Should we have single-payer healthcare?

[johnfree7]

Although the free market is a great tool for providing the public with the best, cheapest TV set, washer/dryer or car, maybe it doesn't work for healthcare, which is part of the reason countries with "socialized" medicine end up with much cheaper care and comparable results.
Many of the elements that make a free market efficient are simply not present in healthcare :
1) The person making the decision to consume a certain drug or medical procedure (doctor) is most often not the person paying for it (patient or insurance co). Often, the person making that decision doesn't even know the cost of the drug or procedure or at worst, is in conflict of interest.
2) People are not rational agents when it comes to healthcare : When facing death or suffering, most people will be willing to spend fortunes on things that only offer very marginal benefits. Few people would buy a car that is 10 times more expensive but gives you 5% better odds of surviving an accident. Yet when it comes to pharmaceuticals, such a marginal effect is enough for a drug to become the new guideline (especially in oncology), no matter the cost of that drug.
3) Reliance on ever longer patents : succesful lobbying and tinkering with certain molecules have allowed pharmaceutical to prolong the patents on blockbuster drugs. The prices are then arbitrarily set by these pharma co (see the Shkreli case) who rarely have to justify themselves. Competition only enters the picture when generics are allowed, often only after decades.
4 ) Limited ability to compare options : Altough it is always possible to get a second opinion for elective operations or treatment fo chronic diseases, that is simply absent for all urgent care. Furthermore, most people do not know enough to adequatly compare the different options available to them and simply rely on the authorithy of a trusted healthcare provider (which again is often in a position of conflict of interest).

Furthermore, patients have the most expensive healthcare in the world in the US, but we are ranked 31, and below many countries in terms of patient outcome. It's not working for the vast majority of Americans. It just isn't.

This is why healthcare in general, including drug development and production, should be managed by the state, that has an interest in having the healthiest population for the least amount of money, instead of simply higher profits for the shareholders.

---

Members don't see this ad.

 

[jqueb29]

No.

 

[Bones 2020]

Good luck destroying and trying to rebuild one of the biggest parts of the US economy

 

[johnfree7]

Good luck destroying and trying to rebuild one of the biggest parts of the US economy

The United States is the only major country on earth that doesn’t guarantee health care to all people. And we end up spending far more per capita in health care as do the people of any other country.

Do the American people get what they pay for? The World Health Organization doesn't even rank us in the top 25 in terms of overall quality of healthcare.

We pay the most. We are ranked 31.

Outcomes in every other developed country are better on almost every measure, from infant mortality to life expectancy.

That is pathetic. We need to start over.

 

[ERDOC555]

Although the free market is a great tool for providing the public with the best, cheapest TV set, washer/dryer or car, maybe it doesn't work for healthcare, which is part of the reason countries with "socialized" medicine end up with much cheaper care and comparable results.
Many of the elements that make a free market efficient are simply not present in healthcare :
1) The person making the decision to consume a certain drug or medical procedure (doctor) is most often not the person paying for it (patient or insurance co). Often, the person making that decision doesn't even know the cost of the drug or procedure or at worst, is in conflict of interest.
2) People are not rational agents when it comes to healthcare : When facing death or suffering, most people will be willing to spend fortunes on things that only offer very marginal benefits. Few people would buy a car that is 10 times more expensive but gives you 5% better odds of surviving an accident. Yet when it comes to pharmaceuticals, such a marginal effect is enough for a drug to become the new guideline (especially in oncology), no matter the cost of that drug.
3) Reliance on ever longer patents : succesful lobbying and tinkering with certain molecules have allowed pharmaceutical to prolong the patents on blockbuster drugs. The prices are then arbitrarily set by these pharma co (see the Shkreli case) who rarely have to justify themselves. Competition only enters the picture when generics are allowed, often only after decades.
4 ) Limited ability to compare options : Altough it is always possible to get a second opinion for elective operations or treatment fo chronic diseases, that is simply absent for all urgent care. Furthermore, most people do not know enough to adequatly compare the different options available to them and simply rely on the authorithy of a trusted healthcare provider (which again is often in a position of conflict of interest).

Furthermore, patients have the most expensive healthcare in the world in the US, but we are ranked 31, and below many countries in terms of patient outcome. It's not working for the vast majority of Americans. It just isn't.

This is why healthcare in general, including drug development and production, should be managed by the state, that has an interest in having the healthiest population for the least amount of money, instead of simply higher profits for the shareholders. Do you agree?

Seems like the lack of a free market in medicine is causing most of these issues. We have a completely messed up system as is and single payer would only exacerbate these issues further.

Also, as a country we need to eventually say that enough is enough. We spend too much fighting end of life illnesses instead of just going out peacefully with morphine. The worst part is that everyone expects the state to cover those costs.

If we want to start fixing things, I think we need some serious drug, administrative (less administrative burden/bureaucracy), and legal (stop making doctors practice CYA Medicine) reforms for things to change.

