability to pay the bills, either by cash or by insurance. Thus, we are providing extremely expensive and dubiously effective care to some while relegating thousands to nothing at all. Oh, unless they show up in the ED with a severed arm, then they get hours and hours of surgery and absolutely no way to pay, and it gets eaten by the hospital, and they declare bankruptcy, and costs go up for us all.

That is a much more damning system of rationing than any I've ever heard of. It can't just be brushed aside because "those that have access," have access. I mean that's just a tautology.

 

[Dwindlin]

How is that not rationing? Those who can afford it, get it. Those who can't, don't. It is rationed by the capability to pay the bills, either by cash or by insurance. Thus, we are providing extremely expensive and dubiously effective care to some while relegating thousands to nothing at all. Oh, unless they show up in the ED with a severed arm, then they get hours and hours of surgery and absolutely no way to pay, and it gets eaten by the hospital, and they declare bankruptcy, and costs go up for us all.

That is a much more damning system of rationing than any I've ever heard of. It can't just be brushed aside because "those that have access," have access. I mean that's just a tautology.

As I said I get what you're saying, and I agree with you its a problem, but I don't think it is rationing. Maybe rationing is a poor term but I don't know what else to call it. When I say rationing I specifically mean set limits by a governing body specifically meant to curtail costs. That does not happen here.

Now again the only reason I really bring it up is because they are two separate problems that you haven't mentioned in your previous arguments. And as I said a few posts ago I may have misunderstood you're points but you made a comment about other countries implementing a UHC system and keeping costs in check and my point was the UHC didn't keep costs under control, the rationing did.

You cannot tell me that a universal system would be sustainable without a major overhaul in the way medicine is actually practiced in this country.

 

[Concubine]

Are you one of those guys who thinks taxation is theft? Governments provide goods and services for citizens, rich and poor. They get revenue generally via taxes. I see it as a common interest, both in terms of public health and in terms of ethics/justice, that a poor dude be given PCN for his syphilis, or any number of other things. That's not forcing responsibility, it's part of being a taxpaying member of a ridiculously wealthy first-world nation that has no problem with people like Paris Hilton growing up with the biggest silver spoon in her mouth and literally contributing nothing other than being born.

Civilization requires government, and government requires funding, so no. However, I do believe the governments role should be minimal. As you point out, this sort of freedom has a cost (i.e the Paris Hiltons), but the pros (at least to me) far outweigh the cons.

 

[bad virus]

I don't know. Honestly, sometimes I get the feeling docs are treated like the flies on govt. radar and gluttonous stepchildren by the patient population.

I'm sorry. I don't get it. Doctors are the ones with the knowledge base and the education. Doctors are the ones with the licenses. Doctors are the ones who go through extensive training to perfrom procedures, who diagnose, treat, and notice the clinical issues that start the ball rolling in the direction of necessary new research and technology.

Why is it ok for star football players and members of Congress to rake in trillions of dollars, while we can't even control our own fate despite all the **** we go through in training and the debt we incur to HELP PEOPLE instead of throwing a pigskin or BS rhetoric around?!

We as future docs HAVE TO take control of where our future is going to go. I wonder how significant all these players in the healthcare game would feel if docs just dropped their scalpels and refused to put up with crap. The problem is that compassion is often taken for granted.

What's up with the whole woe is me attitude? Relax, your still going to be making 150k+ and I am pretty sure you will be able to pay those loans off.

How much is a fair asking rate for doctors? Is it 400k? Maybe 300K? Who decides what's fair? I am just curious. I come from a family that has never made over $20,000 a year and still happily supported 7 children who are all top notch students. The way I see it, once you hit that 100k mark, I can't imagine how different it would be from there on up. I guess I am niave in the sense that I don't know what it's like at that level, so maybe it does make a difference. Anyway, the only sad thing about the field of medicine has to be the loans (thank god I don't got any).

The above questions were just rambles of curiosity.

 

[Dr Oops]

What's up with the whole woe is me attitude? Relax, your still going to be making 150k+ and I am pretty sure you will be able to pay those loans off.

