Why would anyone go into primary care nowadays?

[Greenberg702]

Well if you want Universal healthcare, they're the party that's gonna get it for you. So it's worth paying attention to what they have to say.

LOL. Thank god people like him will never be leaders in medicine.

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[WhippleWhileWeWork]

I edited the post to add some content. You guys move too fast.

I purposefully haven't considered the political reality in the country. I know that what I want is impossible right now. I think we are kinda sorta moving in that sort of direction, but in a weird piecemeal way that might or might not work out. Don't mistake my opinions as me advocating for a massive shift in health care in that way.

What are you advocating for?
Spell it out clearly and concisely to end the straw men.
Do you hate roads?

 

[el_duderino]

I'm not advocating anything in particular.

 

[WhippleWhileWeWork]

I'm not advocating anything in particular.

HAHAHA, classic.

 

[DermViser]

Probably, yeah. Maybe some independent body made up of people appointed by the industry. I don't know.

Like I said, the words to describe you, aren't worth me getting banned.

 

[tdram]

I've been to hospitals outside of america and europe. It's just like a store, you can get anything if you pay for it. No insurance authorizations, no bull****. No this isn't covered, but that is, etc. You want an MRI? Just pay for it. CT scan? No problem, just pay for it. They give you a list of the services and you buy whatever you want, and best of all it's CHEAP! I would absolutely love that here.

No prescriptions either. Just go to the pharmacist, say what you want, and you've got it.

 

[el_duderino]

HAHAHA, classic.

Kinda funny, but it's true. I'm not advocating for any particular plan or program. I'm open to all sorts of ideas. I am stating my opinion that I think it's time to start treating access to basic medical care as a right. There are a lot of different ways we could do this.

 

[DermViser]

I edited the post to add some content. You guys move too fast.

I purposefully haven't considered the political reality in the country. I know that what I want is impossible right now. I think we are kinda sorta moving in that sort of direction, but in a weird piecemeal way that might or might not work out. Don't mistake my opinions as me advocating for a massive shift in health care in that way.

You've advocated for a universal system in which rationing by govt. bureaucrats decide whether someone receives medical care or not. That's not a massive shift to you?

 

[WhippleWhileWeWork]

Kinda funny, but it's true. I'm not advocating for any particular plan or program. I'm open to all sorts of ideas. I am stating my opinion that I think it's time to start treating access to basic medical care as a right. There are a lot of different ways we could do this.

Wait. Advocating nothing in particular and advocating medical care as a right, are not the same thing. I guess you mean that you're advocating nothing particular about how medical care should be a right?

 

[tdram]

Kinda funny, but it's true. I'm not advocating for any particular plan or program. I'm open to all sorts of ideas. I am stating my opinion that I think it's time to start treating access to basic medical care as a right. There are a lot of different ways we could do this.

You still have yet to define what you mean by 'basic medical care'.

 

[WhippleWhileWeWork]

You've advocated for a universal system in which rationing by govt. bureaucrats decide whether someone receives medical care or not. That's not a massive shift to you?

Just curious and I apologize if I missed this, are you in favor of rationing by available resources, by disposable income in particular?
In other words, like most other commodities in life?

 

[tdram]

Wait. Advocating nothing in particular and advocating medical care as a right, are not the same thing. I guess you mean that you're advocating nothing particular about how medical care should be a right?

haha, yeah, exactly

 

[tdram]

There's no such thing as a right. Life's not even a right, because try all you might, you can't keep it forever and have no control over when it comes or goes.

Some things are nice to have, and mutually beneficial for us to provide to each other, but I don't believe you're owed anything from anybody by existing.

I always laugh when people talk about healthcare as a 'right'.

 

[DermViser]

Just curious and I apologize if I missed this, are you in favor of rationing by available resources, by disposable income in particular?
In other words, like most other commodities in life?

Neither. I prefer that patients make their own medical decisions, not some govt. bureaucrat.

 

[tdram]

Neither. I prefer that patients make their own medical decisions, not some govt. bureaucrat.

I think he means "rationing" in the sense of the free-market, where resources are allocated by laws of supply and demand, not arbitrarily assigned by a government committee.