 

[jqueb29]

Are you even in medical school? I feel like you would be singing a completely different tune if you had seen a little bit of the real world.

 

[Lucca]

Seems like the lack of the free market in medicine is causing most of these issues. We have a completely messed up system as is and single payer would only exacerbate these issues further.

Also, as a country we need to eventually say that enough is enough. We spend too much fighting end of life illnesses instead of just going out peacefully on morphine. The worst part is that everyone expects the state to cover those costs. I think we need some serious drug, administrative, and legal reforms for things to change.

"We need free markets in medicine, single payer is bad because reasons"

K

"...but we need to regulate care to stop spending money on old people dying and just let them die"

What this actually means in a free market system is that poor people get morphine and die and rich people get to pay their private provider however much they want to extend their lives as much as they see fit. It also means that you think regulating healthcare markets to lower costs and improve accessibility is bad but regulating medical care to remove autonomy from the physician and patient in order to lower costs and worsen accessibility is good.

"The worst part is everyone expects the state to cover those costs"

What is the point of a state if not to provide life-saving resources to its people when they need them while paying for it with the people's own tax money

"We need all of these reforms"

We need all of this other stuff so let's not think about this other thing is not a particularly convincing argument

 

[osckey]

People need to look into DPC models a lot more. That's a free market option that has been doing well so far.

 

[ERDOC555]

"We need free markets in medicine, single payer is bad because reasons"

K

"...but we need to regulate care to stop spending money on old people dying and just let them die"

What this actually means in a free market system is that poor people get morphine and die and rich people get to pay their private provider however much they want to extend their lives as much as they see fit.

"The worst part is everyone expects the state to cover those costs"

What is the point of a state if not to provide life-saving resources to its people when they need them while paying for it with the people's own tax money

"We need all of these reforms"

We need all of this other stuff so let's not think about this other thing is not a particularly convincing argument

Fair warning, I really don't have the time to get into a full fledged debate, so this will likely be all of a response I'll give

If rich people want to spend millions of their money for an extra 6-12 months of life via experimental treatments and other costly measures, then by all means let them spend their money as they see fit. Just take a look at how much the US spends for end of life care. We are simply dragging out the inevitable by a minimal amount at a ridiculous cost. Most of these extra months are in fact quite painful and miserable. When I'm 85 and break my hip/get cancer/suffer from rare disease, go ahead and put me in hospice, don't spend $500,000 to keep me alive for a few extra months.

 

[DKMA]

.

 

[ParamagicCCP]

Outcomes in every other developed country are better on almost every measure, from infant mortality to life expectancy.

I see this stat all over, but I would contend that the difference in lifestyle in other developed countries may have a major role in this (e.g. walking much more common, smaller portions, ect). However, I would argue that the quality of healthcare in America is unmatched by any other developed country.

 

[deleted600623]

I see this stat all over, but I would contend that the difference in lifestyle in other developed countries may have a major role in this (e.g. walking much more common, smaller portions, ect). However, I would argue that the quality of healthcare in America is unmatched by any other developed country.

This.

 

[Lawpy]

Although the free market is a great tool for providing the public with the best, cheapest TV set, washer/dryer or car, maybe it doesn't work for healthcare, which is part of the reason countries with "socialized" medicine end up with much cheaper care and comparable results.
Many of the elements that make a free market efficient are simply not present in healthcare :
1) The person making the decision to consume a certain drug or medical procedure (doctor) is most often not the person paying for it (patient or insurance co). Often, the person making that decision doesn't even know the cost of the drug or procedure or at worst, is in conflict of interest.
2) People are not rational agents when it comes to healthcare : When facing death or suffering, most people will be willing to spend fortunes on things that only offer very marginal benefits. Few people would buy a car that is 10 times more expensive but gives you 5% better odds of surviving an accident. Yet when it comes to pharmaceuticals, such a marginal effect is enough for a drug to become the new guideline (especially in oncology), no matter the cost of that drug.
3) Reliance on ever longer patents : succesful lobbying and tinkering with certain molecules have allowed pharmaceutical to prolong the patents on blockbuster drugs. The prices are then arbitrarily set by these pharma co (see the Shkreli case) who rarely have to justify themselves. Competition only enters the picture when generics are allowed, often only after decades.
4 ) Limited ability to compare options : Altough it is always possible to get a second opinion for elective operations or treatment fo chronic diseases, that is simply absent for all urgent care. Furthermore, most people do not know enough to adequatly compare the different options available to them and simply rely on the authorithy of a trusted healthcare provider (which again is often in a position of conflict of interest).

Furthermore, patients have the most expensive healthcare in the world in the US, but we are ranked 31, and below many countries in terms of patient outcome. It's not working for the vast majority of Americans. It just isn't.

This is why healthcare in general, including drug development and production, should be managed by the state, that has an interest in having the healthiest population for the least amount of money, instead of simply higher profits for the shareholders.