How much is a fair asking rate for doctors? Is it 400k? Maybe 300K? Who decides what's fair? I am just curious. I come from a family that has never made over $20,000 a year and still happily supported 7 children who are all top notch students. The way I see it, once you hit that 100k mark, I can't imagine how different it would be from there on up. I guess I am niave in the sense that I don't know what it's like at that level, so maybe it does make a difference. Anyway, the only sad thing about the field of medicine has to be the loans (thank god I don't got any).

The above questions were just rambles of curiosity.

20K for a for a family of 7 is well below the poverty line. That sounds like it would be very difficult to make work.

 

[bad virus]

20K for a for a family of 7 is well below the poverty line. That sounds like it would be very difficult to make work.

Let's just say that I never got those Nike's I wanted so bad till I got a job.

Other than that, we were pretty happy. My dad has a BS in Electrical Engineering from LSU, but when we came back to the U.S. during the Gulf War as refugees he wasn't able to get an official work permit or whatever it is that was needed to work in the U.S. . So he did things like fast food and other junk like that to support us. My dad drives a Cab till this very day, and it is my goal to make him retire in four years after I graduate.

 

[Food]

Time to join the fray...

Are there no idealists here who will continue to doctor even if it means making peanuts? If it gets too bad/stressful to make a decent living in the U.S. why not go abroad? I'd consider working for some non-profits or NGOs - at least that way, even if I'm making no money, I'm still being constructive.

 

[Concubine]

Time to join the fray...

Are there no idealists here who will continue to doctor even if it means making peanuts? If it gets too bad/stressful to make a decent living in the U.S. why not go abroad? I'd consider working for some non-profits or NGOs - at least that way, even if I'm making no money, I'm still being constructive.

Oh, I don't know. As long as I can pay off my loans in a reasonable amount of time, afford a descent house/land, then I would probably still work as a physician. If it ever got to the point that I couldn't, well, who knows. I imagine if salaries fell significantly, doctors wouldn't put up with working such long hours, which would be at least one plus.

 

[Food]

What's up with the whole woe is me attitude? Relax, your still going to be making 150k+ and I am pretty sure you will be able to pay those loans off.

How much is a fair asking rate for doctors? Is it 400k? Maybe 300K? Who decides what's fair? I am just curious. I come from a family that has never made over $20,000 a year and still happily supported 7 children who are all top notch students. The way I see it, once you hit that 100k mark, I can't imagine how different it would be from there on up. I guess I am niave in the sense that I don't know what it's like at that level, so maybe it does make a difference. Anyway, the only sad thing about the field of medicine has to be the loans (thank god I don't got any).

The above questions were just rambles of curiosity.

Lol seriously? 20k a year and 7 kids? I dunno man...that sounds pretty ridiculous...you had to be living off some form of welfare...

 

[Concubine]

Lol seriously? 20k a year and 7 kids? I dunno man...that sounds pretty ridiculous...you had to be living off some form of welfare...

Believe me, It's doable...especially if you live in a small town or out in the middle of nowhere like I did. My family was in the same situation and we weren't on welfare. I imagine pulling that off in a larger city would be more difficult though.

 

[meister]

As I said I get what you're saying, and I agree with you its a problem, but I don't think it is rationing. Maybe rationing is a poor term but I don't know what else to call it. When I say rationing I specifically mean set limits by a governing body specifically meant to curtail costs. That does not happen here.

Oh, you mean you redefine rationing to mean something other than what it actually means. Please, take a few minutes to really think about this one here, because it is what so many people seem to be missing. We already have rationing. Just admit that it is rationing you can live with because it means that the rich and lucky get expensive adequate care and subspecialists get exorbitant salaries.

You cannot tell me that a universal system would be sustainable without a major overhaul in the way medicine is actually practiced in this country.

Absolutely, we have to end our obsession with high cost fancy procedures. We have to end our societal issues in dealing with being old and dying. These are things that should be discussed, but none of them are. In fact, the total opposite conversation is going on with the whole death panel debate. It's ridiculous and Obama's plan is going to bankrupt the nation, although probably not as quickly as if we just let our current situation continue for a couple more decades.

