Should we have single-payer healthcare?

[Nietzschelover]

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.

They DO care when it's what they're going to have. And physicians have every right to lobby just like everyone else. Your anger seems to be getting in the way of you seeing clearly.

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[Mad Jack]

They DO care when it's what they're going to have. And physicians have every right to lobby just like everyone else. Your anger seems to be getting in the way of you seeing clearly.

I'm not angry lol.

And politicians will always be able to pay someone outside the system to provide them with better care, as they do in virtually every country, so no, they won't give two ****s about how the system affects them.

http://articles.latimes.com/2013/dec/01/nation/la-na-lawmakers-health-plans-20131201

 

[Nietzschelover]

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.

You mean deciding what is elective or not the way private insurance companies do now? "Managed care" came from the private sector. Look no further than Kaiser Permanente.

 

[Nietzschelover]

I'm not angry lol.

And politicians will always be able to pay someone outside the system to provide them with better care, as they do in virtually every country, so no, they won't give two ****s about how the system affects them.

http://articles.latimes.com/2013/dec/01/nation/la-na-lawmakers-health-plans-20131201

Do you know what congresspersons make? Many can't afford to live in DC.

 

[Mad Jack]

Do you know what congresspersons make? Many can't afford to live in DC.

Yeah, they're really struggling to get by:

http://www.breitbart.com/big-govern...c-region-has-highest-median-household-income/

Meanwhile our members of Congress are making a paltry $174,000, just shy of double the median income in DC. I weep for them, surely.

 

[Nietzschelover]

Are you OK with 174K when you are 40-60 years old?

 

[ERDOC555]

Are you OK with 174K when you are 40-60 years old?

People would kill to make 174k a year when they are 40-60!

As a doctor, of course not since we trained for 12+ years after high school and paid nearly a half million to become a doctor. For someone who requires no formal education or qualifications, 174k is incredible!

Also, politicians get loads of non-money compensation. Think lobbying, benefits, connections, and back door deals. There is a reason why politicians are rich yet make under 200k per year.

 

[Mad Jack]

Are you OK with 174K when you are 40-60 years old?

If I had to have zero qualifications whatsoever? Sure. I'd drop out of med school right now and take that deal.

 

[Med Ed]

Since you revere the "socialized system",

I don't.

 

[Med Ed]

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.

Nah, if it were you back then, you'd be on the front lines with the rest of the residents, screaming for a living wage and disability insurance. It's always easy to make promises you know you'll never have to keep.

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.

When it comes to healthcare in the US, the history reads more like: government steps in to deal with patient populations that private insurers won't touch, physician lobby makes a bunch of short-sighted demands to sign on, system becomes financially untenable from being bilked, oh look, here comes the DRG...

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.

We'll see.

 

[Nietzschelover]

If I had to have zero qualifications whatsoever? Sure. I'd drop out of med school right now and take that deal.

Zero qualifications? You might be surprised at the credentials of some of the people who work in those offices. Now I'm not a big fan of a lot of congressmen but they are on 2 year contracts.

 

[Mad Jack]

Zero qualifications? You might be surprised at the credentials of some of the people who work in those offices. Now I'm not a big fan of a lot of congressmen but they are on 2 year contracts.

They don't have to invest in a minimum of 11-15 years of school and training at the cost of hundreds of thousands of dollars to even have the basic qualification to do their job. While some may have an impressive undergraduate degree or a law degree, those are as unnecessary for them to become a congressman as a MPH our MBA is to become a physician.

 

[whitemagic]

Zero qualifications? You might be surprised at the credentials of some of the people who work in those offices. Now I'm not a big fan of a lot of congressmen but they are on 2 year contracts.

Qualifications =/= credentials.

 

[Nietzschelover]

They don't have to invest in a minimum of 11-15 years of school and training at the cost of hundreds of thousands of dollars to even have the basic qualification to do their job. While some may have an impressive undergraduate degree or a law degree, those are as unnecessary for them to become a congressman as a MPH our MBA is to become a physician.

You sound unhappy with your career choice.