A nice continuation to...

http://forums.studentdoctor.net/thr...-single-payer-healthcare-system-work.1180162/

Which got dumped in SPF!

 

[guest794]

However, I would argue that the quality of healthcare in America is unmatched by any other developed country.

I see this stat all over, but I would contend that the difference in lifestyle in other developed countries may have a major role in this (e.g. walking much more common, smaller portions, ect). However, I would argue that the quality of healthcare in America is unmatched by any other developed country.

Translation: We have the highest quality of care for people who can afford it.

Again; the developed countries that have an interest in having the healthiest population for the least amount of money have a healthier overall population, including a greater emphasis on preventative care, instead of simply focusing on higher profits for shareholders.

As a supposedly first-world developed country we rank absolutely horrible in terms of overall healthcare.

It's pathetic and disgusting. We should be ashamed of the state of overall healthcare in the United States.

 

[jqueb29]

I see this stat all over, but I would contend that the difference in lifestyle in other developed countries may have a major role in this (e.g. walking much more common, smaller portions, ect). However, I would argue that the quality of healthcare in America is unmatched by any other developed country.

Lol yeah I see people say what johnfree said all over the place...and those people are all pre-meds. When you actually see patients in real life, you realize that a large part of our poorer outcomes is due to the fact that Americans are just lazy. When you see a 350 pound patient with Type 2 diabetes who is euthyroid, and then 3 office visits later they're over 400 pounds, that is NOT the fault of the American healthcare system.

 

[guest794]

Lol yeah I see people say what johnfree said all over the place...and those people are all pre-meds. When you actually see patients in real life, you realize that a large part of our poorer outcomes is due to the fact that Americans are just lazy. When you see a 350 pound patient with Type 2 diabetes who is euthyroid, and then 3 office visits later they're over 400 pounds, that is NOT the fault of the American healthcare system.

A less than well-off aunt of mine (who wasn't obese, didn't have diabetes or any pre-existing conditions she was aware of) hadn't had a physical in 22 years. The reason? She said she couldn't afford one (raising 4 kids who all received timely doctors appointments) and that she felt "fine". My aunt was a great person; inspiring, hard-working and a single-parent who always put her kids before herself in all things. She ended up dying in her 50s of stage 4 breast cancer.
Would she still be alive had she been born in Canada? Maybe; she had no chance here.

 

[ERDOC555]

Lol yeah I see people say what johnfree said all over the place...and those people are all pre-meds. When you actually see patients in real life, you realize that a large part of our poorer outcomes is due to the fact that Americans are just lazy. When you see a 350 pound patient with Type 2 diabetes who is euthyroid, and then 3 office visits later they're over 400 pounds, that is NOT the fault of the American healthcare system.

This is gold! I haven't even had a whole lot of in depth exposure to the field of medicine and I quickly realized that this is the case. So many cases that shouldn't even be in a hospital or clinic. Preventable disease is one of the biggest drivers of cost in America and it is responsible for so many poor outcomes. Americans overall refuse to live a healthy and active lifestyle and it is literally killing us.

 

[Nietzschelover]

YES.

And also agree about the excessive costs with end of life which are likely to just get worse with technological advances.

 

[NeuResurgens]

You're quoting a lot of "facts" that are dubious at best and subject to different viewpoints. For example, the "ranking" of the U.S. system (#31) was based on a study that used "cheapness or being free" as a significant indicator in its statistics - it ended up being very biased to socialized systems. The U.S. also has a slightly lower life expectancy than socialized countries but that doesn't account for culture playing into it (more unhealthy eating habits and greater instances of childhood and young adulthood traumatic death - drunk driving is way more of a big deal here than other places, for example). Don't forget the huge tax burden - you think only the rich will be the ones shouldering the cost for a massively expensive system paid for by the government? And also, look at the quality of other US government programs. I don't want the same system that produced public education, the DMV or the USPS running my healthcare.

I tend to lean more toward a hybrid system - have a government subsidized option for the poor so that everyone can receive preventative treatments and can be taken care of, but allow a private system to exist alongside it for those wishing to pay for their healthcare. I think that would be the best option for the way our healthcare is currently run.

 

[Nietzschelover]

You're quoting a lot of "facts" that are dubious at best and subject to different viewpoints. For example, the "ranking" of the U.S. system (#31) was based on a study that used "cheapness or being free" as a significant indicator in its statistics - it ended up being very biased to socialized systems. The U.S. also has a slightly lower life expectancy than socialized countries but that doesn't account for culture playing into it (more unhealthy eating habits and greater instances of childhood and young adulthood traumatic death - drunk driving is way more of a big deal here than other places, for example). Don't forget the huge tax burden - you think only the rich will be the ones shouldering the cost for a massively expensive system paid for by the government? And also, look at the quality of other US government programs. I don't want the same system that produced public education, the DMV or the USPS running my healthcare.