If you had actually read any of my posts in this thread, you would see that reforming American Medicine is one of the three basic things I'm arguing. Namely:

1. Full subsidization of medical education
2. Drastic reformation in the practice of medicine
3. Single-payer, either through private non-profit highly regulated entities or via the state governments

Civilization requires government, and government requires funding, so no. However, I do believe the governments role should be minimal. As you point out, this sort of freedom has a cost (i.e the Paris Hiltons), but the pros (at least to me) far outweigh the cons.

Yeah...the freedoms outweigh the costs. Who's taking your freedoms exactly? You do realize saddling half the nation in debt via mortgages, car loans and medical bills is not freedom at all, right? And raising taxes on the wealthy is not taking their freedom, it is ensuring that our country doesn't become Feudal State v2.0 in a decade.

So what freedom, exactly, is being taken from you if we ensure that all have a baseline access to care?

Ensuring proper medical care in spite of socioeconomic status is an indicator of a fully functioning first world democracy. I'm afraid that in this respect we are in the same league as Slovenia.

Lol seriously? 20k a year and 7 kids? I dunno man...that sounds pretty ridiculous...you had to be living off some form of welfare...

Isn't that the point of welfare? Why does this matter?

 

[RGMSU]

Absolutely, we have to end our obsession with high cost fancy procedures. We have to end our societal issues in dealing with being old and dying.

Sounds like you're way too young to have needed a "fancy procedure" to save your life. Also sounds like you're way too young to be lying in a hospital bed not wanting today to be your last day. Basically, I'm respectfully saying you and the people like you are naive. Naive about what it takes to keep someone chronically ill alive, ie, "fancy procedures." Naive about what it's like to be a patient instead of a physician, ie, lying there wondering whether you're going to live or die that day. I recently saw the cover of Newsweek about how "killing granny" may help America, and I just shook my head at the state of American medicine. Hippocratic oath - where have you gone? I don't recall a phrase in the Hippocratic oath that says "unless it costs too much."

 

[ChimpanzeeMinky]

Yeah...the freedoms outweigh the costs. Who's taking your freedoms exactly? You do realize saddling half the nation in debt via mortgages, car loans and medical bills is not freedom at all, right? And raising taxes on the wealthy is not taking their freedom, it is ensuring that our country doesn't become Feudal State v2.0 in a decade.

Saddling half the nation in debt via mortgages and car loans? Someone has a gun to peoples' heads forcing them to purchase houses larger than they can afford and assume mortgages that are destined to default? Someone has a gun to peoples' heads forcing them to purchase $60,000 automobiles over 6 year terms at high interest rates instead of purchasing something within their means?

Missing from every single one of your posts is any acknowledgement whatsoever of individual responsibility. Anyone who is in dire financial straits is a victim made so by the system.

But hey, why should anyone worry about taking responsibility for their own actions when we can simply raise taxes on the rich to pay for poor judgment? You subsidize something - you get more of it.

 

[meister]

Sounds like you're way too young to have needed a "fancy procedure" to save your life. Also sounds like you're way too young to be lying in a hospital bed not wanting today to be your last day. Basically, I'm respectfully saying you and the people like you are naive. Naive about what it takes to keep someone chronically ill alive, ie, "fancy procedures." Naive about what it's like to be a patient instead of a physician, ie, lying there wondering whether you're going to live or die that day. I recently saw the cover of Newsweek about how "killing granny" may help America, and I just shook my head at the state of American medicine. Hippocratic oath - where have you gone? I don't recall a phrase in the Hippocratic oath that says "unless it costs too much."

What are you talking about? Talk about a non-sequitur. Americans have problems dealing with death, generally, and as a result we spend hundreds of billions of dollars on people during the last few months of their life. One of the most basic things possible, the thoughtful development of a living will and other advanced medical directives, are routinely neglected even by the most educated of patients.