 

[Mad Jack]

You sound unhappy with your career choice.

Never said that, just said that I'd be quite happy to take a job with zero minimum qualifications for 175k a year, rather than the one with over a decade of training that pays me just over 200k a year. You'd have to be stupid not to.

Now, as to how this factors into single payer- medicine needs people like me to enter the field and do our best from stopping it from happening. I honestly believe that single payer will hurt patient options, limit patient choice, and harm physician autonomy and income. It's a bad deal all around. I'm frequently confronted with, "if you aren't okay with universal healthcare, why did you enter the field?" The answer is simple- for the same reason anyone with any other ideology entered the field. Once the field becomes completely incompatible with my personal ideology or ethics, I will leave. Until then, I'm going to fight for what I believe to be right.

 

[Nietzschelover]

They don't have to invest in a minimum of 11-15 years of school and training at the cost of hundreds of thousands of dollars to even have the basic qualification to do their job. While some may have an impressive undergraduate degree or a law degree, those are as unnecessary for them to become a congressman as a MPH our MBA is to become a physician.

Do you know any 22 year old congressmen? Most have to build some kind of resume for 10-20 years to "qualify." And even then most "applicants" lose. And if they "win," they have to win again inside of 2 years. You might be devaluing what's involved just a bit. At any rate, there's an easy answer to your concern...just tell the congressmen that you'll take the same single payer plan that they will get.

 

[Mad Jack]

Do you know any 22 year old congressmen? Most have to build some kind of resume for 10-20 years to "qualify." And even then most "applicants" lose. And if they "win," they have to win again inside of 2 years. You might be devaluing what's involved just a bit. At any rate, there's an easy answer to your concern...just tell the congressmen that you'll take the same single payer plan that they will get.

I don't want a single payer plan. I want to be able to pay more for better access and service if I so choose. I also don't want to accept a single payer plan, as I believe physicians should be free to choose what methods of payment they accept, the same as any other field. Even in Britain, basically anyone with a decent income has private insurance to skip the NHS for a reason- it has longer waits, poorer service, and less options.

As to "not doing nothing," yeah, they weren't doing nothing- they were largely working, earning an income, and enjoying life like normal human beings, unlike physicians, who spend 60-80+ hours a day slaving away on nights, weekends, and holidays throughout our training.

Also, the post you responded to wasn't fully completed- I'd encourage you to look at it again.

 

[Nietzschelover]

Never said that, just said that I'd be quite happy to take a job with zero minimum qualifications for 175k a year, rather than the one with over a decade of training that pays me just over 200k a year. You'd have to be stupid not to.

Now, as to how this factors into single payer- medicine needs people like me to enter the field and do our best from stopping it from happening. I honestly believe that single payer will hurt patient options, limit patient choice, and harm physician autonomy and income. It's a bad deal all around. I'm frequently confronted with, "if you aren't okay with universal healthcare, why did you enter the field?" The answer is simple- for the same reason anyone with any other ideology entered the field. Once the field becomes completely incompatible with my personal ideology or ethics, I will leave. Until then, I'm going to fight for what I believe to be right.

I don't like private managed care companies and how they limit my options. I also like my kids being insured to age 26. And not getting screwed on pre-existing conditions. You sort of act like you are comparing single payer to some system we had 10 years ago that worked superbly and had no limitations in terms of access, coverage, choice, etc.

 

[Mad Jack]

I don't like private managed care companies and how they limit my options. I also like my kids being insured to age 26. And not getting screwed on pre-existing conditions. You sort of act like you are comparing single payer to some system we had 10 years ago that worked superbly and had no limitations in terms of access, coverage, choice, etc.

I'll take the issues of the former over the issues of the latter. And I'd actually be okay with universal basic coverage, so long as there were private options still available and physicians aren't obligated to be a part of the system.

 

[Nietzschelover]

I'll take the issues of the former over the issues of the latter. And I'd actually be okay with universal basic coverage, so long as there were private options still available and physicians aren't obligated to be a part of the system.