I tend to lean more toward a hybrid system - have a government subsidized option for the poor so that everyone can receive preventative treatments and can be taken care of, but allow a private system to exist alongside it for those wishing to pay for their healthcare. I think that would be the best option for the way our healthcare is currently run.

We have that now. Called ACA (aka Obamacare).

 

[DokterMom]

Although the free market is a great tool for providing the public with the best, cheapest TV set, washer/dryer or car, maybe it doesn't work for healthcare, which is part of the reason countries with "socialized" medicine end up with much cheaper care and comparable results.
Many of the elements that make a free market efficient are simply not present in healthcare :
1) The person making the decision to consume a certain drug or medical procedure (doctor) is most often not the person paying for it (patient or insurance co). Often, the person making that decision doesn't even know the cost of the drug or procedure or at worst, is in conflict of interest.
2) People are not rational agents when it comes to healthcare : When facing death or suffering, most people will be willing to spend fortunes on things that only offer very marginal benefits. Few people would buy a car that is 10 times more expensive but gives you 5% better odds of surviving an accident. Yet when it comes to pharmaceuticals, such a marginal effect is enough for a drug to become the new guideline (especially in oncology), no matter the cost of that drug.
3) Reliance on ever longer patents : succesful lobbying and tinkering with certain molecules have allowed pharmaceutical to prolong the patents on blockbuster drugs. The prices are then arbitrarily set by these pharma co (see the Shkreli case) who rarely have to justify themselves. Competition only enters the picture when generics are allowed, often only after decades.
4 ) Limited ability to compare options : Altough it is always possible to get a second opinion for elective operations or treatment fo chronic diseases, that is simply absent for all urgent care. Furthermore, most people do not know enough to adequatly compare the different options available to them and simply rely on the authorithy of a trusted healthcare provider (which again is often in a position of conflict of interest).

Furthermore, patients have the most expensive healthcare in the world in the US, but we are ranked 31, and below many countries in terms of patient outcome. It's not working for the vast majority of Americans. It just isn't.

This is why healthcare in general, including drug development and production, should be managed by the state, that has an interest in having the healthiest population for the least amount of money, instead of simply higher profits for the shareholders.

I was with you all the way until your last paragraph --- Everything in the preceding paragraphs is true and contributes significantly to the overall problem. I'm guessing you either ran out of time at the end or maybe just got lazy -- because just having the government step in and manage everything is not the answer. And even if it were - good luck getting it to happen. AND of course our terribly unhealthy lifestyles.

 

[NeuResurgens]

We have that now. Called ACA (aka Obamacare).

An individual mandate isn't what I'm talking about. I'm thinking more along the lines of a VA type system available for free for lower income individuals. With a private system similar to what we currently have. Take care of those without insurance while still letting people keep their insurance if they want it, pay for their own care if they want to etc.

I'm no economist so I don't understand the details but in theory it seems more feasible than single payer and would still give people a bit of freedom with their healthcare, which I think is important.

 

[Med Ed]

Although the free market is a great tool for providing the public with the best, cheapest TV set, washer/dryer or car, maybe it doesn't work for healthcare, which is part of the reason countries with "socialized" medicine end up with much cheaper care and comparable results.
Many of the elements that make a free market efficient are simply not present in healthcare :
1) The person making the decision to consume a certain drug or medical procedure (doctor) is most often not the person paying for it (patient or insurance co). Often, the person making that decision doesn't even know the cost of the drug or procedure or at worst, is in conflict of interest.
2) People are not rational agents when it comes to healthcare : When facing death or suffering, most people will be willing to spend fortunes on things that only offer very marginal benefits. Few people would buy a car that is 10 times more expensive but gives you 5% better odds of surviving an accident. Yet when it comes to pharmaceuticals, such a marginal effect is enough for a drug to become the new guideline (especially in oncology), no matter the cost of that drug.
3) Reliance on ever longer patents : succesful lobbying and tinkering with certain molecules have allowed pharmaceutical to prolong the patents on blockbuster drugs. The prices are then arbitrarily set by these pharma co (see the Shkreli case) who rarely have to justify themselves. Competition only enters the picture when generics are allowed, often only after decades.
4 ) Limited ability to compare options : Altough it is always possible to get a second opinion for elective operations or treatment fo chronic diseases, that is simply absent for all urgent care. Furthermore, most people do not know enough to adequatly compare the different options available to them and simply rely on the authorithy of a trusted healthcare provider (which again is often in a position of conflict of interest).

Furthermore, patients have the most expensive healthcare in the world in the US, but we are ranked 31, and below many countries in terms of patient outcome. It's not working for the vast majority of Americans. It just isn't.

This is why healthcare in general, including drug development and production, should be managed by the state, that has an interest in having the healthiest population for the least amount of money, instead of simply higher profits for the shareholders.