Why am I not surprised that you judged a book by its cover and didn't bother to read the article? You'd be wise to really think about "unless it costs too much" and apply that logic to those without insurance, or those who are underinsured, or basically anyone in the US who doesn't have a cadillac insurance plan or isn't wealthy.

 

[meister]

Someone has a gun to peoples' heads forcing them to purchase houses larger than they can afford and assume mortgages that are destined to default?

No, we just have a chronically deficient public school system that doesn't offer any real education on good personal finances.

Someone has a gun to peoples' heads forcing them to purchase $60,000 automobiles over 6 year terms at high interest rates instead of purchasing something within their means?

You deny the innate inequity of a single individual dealing with a bank? You deny any culpability on the part of the corporations who profited tremendously in the past ten years by saddling millions in the US with mortgages they can't pay and repackaging all the crap mortgages a thousand times over, getting it rated AAA and using CDOs and CDSs as a means to over-leverage and reap mega-profits?

Missing from every single one of your posts is any acknowledgement whatsoever of individual responsibility.

Because "individual responsibility" is a loaded term from a bygone era, just like "tort reform." The solutions to our problems aren't going to come from individuals making good choices, they're going to come from a total overhaul of our terrible system. Nowhere did I say individuals have zero responsibility for themselves.

 

[Downbytheicu]

Yeah...the freedoms outweigh the costs. Who's taking your freedoms exactly? You do realize saddling half the nation in debt via mortgages, car loans and medical bills is not freedom at all, right? And raising taxes on the wealthy is not taking their freedom, it is ensuring that our country doesn't become Feudal State v2.0 in a decade.

So what freedom, exactly, is being taken from you if we ensure that all have a baseline access to care?

First of all, you guys are using freedom in different ways. You are talking about a freedom from worries, the sort of freedom that children experience with their parents. The other argument is a freedom of choice. So get on the same page and argue with the same definitions, or else end the argument.

Ensuring proper medical care in spite of socioeconomic status is an indicator of a fully functioning first world democracy. I'm afraid that in this respect we are in the same league as Slovenia.

Isn't that the point of welfare? Why does this matter?

On this note, you can't compare us to Slovenia, like many people erroneously do. Why? Because our cultures are not the same. We have tremendously high levels of obesity and diabetes that drive up our cost and affect statistics like infant mortality. Is that an effect of poor health care? Maybe, but maybe not. It's more likely an effect of our country's collective lifestyle. Do statistics flesh out these issues? No. So let's end that rhetoric and talk about Physician Salaries.

 

[meister]

So let's end that rhetoric and talk about Physician Salaries.

We sort of tried a few pages back but it just gets derailed because some people think what's happening is government takeover of healthcare and physician salaries of less than $100k. That idea is preposterous, as most observers would agree, and physician salaries aren't really in danger of tanking to $50k at the moment so what is there to discuss exactly? What I have been proposing isn't going to happen, and what Prowler is proposing isn't going to happen. What is going to happen is an individual mandate, higher out-of-pocket expenses for the middle class, no business mandate to speak of, and the further cementing of for-profit corporations as the main benefactors of profitable, healthy, young patients. And the taxpayer gets saddled with the poor, the elderly, the military, the retired military, the newly bankrupt and the disabled.

Thus, we keep coming back to the same debate. Because the "debate" happening in DC isn't really a debate at all and is just a sad morbid display of cynicism.

 

[RGMSU]

What are you talking about? Talk about a non-sequitur. Americans have problems dealing with death, generally, and as a result we spend hundreds of billions of dollars on people during the last few months of their life. One of the most basic things possible, the thoughtful development of a living will and other advanced medical directives, are routinely neglected even by the most educated of patients.

Why am I not surprised that you judged a book by its cover and didn't bother to read the article? You'd be wise to really think about "unless it costs too much" and apply that logic to those without insurance, or those who are underinsured, or basically anyone in the US who doesn't have a cadillac insurance plan or isn't wealthy.