I would encourage you to explore the world of correctional healthcare and privatization. Who do you think has it better....employees of a private vendor contracted to provide services or state employees? Do you think correction officers, court officers, police officers, etc, etc would prefer to be privatized?

 

[NeuResurgens]

The two sides in this thread basically illustrate why I like the option of having parallel govt. and private systems. There is freedom of choice with a system like this. Everyone would get healthcare in some capacity, so those who worry that healthcare is currently inaccessible should find it agreeable. But there would be an option for those of you who distrust the government's involvement or what the quality of such a system would look like, and private practice would still exist. The public system might draw physicians by paying for medical school similar to the way the military does it, and it might be allowed for otherwise privatized physicians to volunteer some of their time in the system as well (which I imagine would occur because medical schools strongly select for altruism these days). In addition, the public system would probably offer legal protections not otherwise accessible to private physicians, allowing individual physicians to evaluate what their ideal practice setting is and giving them options to fit that. Patients would have the option of receiving free preventative care, which would over time lower long-term medical costs, and it would create less incentive to procrastinate medical care. I think it would work and would very likely work better than what we have now.

 

[Mad Jack]

I would encourage you to explore the world of correctional healthcare and privatization. Who do you think has it better....employees of a private vendor contracted to provide services or state employees? Do you think correction officers, court officers, police officers, etc, etc would prefer to be privatized?

Physicians can bill for our services- that's the big difference. Because of the nature of the criminal justice system, your "clients" (criminals) aren't paying for your services, because you're providing a service that they do not want. Society wants to impose that unwanted service upon the criminals, and thus must pay your wages.

And private healthcare does not imply employed- physicians can directly bill for their services without being employees. That's a big disconnect between physicians and the rest of society- we are professionals, of the professional class, which has traditionally been comprised of business owners and decision-makers, not employees. I don't want to be an employee, I want to be either independent or a group partner.

 

[Mad Jack]

The two sides in this thread basically illustrate why I like the option of having parallel govt. and private systems. There is freedom of choice with a system like this. Everyone would get healthcare in some capacity, so those who worry that healthcare is currently inaccessible should find it agreeable. But there would be an option for those of you who distrust the government's involvement or what the quality of such a system would look like, and private practice would still exist. The public system might draw physicians by paying for medical school similar to the way the military does it, and it might be allowed for otherwise privatized physicians to volunteer some of their time in the system as well (which I imagine would occur because medical schools strongly select for altruism these days). In addition, the public system would probably offer legal protections not otherwise accessible to private physicians, allowing individual physicians to evaluate what their ideal practice setting is and giving them options to fit that. Patients would have the option of receiving free preventative care, which would over time lower long-term medical costs, and it would create less incentive to procrastinate medical care. I think it would work and would very likely work better than what we have now.

Ah, but liberals don't want people to have a choice- they want to force people into a system whether they like it or not, both on the provider and patient end. Choice is antithetical to socialist values.

 

[Nietzschelover]

Ah, but liberals don't want people to have a choice- they want to force people into a system whether they like it or not, both on the provider and patient end. Choice is antithetical to socialist values.

You nailed it. It's that simple.

 

[Mad Jack]

You nailed it. It's that simple.

I'm glad you understand your position.

 

[Med Ed]

The two sides in this thread basically illustrate why I like the option of having parallel govt. and private systems. There is freedom of choice with a system like this. Everyone would get healthcare in some capacity, so those who worry that healthcare is currently inaccessible should find it agreeable. But there would be an option for those of you who distrust the government's involvement or what the quality of such a system would look like, and private practice would still exist. The public system might draw physicians by paying for medical school similar to the way the military does it, and it might be allowed for otherwise privatized physicians to volunteer some of their time in the system as well (which I imagine would occur because medical schools strongly select for altruism these days). In addition, the public system would probably offer legal protections not otherwise accessible to private physicians, allowing individual physicians to evaluate what their ideal practice setting is and giving them options to fit that. Patients would have the option of receiving free preventative care, which would over time lower long-term medical costs, and it would create less incentive to procrastinate medical care. I think it would work and would very likely work better than what we have now.

