Should medicine be an entitlement?

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PL198 said:
so when there aren't major cover-ups, long waits, poor pay you mean?
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Most locations never "covered up" anything. Americans have gotten used to getting things on demand. Those "long waits" aren't really that long and things that need to be done soon, are. Pay isn't poor it's completely proportional to the work done. Plus there is no job left in medicine with a 20 years to retirement, except the VA. What's it to you if some docs like the trade in hours and the prospect of a pension for a lower pay?
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DocVader1990 said:
Unless you have Down Syndrome there isn't much to disagree with in what I said.
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Ah now you've clearly convinced me that yours is the more compassionate and worthy side of the argument!
 
DocVader1990 said:
1)I was talking about an ideal govt but vent away.

2) This does not even address my point and is purely anecdotal.

3) Americas system is expensive because of basic economics. You decrease spending by cutting a middle man. In the US we added a middle man in the insurance companies, costs went up. This is a system designed to make money, not to benefit society. Unnecessary procedures are secondary to this "free market healthcare" and are actively encouraged by policy and current individualistic societal values.

My reply will of course be meaningless to you since your anti-govt biases are readily apparent but here goes. To reiterate ( for the 3rd time in one stupid thread) the primary function of the govt. is to serve its people. The US govt. does this by providing funding for public order (police spending, defense spending, military spending) and maintaining proper infrastructure ( roads, stoplights, transportation) all of which is funded by taxes. Unless you have Down Syndrome there isn't much to disagree with in what I said.

Interestingly these public services are not seen by many as an entitlements but wait a second....they are.You want roads? Work harder and pay for them yourself.

And if medicine is an entitlement that should be forbidden then all public services should be suspended for being entitlements too, it is only logical. From welfare to unemployment insurance, plowing the roads during winter, building bridges, fixing highways, every last one of them gone.

Obviously I am being sarcastic. We don't live in a world where military spending or road spending will be more important than healthcare right?? WRONG! Welcome to the United States of America, a country with more military spending than the rest of the world combined ( even after spending cuts!!!!).

Why can't the govt provide free health care for all? Is that not its purpose? To serve and protect its citizens. That why we have a govt. The answer given by many is always one of principle and conservative thinking. "It's not American!" goes the stupefying rallying cry of masses. This issues reveals the hypocrisy that currently permeates modern American thought. We would gladly allow the govt to prioritize and spend trillions on military spending but never allow it to spend a portion of that to provide healthcare for all its citizens.
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it's not free. if you can't get around that concept, then you're naive to the nth level. everything has a cost.

that's like when your school gives you uworld for " free" yeah go look in your student fees and tell me how free it is
 
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jdh71 said:
That's not a fair representation at all. Physician pay is lower but they don't work as hard. Most treatments don't need to be done "right now" and can wait. No one makes vets live hours from their medical care and if there is anything emergent local services are covered. The staff who hid the outpatient visit wasn't a systemic phenomenon and occurred in only a few locales. It work great for almost all veterans. It's not perfect, nor does it claim perfection but it's not a mess. Not even close.
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Yeah; it's so not a mess that the guy who led it had to resign.
 
GUH said:
Yeah; it's so not a mess that the guy who led it had to resign.
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That's politics. Not evidence that the entire VA system is a "mess".

Show me real objective numbers not headlines if you want to make your case. Don't appeal to emotion here.

I worked primary care and speciality care at the VA for 6 years. Vets were treated very good and all got the care they needed. And when needed right away, it happened right away.
 
jdh71 said:
Most locations never "covered up" anything. Americans have gotten used to getting things on demand. Those "long waits" aren't really that long and things that need to be done soon, are. Pay isn't poor it's completely proportional to the work done. Plus there is no job left in medicine with a 20 years to retirement, except the VA. What's it to you if some docs like the trade in hours and the prospect of a pension for a lower pay?
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I have no problem with a situation like you said regarding pay, but it's my understanding that the hours at the VA are often mis-represented and physicians end up working longer than is stated
 
PL198 said:
I have no problem with a situation like you said regarding pay, but it's my understanding that the hours at the VA are often mis-represented and physicians end up working longer than is stated
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You mean sometimes docs work longer to take care of patients? That's called being a "doctor". Some specialties will have it better with the edge of the hours than the others but it's largely contracted gig. You work your hours or shifts and then punch out.
 
jdh71 said:
That's politics. Not evidence that the entire VA system is a "mess".