Not a non-sequitir. You just brought up again exactly what I'm referring to. I'm not talking about the article. I'm referring to your own words. Example - "We spend hundreds of billions of dollars on people during the last few months of their life." Yep, it's kinda customary to need more medical care when you're dying. So, what, just knock 'em off a little early and save money? If you spent much time with patients and patients families, you would respect the fact that decreasing medical care at a time of chronic decline is usually not desired. Thoughtful development of a living will? Now, that's a non-sequitir. A living will does nothing to curb the costs of chronic care, unless of course the patient desires not to have chronic terminal care, which is usually not the case. Most patients don't offer advanced medical directives, not because they are too uneducated to do so, but because they desire that everything possible be done in the moment it is required, rather than making a premature determination not to receive a certain type of intervention. And, yes, I think we can treat the uninsured and underinsured in a SIMILAR manner (not the SAME) as we treat those with "cadillac" plans. Point 1 - If we spend millions of dollars on bribing rogue nations as a society, we can spend a few bucks on our own damned people. Point 2 - A lot of docs would engage in benevolent pro-bono treatment if Medicare/Medicaid rules didn't prevent them from doing so without jumping through a bunch of hoops. Point 3 - My argument isn't against providing everyone healthcare. My argument is against insuring everyone with a lower quality care for many imposed by a third party. You seem to be conceding that lower quality care must result for some (eg, no "fancy procedures" or chronic end-of-life care). I am not suggesting that everyone should receive everything without discretion. That is unreasonable. But outright denying care by insurance company bureaucrats and government flunkies against a physician's advice is insane.

What is the solution? I honestly don't have the first damn clue. It seems the proposals are getting worse rather than better though. In the movement from the original plan to the Baucus plan, we lost the public option, which largely removes the entire justification for undertaking healthcare reform anyway since everyone will not be covered. I live in an area with a private geographic HMO that is quite successful - Scott and White in Texas. Care is top notch and prices are reasonable. Having a primary care physician gate keeper is a more effective way to trim costs than having decisions made by bureaucrats, since primary care physicians actually have medical knowledge useable in decision-making on a case-by-case basis. Yet, we have a shortage of primary care physicians that will likely worsen rather than improving. I suspect that the desire to extend care to everyone and cut costs at the same time is almost impossible on the face of the argument. You can either cut costs by decreasing care or increase care, which will increase costs. You can't do both at the same time very effectively. So, what is the goal of the healthcare reform proposals - cost control, universal coverage, or both? If the answer is both, I don't believe it will work - we will wind up spending more on the aggregate and getting less care. If you split the two up, neither outcome is particularly good for public opinion (denied care or increased taxes, respectively).

 

[meister]

I'm not talking about the article. I'm referring to your own words. Example - "We spend hundreds of billions of dollars on people during the last few months of their life." Yep, it's kinda customary to need more medical care when you're dying.

Yes, and not having an advance directive, or a living will, and not communicating with your children or physician exactly what is the extent of life-saving measures you would want is a part of that. Who said anything about government bean-counters pulling the plug? Or denying necessary care if it is indicated and the patient requests it? Or denying care for chronic diseases?

These are just strawmen you're building up. I have not said one damn thing about any of that.

So, what, just knock 'em off a little early and save money?

This is the same cynical misrepresentation that some of the more repugnant politicians are using as the current political football de jour. There is no need to insinuate that I want to kill elderly patients. I just feel that conversations about end-of-life care with physicians and with family members is something that is not fully appreciated and ignored in our country.

But outright denying care by insurance company bureaucrats and government flunkies against a physician's advice is insane.

You know some of what you say is very agreeable but no one has suggested anything like this, just FYI.