So you like Australia. So do I, but we went 3/4 Switzerland with the passage of the ACA, and I don't think anyone with have the stomach for another significant overhaul any time soon.

 

[tenblackalps]

and it might be allowed for otherwise privatized physicians to volunteer some of their time in the system as well (which I imagine would occur because medical schools strongly select for altruism these days)

Not realistic for a government program serving hundreds of millions of people

 

[ct303]

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.

Yes, it is also pathetic and disgusting how we as Americans choose to live. But we need to stop asking for others to pay for the effects of the Super Big Gulp and McWhopper-induced MI and start holding people accountable for their health choices.

 

[Nietzschelover]

Yes, it is also pathetic and disgusting how we as Americans choose to live. But we need to stop asking for others to pay for the effects of the Super Big Gulp and McWhopper-induced MI and start holding people accountable for their health choices.

And what would holding them accountable look like? Don't get an appendectomy because I'm too fat? Or withhold Zoloft because I created my own depression?

 

[Lucca]

Yes, it is also pathetic and disgusting how we as Americans choose to live. But we need to stop asking for others to pay for the effects of the Super Big Gulp and McWhopper-induced MI and start holding people accountable for their health choices.

If the most affordable meal for your family is McDonald's and you don't have the education (or access to a PCP or nutritionist) to know which decisions are best to make, or time to cook because you are a single parent working two jobs, or are not physically proximal to a grocery store with fresh fruits and vegetables and proteins then how accountable, exactly, are you?

This is the problem with the way people like to use the word "choice". Some people in this country have a lot of choice ("I'm rich, all of these choices are reasonable for me"). Others have the illusion of choice ("I can afford A and B out of 50 choices, I guess I'll pick from them"). Others just get ****ed.

Most of us are intuitively OK with situations 1 and 2 existing, even together. 3 is what is unacceptable (and man-made, cough cough) but it is also our reality when it comes to healthcare access, nutrition, and other basic needs that are by all reasonable accounts human rights.

 

[NeuResurgens]

Yes, it is also pathetic and disgusting how we as Americans choose to live. But we need to stop asking for others to pay for the effects of the Super Big Gulp and McWhopper-induced MI and start holding people accountable for their health choices.

And what would holding them accountable look like? Don't get an appendectomy because I'm too fat? Or withhold Zoloft because I created my own depression?

There are two sides to this issue. I do think there's a culture which encourages overeating, large portion sizes, and poor choice of food among some who could otherwise eat better, and there should be a bit more accountability for that. That's not something that can be enforced, only encouraged.

But on the other hand, there are systemic issues that lead to our eating habits in this country and which needed to be addressed together. First is our massive consumption of sugar, which I believe is due to a bunch of economic and cultural factors. We have cheap sweeteners like fructose available and we culturally prefer very sweet food. Further, we make unhealthy food cheaper and more available in many cases, while healthier "organic" foods occupy a niche market that commands a higher price. This discourages the poor from eating healthier because they simply can't afford to.

I don't pretend to know the solutions to these issues, but my point is that it's necessary to recognize all the factors that play into a problem. That gives you a better chance of proposing something that will hopefully solve more problems than it creates.

 

[NeuResurgens]

Not realistic for a government program serving hundreds of millions of people

I didn't expect that to be the sole source of physician labor, just one small element of it. There would need to be other incentives to work there.

 

[ct303]

And what would holding them accountable look like? Don't get an appendectomy because I'm too fat? Or withhold Zoloft because I created my own depression?

I didn't say it's a perfect model for every condition. You assumed that. But look at the conditions that account for the majority of healthcare expenditure and I'm sure you'll find a couple preventable diseases.

 

[NeuResurgens]

So you like Australia. So do I, but we went 3/4 Switzerland with the passage of the ACA, and I don't think anyone with have the stomach for another significant overhaul any time soon.