Yeah, good luck with this. Watching SDN pre-allo discuss health policy is like watching a bunch of fourth graders discuss sex, the major difference being that the fourth graders would, on rare occasion, accidentally get something right.

 

[johnfree7]

Yeah, good luck with this. Watching SDN pre-allo discuss health policy is like watching a bunch of fourth graders discuss sex, the major difference being that the fourth graders would, on rare occasion, accidentally get something right.

You could have posted a half thought out rebuttal to my question rather than an easy cop-out attack. Anyone can do it.

 

[Med Ed]

Perhaps you could have posted a half thought out rebuttal to my question rather than an easy cop-out attack. Anyone can do it.

Oh, I'm not attacking you, merely pointing out that 100% of these discussions rapidly devolve into emotional, politically-charged, fact-bare arguments that persuade exactly zero people in either direction.

Anyone interested in factual but readable account of this topic should pick up Tom Bodenheimer's book and call it a day. I know that ruins all the fun, but hey, if you get bored I'm sure it would equally entertaining to debate abortion via Twitter.

 

[ChrisMack390]

What do SDNers think of the Swiss healthcare system? I've always been curious about it because I think it would be easier to transition toward from our current system.

 

[Bones 2020]

You could have posted a half thought out rebuttal to my question rather than an easy cop-out attack. Anyone can do it.

Which is interesting because you ignored my post in your response

 

[JoeCaputo]

I recently received a documentary from PNHP called Fixit: Healthcare at the Tipping Point. Anyone catch this doc?

 

[justreachforthesky]

Although the free market is a great tool for providing the public with the best, cheapest TV set, washer/dryer or car, maybe it doesn't work for healthcare, which is part of the reason countries with "socialized" medicine end up with much cheaper care and comparable results.
Many of the elements that make a free market efficient are simply not present in healthcare :
1) The person making the decision to consume a certain drug or medical procedure (doctor) is most often not the person paying for it (patient or insurance co). Often, the person making that decision doesn't even know the cost of the drug or procedure or at worst, is in conflict of interest.
2) People are not rational agents when it comes to healthcare : When facing death or suffering, most people will be willing to spend fortunes on things that only offer very marginal benefits. Few people would buy a car that is 10 times more expensive but gives you 5% better odds of surviving an accident. Yet when it comes to pharmaceuticals, such a marginal effect is enough for a drug to become the new guideline (especially in oncology), no matter the cost of that drug.
3) Reliance on ever longer patents : succesful lobbying and tinkering with certain molecules have allowed pharmaceutical to prolong the patents on blockbuster drugs. The prices are then arbitrarily set by these pharma co (see the Shkreli case) who rarely have to justify themselves. Competition only enters the picture when generics are allowed, often only after decades.
4 ) Limited ability to compare options : Altough it is always possible to get a second opinion for elective operations or treatment fo chronic diseases, that is simply absent for all urgent care. Furthermore, most people do not know enough to adequatly compare the different options available to them and simply rely on the authorithy of a trusted healthcare provider (which again is often in a position of conflict of interest).

Furthermore, patients have the most expensive healthcare in the world in the US, but we are ranked 31, and below many countries in terms of patient outcome. It's not working for the vast majority of Americans. It just isn't.

This is why healthcare in general, including drug development and production, should be managed by the state, that has an interest in having the healthiest population for the least amount of money, instead of simply higher profits for the shareholders.

I don't think you're going to find the right answers from pre-meds on this board. You will find great answers from non-trads, residents and attending physicians. (The AAMC should cut out psychology from the MCAT and make students take economics instead.) Lets face it, physician bargaining power is moot. Nurses make a relative killing when considering years spent in education and have great benefits. Teachers get half the year off and have done so through bargaining power. Doctors in the US have not organized well, even though they are in a lovely position to do so (they are more of an immediate necessity than teachers are, training a doctor takes longer than training a nurse or teacher, who's going to picket the fence? a hospital isn't an unskilled labor factory even though residency will treat you as such.) All in all, you're probably asking the right question in the wrong place.

 

[Bones 2020]

I don't think you're going to find the right answers from pre-meds on this board. You will find great answers from non-trads, residents and attending physicians. (The AAMC should cut out psychology from the MCAT and make students take economics instead.) Lets face it, physician bargaining power is moot. Nurses make a relative killing when considering years spent in education and have great benefits. Teachers get half the year off and have done so through bargaining power. Doctors in the US have not organized well, even though they are in a lovely position to do so (they are more of an immediate necessity than teachers are, training a doctor takes longer than training a nurse or teacher, who's going to picket the fence? a hospital isn't an unskilled labor factory even though residency will treat you as such.) All in all, you're probably asking the right question in the wrong place.