 

[RGMSU]

Communicating about end-of-life care may or may not be of dubious value, but I agree with you that there is not enough communication about it. Every grandma in America still wants to buy a mechanized chair whether they will use it or not. Why? Because they see a commercial on TV that says they can get one. Communicating about end-of-life care may backfire. You may discover that people desire MORE rather than LESS of it. When you bring up end-of-life costs and reducing "fancy procedures" in debate, you should know that it will imply cost saving attempts in the minds of your listeners. It's interesting how folks start back-tracking on the end-of-life care and chronic care cost-saving business. Again, I don't know how you're going to SAVE money by increasing the patient base AND offering to give everyone end-of-life care and chronic care without rationing. You don't think existing government programs, the most egregious of which being Medicaid, ever denies anybody anything? These issues of increasing the patient base while also cutting costs aren't straw men. They're the big elephants in the corner of the room that nobody who is proposing healthcare reform wants to talk about. That is why public opinion is swinging against it. We are not all stupid enough to believe that these issues will not have to be revisited after a healthcare bill is passed. Proponents of reform hope these controversial issues are addressed after passage rather than before, I have noticed. Questioning politicians' understanding of the complexities of this issue and how this will affect future implementation is not "cynical misrepresentation," but rather reasonable exploration of possible consequences of actions. Again, the thrust of my argument is that suggesting increased coverage with decreased cost is disingenous. You can increase coverage, but it won't cost less to do it. I believe that most of the public understands this, they know that politicians are lying about it, that's why they smell a skunk, and their public opinion about the issue reflects it.

 

[meister]

Again, I don't know how you're going to SAVE money by increasing the patient base AND offering to give everyone end-of-life care and chronic care without rationing.

So we should keep the patient base as little as possible...by....wait for it....rationing! Dude just admit that we ration already by some of the cruelest methods possible and let's move on.

Again, the thrust of my argument is that suggesting increased coverage with decreased cost is disingenous. You can increase coverage, but it won't cost less to do it. I believe that most of the public understands this, they know that politicians are lying about it, that's why they smell a skunk, and their public opinion about the issue reflects it.

Public opinion is widely in favor of a public insurance option. But the thing is that you are essentially correct, but not for the reason you think. Insuring everyone in our current paradigm is going to bankrupt the middle class and the nation. That's why the whole thing has to be restructured. That won't happen until we're forced to seriously deal with our fiscal irresponsibility and forced to abandon our global empire.

 

[Concubine]

Sounds like you're way too young to have needed a "fancy procedure" to save your life. Also sounds like you're way too young to be lying in a hospital bed not wanting today to be your last day. Basically, I'm respectfully saying you and the people like you are naive. Naive about what it takes to keep someone chronically ill alive, ie, "fancy procedures." Naive about what it's like to be a patient instead of a physician, ie, lying there wondering whether you're going to live or die that day. I recently saw the cover of Newsweek about how "killing granny" may help America, and I just shook my head at the state of American medicine. Hippocratic oath - where have you gone? I don't recall a phrase in the Hippocratic oath that says "unless it costs too much."

There has to be a balance. I could see Meister's plan going the opposite direction, where government takes away most of individualized medicine and replaces it with a more "bottom line" form of medicine. The opposite of that is basically what we have now, where we spend millions of dollars on (in many situations) futile end-of-life care. If we could afford it, great, but we simply cannot. It is bankrupting us and even more importantly, our children. It's not like we are drawing the line because we want to, more like because we have to.

 

[Blesbok]

This is a very good point, why would I take on more debt and greater and harder time commitment to make the same as some who didnt. However i dont kno if washington cares/understands this.

The same can be said about cardiologists and IM docs. Sure, they can cut specialist costs somewhat, but there is a delicate balance there that if they disrupt will result in a complete lack of specialists. No one is going to do twice the residency/fellowship to get paid the same amount.

 

[meister]

The same can be said about cardiologists and IM docs. Sure, they can cut specialist costs somewhat, but there is a delicate balance there that if they disrupt will result in a complete lack of specialists. No one is going to do twice the residency/fellowship to get paid the same amount.

Just because cardiology might get a cut in reimbursement for some procedures and IM docs might get a boost on a few does not mean they would equalize.

These debates about salary are really quite sad because physicians as a group are lucky SOBs when it comes to job security and salary. But because of the MONSTROUS debt we are all worried about the bottom line. It's like no one can accept a yearly salary that's less than their total debt amount.

Just subsidize the education already, all this posturing is sad.

 

[Downbytheicu]

Alright, if we're going to keep on with this topic, here's a little wisdom from my undergrad engineering design classes:
"Something can be made cheaply, made with quality, or made quickly. The best you can get is two out of the three."