Show me real objective numbers not headlines if you want to make your case. Don't appeal to emotion here.

I worked primary care and speciality care at the VA for 6 years. Vets were treated very good and all got the care they needed. And when needed right away, it happened right away.
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Because you worked for the VA, we should trust you when you say that the VA is great in spite of the many outside reports (and reports from veterans) of rampant mismanagement?
 
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GUH said:
Because you worked for the VA, we should trust you when you say that the VA is great in spite of the many outside reports (and reports from veterans) of rampant mismanagement?
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Show me all of these reports.

You don't have to trust me about anything. What I am trying to tell you is that your accusations here do not line up with reality at one if the largest VAs in the country in my experience. I do wonder why? If it as rampant as you would have me believe?

You can always find unhappy people and outlier cases. These do not a systemic problem make.

The VA does have problems currently with handling disability claims and managing psychiatric illness system wide. In a few locations they have had problems with primary care. Otherwise pretty good care.
 
jdh71 said:
Most locations never "covered up" anything. Americans have gotten used to getting things on demand. Those "long waits" aren't really that long and things that need to be done soon, are. Pay isn't poor it's completely proportional to the work done. Plus there is no job left in medicine with a 20 years to retirement, except the VA. What's it to you if some docs like the trade in hours and the prospect of a pension for a lower pay?
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Don't forget no malpractice. I considered getting a va job but they didn't have any available in locations i liked.

I have also received va care and it was decent and timely for me. My uncle and my dad haven't had any complaints either. That might be related to it being in big cities though.
 
dpmd said:
Don't forget no malpractice. I considered getting a va job but they didn't have any available in locations i liked.

I have also received va care and it was decent and timely for me. My uncle and my dad haven't had any complaints either. That might be related to it being in big cities though.
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Almost forgot about the no malpractice
 
jdh71 said:
Almost forgot about the no malpractice
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I recently paid my full annual premium (which is still heavily discounted because i am newly practicing) so it is hard for me to forget.

Also licensing is nice. No need to get a new license if working at a different va (unless you want to work another job too i guess).
 
dpmd said:
Don't forget no malpractice. I considered getting a va job but they didn't have any available in locations i liked.

I have also received va care and it was decent and timely for me. My uncle and my dad haven't had any complaints either. That might be related to it being in big cities though.
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The other nice thing is you only need to be licensed in ONE state.
 
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dpmd said:
I recently paid my full annual premium (which is still heavily discounted because i am newly practicing) so it is hard for me to forget.

Also licensing is nice. No need to get a new license if working at a different va (unless you want to work another job too i guess).
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That's what I get for not refreshing the thread.
 
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If we stopped going to war, we could have free healthcare and education
 
GunnerBMS said:
If we stopped going to war, we could have free healthcare and education
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you keep using the word free. I don't think you know what that means
 
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GunnerBMS said:
If we stopped going to war, we could have free healthcare and education
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Or we could instead stop getting further in debt to China and allow working people to keep more of their own money.
 
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PL198 said:
it's not free. if you can't get around that concept, then you're naive to the nth level. everything has a cost.

that's like when your school gives you uworld for " free" yeah go look in your student fees and tell me how free it is
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Well of course not, its paid for by taxes! Which are taken from our pockets either way, so you are right it's not free.

The issues is that you're reply yet again fails to address the issues raised in my post and focuses on petty semantics. But once again on the forums of SDN I am the on that is naive to the nth level.
 
panamerica said:
Sometimes I wish time travel were a thing, purely for the purpose of allowing the modern conservative to go back to the Utopian days of the early industrial revolution before we ruined everything with evil social safety nets.
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Is this even serious? I really hope this isn't serious...
 