Agreed. Took some time to look up Switzerland - looks to me like it has a decently well-functioning system, and they have still preserved public and private systems, with the payment being arranged through an individual mandate not unlike the ACA as you said. Perhaps the best course of action is to let the ACA play out longer and try to streamline its implementation rather than try to perform yet another overhaul of the system before the first overhaul even really can be evaluated. The biggest difference between Switzerland and the U.S. obviously is the population difference, but their culture might have something to do with how they consume healthcare vs. Americans as well. Their healthcare is still apparently relatively expensive compared to more socialized systems, but they score very well in many rankings. How long have they been using their individual mandate?

 

[ct303]

If the most affordable meal for your family is McDonald's and you don't have the education (or access to a PCP or nutritionist) to know which decisions are best to make, or time to cook because you are a single parent working two jobs, or are not physically proximal to a grocery store with fresh fruits and vegetables and proteins then how accountable, exactly, are you?

This is the problem with the way people like to use the word "choice". Some people in this country have a lot of choice ("I'm rich, all of these choices are reasonable for me"). Others have the illusion of choice ("I can afford A and B out of 50 choices, I guess I'll pick from them"). Others just get ****ed.

Most of us are intuitively OK with situations 1 and 2 existing, even together. 3 is what is unacceptable (and man-made, cough cough) but it is also our reality when it comes to healthcare access, nutrition, and other basic needs that are by all reasonable accounts human rights.

I normally ignore anecdotal evidence as they are exaggerated examples used to make an extreme seem normal.
But to your points, yes, the system could definitely do better at educating, providing resources, etc.
Medicine, however, is the endpoint of a lot of processes. I think that more time and resources focused on the earlier points mentioned previously would help to reduce medical costs all around.

 

[MDProspect]

Yes, it is also pathetic and disgusting how we as Americans choose to live. But we need to stop asking for others to pay for the effects of the Super Big Gulp and McWhopper-induced MI and start holding people accountable for their health choices.

I don't understand how this is relevant to whether a single-payer system would be better than what we have now. No matter what system is in place, you will still be expected to pony up the money for someone else's care through taxes. Besides if we start holding people responsible for their poor life choices, then we can chalk-up any medical condition or disease to a choice with the exception of hereditary diseases.
I think the real questions that should be addressed is whether under the new system, will hospitals that have an overwhelming majority of patients from lower socioeconomic status receive more funding or will every hospital receive the same amount since everyone will have health insurance. Will hospitals with high readmission rates still be penalized with lower reimbursement rates as they are now? Will the PCP in Timbuktu, Wisconsin make the same amount as the PCP in Beverly Hills?

 

[heebeejeebies]

I wonder how many of you saying no mentioned "a drive to deliver care to the undeserved" in your personal statements.

This is pathetic. Up in Canada, we have med students fighting tooth and nail for the implementation of a universal pharmacare program, while you guys are saying no and lining your pockets with the suffering of the poor.

 

[MDProspect]

I wonder how many of you saying no mentioned "a drive to deliver care to the undeserved" in your personal statements.

This is pathetic. Up in Canada, we have med students fighting tooth and nail for the implementation of a universal pharmacare program, while you guys are saying no and lining your pockets with the suffering of the poor.

Explain to me why the well-off Canadians come here for their medical needs? We have medicaid for the underserved and we can help deliver care to more underserved population if more states would agree to the medicaid expansion. However, imposing state-owned healthcare on me when I am satisfied with my private HMO is unethical and violates my autonomy.

 

[Nietzschelover]

Explain to me why the well-off Canadians come here for their medical needs? We have medicaid for the underserved and we can help deliver care to more underserved population if more states would agree to the medicaid expansion. However, imposing state-owned healthcare on me when I am satisfied with my private HMO is unethical and violates my autonomy.

What if single payer allowed you as much choice (or more) than you have now? The current majority PCP model where my PCP has to be "in network" and sign off any referrals seems pretty constrictive to me. There already are controls in the system having nothing to do with the government that set parameters around the environment. I understand some of the concerns, but I don't see why, by definition, single payer, has to be more constrictive.