I believe the same argument holds for health care. Right now, it is fast and it is quality (I know the statistics but they neglect our poor lifestyles), but not cheap. The reform movement is to make it cheap. What will be the other character?

 

[RGMSU]

Well, we can agree that rationing does occur now, and that it will likely worsen because of the upcoming baby boomer graying. I hate hearing people talk about educational subsidization as a solution. There is no way it would be retroactive, which would mean that those of us already taking out massive debt would get doubly screwed by having our salaries cut and still being forced to pay debt back, while the next wave of physicians wouldn't have the debt burden. I don't think it is unreasonable to talk about salaries. We have entered into a contract with our society. We agree to give up several years of our lives to train to take care of them. We agree to see them when they are sick and put ourselves at risk in the process (eg, H1N1 this fall?). We agree to put them ahead of ourselves when we receive the 2am phonecalls. And, yes, we agree to the massive debt loads that will take at least a decade of steep payments to return to our lenders. Yes, physicians make a great living. However, there are physicians leaving family medicine in droves because of the low reimbursement rates, so in many fields the salaries really can't go much lower and maintain a decent workforce. I still don't believe you can save money, increase coverage, and maintain high quality. That doesn't mean changes shouldn't be made. It just means we should be honest with people about the fact that their taxes will likely increase substantially over the long haul. I'm not sure about your evaluation of public opinion. There sure are a lot of people angry and frightened about all this for the majority to be in favor of it. I'm not sure how much thought people have put into it either.

 

[Blesbok]

Just because cardiology might get a cut in reimbursement for some procedures and IM docs might get a boost on a few does not mean they would equalize.

These debates about salary are really quite sad because physicians as a group are lucky SOBs when it comes to job security and salary. But because of the MONSTROUS debt we are all worried about the bottom line. It's like no one can accept a yearly salary that's less than their total debt amount.

Just subsidize the education already, all this posturing is sad.

There is no luck about it. Physicians are hard working people that reap the benefits of that work. The lazy son who's father owns an oil company is lucky, physicians are reimbursed.

 

[RGMSU]

There is no luck about it. Physicians are hard working people that reap the benefits of that work. The lazy son who's father owns an oil company is lucky, physicians are reimbursed.

I agree. We are fortunate to have the opportunity to be a part of a profession that currently offers several advantages. However, it's not like it was handed to us by any stretch of the imagination.

 

[45408]

There is no luck about it. Physicians are hard working people that reap the benefits of that work. The lazy son who's father owns an oil company is lucky, physicians are reimbursed.

No kidding. For the time put in and financial investment involved, being a physician is in the same league as some other professions. It's not a legitimate comparison to compare physicians to the working population at large.

 

[bcat85]

No kidding. For the time put in and financial investment involved, being a physician is in the same league as some other professions. It's not a legitimate comparison to compare physicians to the working population at large.

Word. BTW, there's absolutely no way Meister is an honest-to-God medical student. Two reasons:

1. No medical student I have ever met has the time to look random crap up like he does.

2. No medical student thinks like that. Seriously? Do you not have any desire to have a family and to be well compensated for literally taking 8-15 years of your life and working like an indentured servant? You are either Mother Theresa's very condescending and rude sister, a troll with a lot of time on his hands, or so naive that you actually believe what you are saying (by far the most frightening of the three possibilities).

 

[meister]

Word. BTW, there's absolutely no way Meister is an honest-to-God medical student. Two reasons:

1. No medical student I have ever met has the time to look random crap up like he does.

2. No medical student thinks like that. Seriously? Do you not have any desire to have a family and to be well compensated for literally taking 8-15 years of your life and working like an indentured servant? You are either Mother Theresa's very condescending and rude sister, a troll with a lot of time on his hands, or so naive that you actually believe what you are saying (by far the most frightening of the three possibilities).

You didn't really read anything I said did you?

 

[TexasFight]

You didn't really read anything I said did you?

As an observer reading along through this tread, I would say he definitely read everything you wrote. I can't say the same for you though.