DocVader1990 said:
Well of course not, its paid for by taxes! Which are taken from our pockets either way, so you are right it's not free, but that was heavily implied in my post which you once again failed to understand.

Worse off you're reply yet again fails to address the issues raised in my post and focuses on petty semantics. But once again on the forums of SDN I am "naive to the nth level.":bow:
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thepoopologist said:
I'm there. I'm totally there. Getting just one license was enough for me.
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I'm licensed in 4 and some of you know my story and I just can't. I hate it so much every time. It's the same crap every time I do a new credentialing too. I mean I get it. ONE doc can really do a lot of damage so you need to head this stuff off are the pass but man wen you're doing through it, it is hard not to take it a little personal.
 
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jdh71 said:
I'm licensed in 4 and some of you know my story and I just can't. I hate it so much every time. It's the same crap every time I do a new credentialing too. I mean I get it. ONE doc can really do a lot of damage so you need to head this stuff off are the pass but man wen you're doing through it, it is hard not to take it a little personal.
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jdh sighting :cat:
 
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jdh71 said:
I'm licensed in 4 and some of you know my story and I just can't. I hate it so much every time. It's the same crap every time I do a new credentialing too. I mean I get it. ONE doc can really do a lot of damage so you need to head this stuff off are the pass but man wen you're doing through it, it is hard not to take it a little personal.
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I can't even imagine. It has to make a stressful process even worse.
 
PL198 said:
you keep using the word free. I don't think you know what that means
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If you weren't buying a twelve-pack of beer, you could get three free boxes of cigarettes!
 
gxb said:
So by your logic, no one should be entitled to use the police services? If a poor person calls the police, they won't come because they know the person won't be able to compensate them for their skills? What kind of logic are you using? Sure, if you have enough money, you can always use a bodyguard or hire a private security company but for the general public, there needs to be a service available to whoever needs it. Plus, who told you that doctors should not be compensated for their skills? I never mentioned this nor implied it and I don't know why you used it in your argument.

In regards to my reference to "life" and "pursuit of happiness," that's my personal understanding and interpretation and should not affect core of the issue here. Most people are opposed to theft, for example, but their opposition can be based on Karma, higher power, morals, belief system, or simply fear of legal consequences. However, collectively, they create a large body of people who oppose theft. Likewise, many people share the belief that medicine should be a right to everyone for various reasons, and mine just happens to be the aforementioned case.
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The original person that you responded to with this response never implied nor even mentioned any of what you responded to. You simply just made up what they were trying to say, and responded to your own made up question. You said "So by your logic," that was an incorrect statement for you to make, and you didn't even respond to their logic. You responded to your projection of their logic. I'm fairly certain that you've made an unethical argument.
 
You are only entitled to something- if you can produce it or gather it yourself without hindering another persons ability to do the same (individual rights.) Even then, you are not entitled to it if you have not gathered the resources to create what you could otherwise produce.

Love, compassion, care, and empathy are what causes someone to share their earnings with another.
 
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jdh71 said:
Show me all of these reports.

You don't have to trust me about anything. What I am trying to tell you is that your accusations here do not line up with reality at one if the largest VAs in the country in my experience. I do wonder why? If it as rampant as you would have me believe?

You can always find unhappy people and outlier cases. These do not a systemic problem make.

The VA does have problems currently with handling disability claims and managing psychiatric illness system wide. In a few locations they have had problems with primary care. Otherwise pretty good care.
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Wasnt one of the whistleblower doctors in Arizona demoted when she complained to the VA admin about those problems?
 
jdh71 said:
Non sequitur
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How is that a non sequitur? You said the VA isn't as bad as people think it is and I showed u where complaints regarding pt. care were involved and they were demoted & silenced.
 
charmiedermie said:
How is that a non sequitur? You said the VA isn't as bad as people think it is and I showed u where complaints regarding pt. care were involved and they were demoted & silenced.
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Do I really need to explain to you how you cannot extrapolate one incident to an entire nationwide system. That it's crappy thinking and you should be embarrassed of yourself for suggesting it? Do I really need to spell that out for you? It's the same categorical error that says if one bad dog bites all dogs must be bad.