Good point. I remember watching the TV series Hopkins 24/7, and one of the physicians went back for his MBA so that he "would know when the wool is being pulled over his eyes" by the hospital administrations

 

[justreachforthesky]

Good point. I remember watching the TV series Hopkins 24/7, and one of the physicians went back for his MBA so that he "would know when the wool is being pulled over his eyes" by the hospital administrations

That reference hits the nail on the head. Sometimes being a good hearted physician with good intentions will allow administration and insurance companies to take advantage of you. Training a physician should involve the tools needed to avoid this. Overloading a physician with too many patients with only 10 minutes per interaction will not be solved by making pre-meds take psych 101. If all doctors refused to work for a day, heck, even an hour, watch even the millionaires and billionaires of this country fall to their knees and cave to modest demands. I assume these demands would be some more respect, less unnecessary paper work when ordering a necessary test, more autonomy when treating their patient especially considering they are, by far, the most educated member of the care team, protection from frivolous lawsuits that will tarnish your record even if you are not at fault, etc. etc. etc.

 

[Lawpy]

Yeah, good luck with this. Watching SDN pre-allo discuss health policy is like watching a bunch of fourth graders discuss sex, the major difference being that the fourth graders would, on rare occasion, accidentally get something right.

Why have a debate when a comic can answer the question accurately and concisely?

And this:

 

[Goro]

Tell ya what. Go call up Mitch McConnell and Paul Ryan, and see what they would tell you.

The United States is the only major country on earth that doesn’t guarantee health care to all people. And we end up spending far more per capita in health care as do the people of any other country.

Do the American people get what they pay for? The World Health Organization doesn't even rank us in the top 25 in terms of overall quality of healthcare.

We pay the most. We are ranked 31.

Outcomes in every other developed country are better on almost every measure, from infant mortality to life expectancy.

That is pathetic. We need to start over.

 

[NeuResurgens]

Anyone interested in factual but readable account of this topic should pick up Tom Bodenheimer's book and call it a day. I know that ruins all the fun, but hey, if you get bored I'm sure it would equally entertaining to debate abortion via Twitter.

Added to my reading list, thanks for the reference!

I really want to get involved in health policy as a physician but am unsure as far as where to start in order to learn what I need to know to be equipped for it. Got any other suggestions for some good reading on this? Especially when it comes to the economics of healthcare, for someone who hasn't studied economics formally.

 

[Med Ed]

Added to my reading list, thanks for the reference!

I really want to get involved in health policy as a physician but am unsure as far as where to start in order to learn what I need to know to be equipped for it. Got any other suggestions for some good reading on this? Especially when it comes to the economics of healthcare, for someone who hasn't studied economics formally.

One of the nice things about Bodenheimer's book is that really don't need anything else to start off with. Each chapter has references, you can scan those for interesting ones and see what else the authors have written. If you want to see the landscape evolving in near real-time, I would suggest accessing the journal Health Affairs through your friendly local library: http://www.healthaffairs.org/

If all you do is read this one book, you will have more policy knowledge than 99.998% of your peers and, sadly, 95% of practicing physicians. When it comes to health care systems and processes, docs tend to figure out their immediate surroundings quite well, but few seem to grasp the larger picture. Can't say I blame them, it's complicated stuff and most of us have more pressing concerns at any given moment.

 

[NeuResurgens]

One of the nice things about Bodenheimer's book is that really don't need anything else to start off with. Each chapter has references, you can scan those for interesting ones and see what else the authors have written. If you want to see the landscape evolving in near real-time, I would suggest accessing the journal Health Affairs through your friendly local library: http://www.healthaffairs.org/

If all you do is read this one book, you will have more policy knowledge than 99.998% of your peers and, sadly, 95% of practicing physicians. When it comes to health care systems and processes, docs tend to figure out their immediate surroundings quite well, but few seem to grasp the larger picture. Can't say I blame them, it's complicated stuff and most of us have more pressing concerns at any given moment.

Thanks for the info. I've definitely heard that because doctors are so busy, they often don't gain the necessary literacy in these issues and thus are not equipped to get involved in healthcare reform, leading to a lot of reforms which weren't made by actual patient care providers (thus not really getting the job done). I'd like to stay ahead of that curve and hopefully get involved later on.

 

[Mad Jack]

The United States is the only major country on earth that doesn’t guarantee health care to all people. And we end up spending far more per capita in health care as do the people of any other country.

Do the American people get what they pay for? The World Health Organization doesn't even rank us in the top 25 in terms of overall quality of healthcare.

We pay the most. We are ranked 31.

Outcomes in every other developed country are better on almost every measure, from infant mortality to life expectancy.

That is pathetic. We need to start over.

Those "rankings" are based on arbitrary nonsense. They are in no way objective- if we are only measuring outcomes for people with private insurance, those in the US fare very well. The trouble is, many of these rankings consider things like health care spending per capita and access to care instead of just the quality of care itself, which is disingenuous.

As to the OP, I will refuse top work under a socialized system if one comes to pass- I'm not investing 14 years of my life to be a government employee.