 

[coldcase331]

Since I don't want this to turn into another 70+ page thread like last time, I'll post what I posted before that seemed to appeal to a lot of people. We should switch to a "German-like" healthcare system.

Point 1: Germany uses a restricted free market model when it comes to the public healthcare sector. The ~ 130 government insurance companies (called sickness funds) are allowed to operate however they see fit, the only rule is that they have to be non-profit. This encourages competition and drives prices down and allows the beauty of economics to occur.

Point 2: Those who do not wish to be a part of the public healthcare system may opt out and pay for the private healthcare companies. This has little to no effect on the people with higher incomes because of point 3.

Point 3: Money paid into a healthcare plan is a burden placed 50% on the employee, and 50% on the employer. In addition, the employee/employer duo have the ability to negotiate the rates paid to the insurance plans. As a result, everyone is held accountable for their own insurance in an affordable way that doesn't have the redistribution of wealth effect (which I absolutely think is a big no-no).

 

[MDProspect]

What if single payer allowed you as much choice (or more) than you have now? The current majority PCP model where my PCP has to be "in network" and sign off any referrals seems pretty constrictive to me. There already are controls in the system having nothing to do with the government that set parameters around the environment. I understand some of the concerns, but I don't see why, by definition, single payer, has to be more constrictive.

I am opened to the idea of a single payer system, but before its implemented or even considered, I want to know what does this system actually mean. Like I posted before, will hospitals that have an overwhelming majority of patients from lower socioeconomic status receive more funding or will every hospital receive the same amount since everyone will have health insurance. Will hospitals with high readmission rates still be penalized with lower reimbursement rates as they are now? Will the PCP in Timbuktu, Wisconsin make the same amount as the PCP in Beverly Hills? Additionally, if everyone will have the same insurance, does it mean that there won't be any networks so everyone can see any doctor that they choose?

 

[criticalelement]

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

And this:

Have you been inside of a V.A.? Spend some time at a va and then come back to me with single payer?

 

[Med Ed]

Since I don't want this to turn into another 70+ page thread like last time, I'll post what I posted before that seemed to appeal to a lot of people. We should switch to a "German-like" healthcare system.

That would be marvelous from a patient perspective, but Germany really does treat its physicians like last week's garbage.

 

[WedgeDawg]

Just a quick reminder to keep your posts civil. This is a sensitive topic and if this thread gets out of hand, it runs the risk of being locked. Thanks!

 

[Nietzschelover]

Have you been inside of a V.A.? Spend some time at a va and then come back to me with single payer?

This impulse to compare the VA, which goes back through numerous administrations, to what a national system would look like is just bizarre.

 

[coldcase331]

That would be marvelous from a patient perspective, but Germany really does treat its physicians like last week's garbage.

But if my med school was payed for like in Germany, I'd be ok with the lower salary. Not to mention that it would increase competition for medical school and give us better qualified doctors


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[coldcase331]

That would be marvelous from a patient perspective, but Germany really does treat its physicians like last week's garbage.

And I said "Germany-like", it doesn't have to be a complete copy, but it's definitely a good place to start.


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[Lawpy]

Just a quick reminder to keep your posts civil. This is a sensitive topic and if this thread gets out of hand, it runs the risk of being locked. Thanks!

On the plus side, @Med Ed gave a pretty good book suggestion to read on health policy. So maybe it's not all that bad.

 

[justreachforthesky]

Are you OK with 174K when you are 40-60 years old?

What are ya smokin there bud, pass that this way

 

[Med Ed]

And I said "Germany-like", it doesn't have to be a complete copy, but it's definitely a good place to start.

Medicare was passed in 1965, the next (failed) opportunity for health reform was Nixon's proposal in 1974, but Ted Kennedy walked away thinking he could get something better if he waited. Almost 20 years later we had a shot at Hillarycare 1.0, which also failed. The ACA was signed in 2010 but only after threading a legislative needle (remember Scott Brown?).

So basically it took almost half a century to get from Medicare to the ACA. We aren't starting over again any time soon.