I will reiterate. A few unhappy customers, one isolated incident do not a bad system make. Please find me the rampant and system wide problems documented in multiple sources in multiple locations.

Google is your friend and I will patiently await your response.
 
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jdh71 said:
Do I really need to explain to you how you cannot extrapolate one incident to an entire nationwide system. That it's crappy thinking and you should be embarrassed of yourself for suggesting it? Do I really need to spell that out for you? It's the same categorical error that says if one bad dog bites all dogs must be bad.

I will reiterate. A few unhappy customers, one isolated incident do not a bad system make. Please find me the rampant and system wide problems documented in multiple sources in multiple locations.

Google is your friend and I will patiently await your response.
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The other link @sb247 posted was at the St. Louis VA not in Arizona. Whistleblowers who rat on the system were dealt with in the same way. These weren't "unhappy customers" but doctors trying to protect veteran patients.
 
charmiedermie said:
The other link @sb247 posted was at the St. Louis VA not in Arizona. Whistleblowers who rat on the system were dealt with in the same way. These weren't "unhappy customers" but doctors trying to protect veteran patients.
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Still waiting to see your rash of multiple cases consistent with a "systemic problem".

Your lack of ability to do so is noted.
 
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charmiedermie said:
3 documented incidents (Phoenix, St. Louis, Wyoming) that actually made it to the press. It isn't an indictment on the people, but the VA system that allows it to happen. But since they are all non-sequiturs to you, there is no point in further discussing this with you.

Here's another one in Colorado :
http://coffman.house.gov/media-center/in-the-news/colorado-va-workers-falsified-veterans-documents
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It happened at a few locations. It never happened in any clinic I was ever associated with and you'd think they would have brought that up at the week evil VA workers meeting in places I worked. Right? If it was so systemic?

Once a week for three years I saw my VA patients. They got all the right medications and appropriate evidence based screening. They were seen by specialist when I sent them. There wasn't a day they were not given excellent care because they were at a VA. Then for the next three years I spent my time taking care of folks in a VA pulmonary clinic at a different VA. Patients got appropriate medications and work up for their pulmonary issues including meeting at 6am once per week with oncologists and surgeons to discus pulmonary lesions and the best way to treat them. Including bronchoscopic evaluation and biopsy and even surgical resection of appropriate cancers that would happen within a week. And when I had free time and was interested in making some extra money Id spend 12 hour shifts working in the ED where EVERY sick patient was taken care of: heart attacks, strokes, septic shock, perforated viscous, PE, etc. Every consult I called to the ED came to see the patient.

So please tell me in all that time and experience if we were taking such ****ty care of VA patients why I never saw it? Not once. Not from a single VA doc?? If thus is such a big system wide problem why aren't veterans just dying in the street and we see articles on the paper every day?

Have you ever even worked a day in a VA in your life? Does your school even have a VA?
 
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jdh71 said:
It happened at a few locations. It never happened in any clinic I was ever associated with and you'd think they would have brought that up at the week evil VA workers meeting in places I worked. Right? If it was so systemic?

Once a week for three years I saw my VA patients. They got all the right medications and appropriate evidence based screening. They were seen by specialist when I sent them. There wasn't a day they were not given excellent care because they were at a VA. Then for the next three years I spent my time taking care of folks in a VA pulmonary clinic at a different VA. Patients got appropriate medications and work up for their pulmonary issues including meeting at 6am once per week with oncologists and surgeons to discus pulmonary lesions and the best way to treat them. Including bronchoscopic evaluation and biopsy and even surgical resection of appropriate cancers that would happen within a week. And when I had free time and was interested in making some extra money Id spend 12 hour shifts working in the ED where EVERY sick patient was taken care of: heart attacks, strokes, septic shock, perforated viscous, PE, etc. Every consult I called to the ED came to see the patient.