 

[Med Ed]

Those "rankings" are based on arbitrary nonsense. They are in no way objective- if we are only measuring outcomes for people with private insurance, those in the US fare very well. The trouble is, many of these rankings consider things like health care spending per capita and access to care instead of just the quality of care itself, which is disingenuous.

The quality-access-cost relationship is referred to as the "iron triangle" of health policy, and, unless one is a total rube, it is anything but arbitrary. This concept nicely illustrates the trade-offs that are inherent in designing certain systems, in this case healthcare. To increase one (e.g. quality) one must typically make sacrifices in another (e.g. access or cost). High performing countries find ways to manage these tradeoffs effectively. The reason the US does poorly in most comprehensive ranking systems is that two of the elements (cost and access) are outliers.

If that doesn't seem like much of a problem, let me frame it a slightly different way: for what we already pay a well-designed system would provide universal access to high quality care. The fact that ours doesn't essentially means we are getting collectively ripped off. We should be #1, many times over. Of course, most premeds don't care because they 1.) are still on their parent's insurance, and 2.) are hoping to someday siphon off their own slice of the bloated, inefficient pie. Can't say I blame them, rational self-interest being what it is.

As to the OP, I will refuse top work under a socialized system if one comes to pass- I'm not investing 14 years of my life to be a government employee.

Out of curiosity, how do you think your career in medicine is going to play out?

 

[Mad Jack]

The quality-access-cost relationship is referred to as the "iron triangle" of health policy, and, unless one is a total rube, it is anything but arbitrary. This concept nicely illustrates the trade-offs that are inherent in designing certain systems, in this case healthcare. To increase one (e.g. quality) one must typically make sacrifices in another (e.g. access or cost). High performing countries find ways to manage these tradeoffs effectively. The reason the US does poorly in most comprehensive ranking systems is that two of the elements (cost and access) are outliers.

If that doesn't seem like much of a problem, let me frame it a slightly different way: for what we already pay a well-designed system would provide universal access to high quality care. The fact that ours doesn't essentially means we are getting collectively ripped off. We should be #1, many times over. Of course, most premeds don't care because they 1.) are still on their parent's insurance, and 2.) are hoping to someday siphon off their own slice of the bloated, inefficient pie. Can't say I blame them, rational self-interest being what it is.



Out of curiosity, how do you think your career in medicine is going to play out?

Private practice, make as much money as I can as fast as I can so I can up and leave if the system breaks down. I'm not particularly attached to medicine as a career, it just happens to be at the sweet spot of what I'm good at, what pays, and what I enjoy. Plenty of other jobs out there I'd be fine doing- I worked for 10 years before starting medical school, it's not like being a doctor is the only job out there I'm capable of doing. Of course, so long as I'm free to work outside of whatever socialist nonsense is constructed, say via cash only private practice, I'd be more than happy to continue working as a physician.

 

[Med Ed]

Private practice, make as much money as I can as fast as I can so I can up and leave if the system breaks down. I'm not particularly attached to medicine as a career, it just happens to be at the sweet spot of what I'm good at, what pays, and what I enjoy. Plenty of other jobs out there I'd be fine doing- I worked for 10 years before starting medical school, it's not like being a doctor is the only job out there I'm capable of doing. Of course, so long as I'm free to work outside of whatever socialist nonsense is constructed, say via cash only private practice, I'd be more than happy to continue working as a physician.

Is it going to feel dirty when your resident salary, benefits, and malpractice insurance are covered by CMS?

 

[tenblackalps]

No. The government is wasteful and when funding is guaranteed through a government program the industry inflates to soak up every federal dollar (just look at college costs).

Also healthcare is a not a human right, just like having a job or having a minimum wage is not a right either. Rights in America (life, liberty, property) do not impose obligations on others but rather are simply only negative obligations to leave you alone. Healthcare cannot be a right because it would require burdening someone with the duty for care, just as the right to a job would impose a burden on an employer and the right to a minimum wage burden an employer to pay, violating another natural right of the individual to voluntarily exchange his labor for a wage he finds suitable.

 

[johnfree7]

One of the nice things about Bodenheimer's book is that really don't need anything else to start off with. Each chapter has references, you can scan those for interesting ones and see what else the authors have written. If you want to see the landscape evolving in near real-time, I would suggest accessing the journal Health Affairs through your friendly local library: http://www.healthaffairs.org/

Thanks for the suggestion, for perspective I will definitely check out Bodenheimer's Understanding Health Policy.

For a lighter read from a different vantage point, I recommend checking out "America's Bitter Pill: Money, politics, backroom deals, and the fight to fix our broken healthcare system" by Steven Brill. Here's a review that encapsulates the book better than I can:

"As a doctor in the US, I see the problems inherent in our medical system from the inside every day. This book is not just about Obamacare, but about the sorry state of our health care in general. The author clearly, and often infuriatingly, explains why Obamacare ended up being so ineffectual, limited, and riddled with unintended consequences as a result of all the compromises in favor of special interest groups who made sure a real reform would not be passed."