So please tell me in all that time and experience if we were taking such ****ty care of VA patients why I never saw it? Not once. Not from a single VA doc?? If thus is such a big system wide problem why aren't veterans just dying in the street and we see articles on the paper every day?

Have you ever even worked a day in a VA in your life? Does your school even have a VA?
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I get it now, when we say, "the VA has a bunch of problems" you are hearing "jdh is a bad doctor"...no one is saying that.
 
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sb247 said:
I get it now, when we say, "the VA has a bunch of problems" you are hearing "jdh is a bad doctor"...no one is saying that.
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No.. I think you're missing the point. VAs certainly do have issues. But so does every hospital in the US, there is always room for improvement. What everyone is saying is that the system isn't as bad as the media would have you believe. Anyone that's spent an appreciable amount of time in a VA likely feels this way too
 
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Beacopp665 said:
No.. I think you're missing the point. VAs certainly do have issues. But so does every hospital in the US, there is always room for improvement. What everyone is saying is that the system isn't as bad as the media would have you believe. Anyone that's spent an appreciable amount of time in a VA likely feels this way too
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My family that spent an appreciable amount of time waiting for appts that they then spent an appreciable amount of time driving to sure think that there a lot of issues

This centrally planned mess isn't efficient in any way, the best solution is to have the gov act as insurer for vets and actually pay out at rates high enough those vets can find their own doctors in their own towns on their own terms.
 
sb247 said:
I get it now, when we say, "the VA has a bunch of problems" you are hearing "jdh is a bad doctor"...no one is saying that.
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Not quite. I know I'm a good doc and the opinion of medical students at SDN aren't part of my validation of that fact.

My problem is that it's just plain wrong that the VA doesn't generally take good care of it's patients.

There are inefficiencies everywhere in every healthcare system, including the cash machines known as the world famous mayo clinic and the Cleveland clinic . . . Unless you are VIP enough. It's just the world we live in. It's not a sign of a systemic problem, it's simply healthcare, everywhere in this country today where it meets a small but vocal demanding and or upset minority. All that noise doesn't a problem make. Four VA hospitals with problems doesn't a systemic wide problem make. And when the problem at those places saw the light of day things were changes to address the problem and fixed as best they could. A sign of a systemic issue would be not addressing the problem at all.

As noted previously the VAs biggest problem in my opinion is it's huge backlog of disability claims and enough psychiatric care to those who need it, including the folks struggling with substance abuse.

The VA doesn't tell people where to live and of one chooses to live far from ones physician that's a free choice made by a person who both wants the VA's help and to live where they want. You can't look at your beautiful cake and eat it as well. Should the VA be open to more fee basis local service for some folks? Sure why not. But it doesn't make them evil if they say, "we have that service here, please drive in - we are paying for all of this after all"
 
SouthernSurgeon said:
Including reimbursement for travel.

Pro tip: Don't ever get between a vet and their travel pay. Single biggest barrier to discharge on a major holiday is that the travel pay folks aren't there.
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Plus they do have a program where you can apply to get care locally. Not sure how hard it is to get into that program, but it is something they have. The real issue is that they are trying to provide care for more people (due to more people being considered to have service connected issues with the recognition of even stuff such as diabetes as service related if you were in certain places during vietnam and other similar scenarios) with a limited budget. Then you have some people deciding that the way to make sure stuff happens is to have arbitrary goals to meet (like a wait time of X) and people working on trying to at least make it seem like they are meeting those goals. It isn't an issue unique to a government run system. If the government just acted as insurer, but told providers they had to meet a wait time goal of X some would comply if it was feasible, but others would just pretend to by shifting around the numbers. Sort of like when you see a hospital claiming not to have had any ventilator associated pneumonia for 2 yrs (which one of the hospitals I work at actually claims).
 
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