 

[Mad Jack]

Is it going to feel dirty when your resident salary, benefits, and malpractice insurance are covered by CMS?

No, because I'll pay enough in taxes over my lifetime to more than pay back my paltry resident salary. Personally I'd be fine with the old training model- room and board with a very small stipend, all provided by the hospital in exchange for my labor during training, but the government has made such a system impossible.

 

[MDProspect]

To everyone who mentioned that America is spending way too much on end-of-life care and that a single payer system would reduces the spending. Would it really? If so, at what cost?

http://www.nydailynews.com/news/nat...urses-overdose-patients-fbi-article-1.2584151

"Hospice care facilities are subject to an “aggregator cap,” which limits Medicare and Medicaid payments based on the average length of stay for a patient. If patients live longer than the average, the provider may be forced to pay back part of the payments, giving them an incentive to prefer patients who die sooner."

And as food for thought, look-up DSH program cuts and medicare readmission penalties.

By opting for a state-operated healthcare system, you would be giving all the power to the same people who are screwing the current system.

 

[Med Ed]

No, because I'll pay enough in taxes over my lifetime to more than pay back my paltry resident salary.

In other words, you refuse to be enslaved by a socialized system... unless it benefits you in the short-term. Gotcha.

 

[Mad Jack]

If you want to know what universal healthcare in the United States would look like, look no further than the VA. Anyone who knows anything about the VA and thinks such a system would be an ideal compared to what we have now is completely and utterly delusional.

 

[Mad Jack]

In other words, you refuse to be enslaved by a socialized system... unless it benefits you in the short-term. Gotcha.

The government didn't pay 400k for my degree, they didn't put thousands of hours into my training. The only thing they've done "for me" is fund the hospitals I'll train at, through no intervention of my own. As I said, if non-Medicare training positions were a thing, I'd be down for that, even at reduced pay and benefits. But, care of government overreach and intervention, such residencies don't exist. I would hardly say that the government paying hospitals to train residents "benefits" us, as teaching hospitals have become completely dependent upon this model to fund residencies, and it has crippled their efforts to expand due to the regulations it has put in place. Had they not become dependent upon government funding to begin with, we wouldn't be approaching a residency crunch right now, as hospitals would be paying physicians fair market value (likely less, possibly nothing) to train greater numbers of residents.

It's typical government intervention- offer some money with a few strings attached, get a system hooked and dependent upon that money, then use that dependence to control a system for your liking. They're not doing a public "good," they're using financial influence to obtain control of a system they would otherwise have little say in. The same thing happened with Medicare- at first things were wonderful, the money flowed freely, etc. But now hospitals and physicians are largely dependent upon Medicare to function, so the government can use Medicare to control the way in which hospitals operate via the Joint Commission, and can use physician reimbursement as a bargaining chip.

There's a reason the first thing I'm doing when I finish residency is opting out of Medicare- that's a deal with the devil I don't need in my life.

 

[Nietzschelover]

If you want to know what universal healthcare in the United States would look like, look no further than the VA. Anyone who knows anything about the VA and thinks such a system would be an ideal compared to what we have now is completely and utterly delusional.

Completely false, and dare I say delusional.

Just because we had universal healthcare would not mean we would have anything like the VA system, and btw Vets actually might benefit. We wouldn't become like 1950s Russia. There would have to be satisfaction with the system and there would be adjustments and improvements over time. The public, interest groups, politicians wouldn't magically lose their voices and influences. Have European and Scandinavian countries become less open and "free" by virtue of having socialized medicine?

 

[Mad Jack]

Completely false, and dare I say delusional.

Just because we had universal healthcare would not mean we would have anything like the VA system, and btw Vets actually might benefit. We wouldn't become like 1950s Russia. There would have to be satisfaction with the system and there would be adjustments and improvements over time. The public, interest groups, politicians wouldn't magically lose their voices and influences. Have European and Scandinavian countries become less open and "free" by virtue of having socialized medicine?

European countries are far more homogenous (or at least were until recently) and egalitarian, in addition to having far smaller populations than we have. That made establishing a system that everyone could agree upon much simpler, as people's interests were far more aligned than a diverse, populous, and economically disparate country such as the US. As to our voices being heard- when have politicians ever given two ****s about what we want, really? The ACA, for instance, served nothing but special interests- pharmaceutical companies, the insurance lobby, the AHA, etc. Politicians don't give a damn about public satisfaction, they just do things that look good at a glance to the public but are riddled with garbage that gets them special interest donations and support for their next election bid.

 

[MDProspect]

In other words, you refuse to be enslaved by a socialized system... unless it benefits you in the short-term. Gotcha.

Since you revere the "socialized system", can you please explain to me what are you going to do when the gov't puts a limit on how many times a patient can see you in a year. Or when they decide that procedure X is now an elective procedure that isn't covered by insurance anymore but the patient still needs it.