If you want to see what happens when solely government bureaucrats decide where to allocate resources, check out the Ghost Cities of China.

 

[el_duderino]

You've advocated for a universal system in which rationing by govt. bureaucrats decide whether someone receives medical care or not. That's not a massive shift to you?

That's one scenario. There are others. Even in that scenario there's a possibility to pay for services not covered.

 

[tdram]

That's one scenario. There are others. Even in that scenario there's a possibility to pay for services not covered.

I think that is possibly the worst situation. What would qualify a bureaucrat in Washington to decide who should live and who should die?

 

[el_duderino]

I think that is possibly the worst situation. What would qualify a bureaucrat in Washington to decide who should live and who should die?

Insurance companies do this behind closed doors all the time. Someone has to.

 

[DermViser]

That's one scenario. There are others. Even in that scenario there's a possibility to pay for services not covered.

You know perfectly well in those scenarios it's near impossible to pay for those services, without it being burdensome. In those systems, a denial by the govt. for care is literally a death sentence which you're apparently ok with.

 

[tdram]

Insurance companies do this behind closed doors all the time. Someone has to.

You can switch insurance companies if you don't like the one you have. You can't switch universal health plans because there's only one.

 

[DermViser]

Insurance companies do this behind closed doors all the time. Someone has to.

Physicians can also write appeals letters to private insurance companies for care that we believe should be allowed and reimbursed. I would know as I've had to type them for my attending to sign for patients we believe, thru our clinical judgement, should receive it. After which, the insurance company reverses its previous rejection.

 

[el_duderino]

You know perfectly well in those scenarios it's near impossible to pay for those services, without it being burdensome. In those systems, a denial by the govt. for care is literally a death sentence which you're apparently ok with.

Probably. But this is inevitable in any system. Even in this scenario there are a lot of things that would be covered that wouldn't be for someone with no coverage at all.

It's madness to look around at what we can do in this country then shrug and tell some 30 year old minimum wage laborer that he's SOL for chemo he can't afford. We can do better than that.

 

[DermViser]

You can switch insurance companies if you don't like the one you have. You can't switch universal health plans because there's only one.

BINGO. In an universal system, the govt. is the last word, and you have no other alternative avenue.

 

[DermViser]

Probably. But this is inevitable in any system. Even in this scenario there are a lot of things that would be covered that wouldn't be for someone with no coverage at all.

It's madness to look around at what we can do in this country then shrug and tell some 30 year old minimum wage laborer that he's SOL for chemo he can't afford. We can do better than that.

Seriously? You're going to actually JUSTIFY rationing of care for people who have health insurance, to fund your pet project of covering "basic" healthcare for those who don't have/don't want to get it?

 

[el_duderino]

It's hard to discuss this with you when you keep fabricating statements. I really want more from you, and I think you can do better. We're not on some political radio show here, you don't need to pander to an audience. Unless what you're actually concerned about is 'winning' vs some random yahoo on the internet instead of actually exchanging ideas.

 

[tdram]

Probably. But this is inevitable in any system. Even in this scenario there are a lot of things that would be covered that wouldn't be for someone with no coverage at all.

It's madness to look around at what we can do in this country then shrug and tell some 30 year old minimum wage laborer that he's SOL for chemo he can't afford. We can do better than that.

Maybe we should think about why medicine is so expensive in this country, and address the problem there, because it's not so expensive everywhere else.

 

[el_duderino]

Maybe we should think about why chemo is so expensive in this country in the first place. Or any medicine or treatment for that matter. The same stuff is much cheaper abroad.

That is a good thing to think about. No doubt you have a better perspective on that than I do. Why is it so expensive?

 

[DermViser]

It's hard to discuss this with you when you keep fabricating statements. I really want more from you, and I think you can do better. We're not on some political radio show here, you don't need to pander to an audience. Unless what you're actually concerned about is 'winning' vs some random yahoo on the internet instead of actually exchanging ideas.

I don't know what I'm fabricating and I'm definitely not pandering. I find your moral values system to be way off for that which a physician should have. As a patient, I would never want you as my doctor, bc you're not interested in my well-being as an individual, but rather than with the collective. That is what is morally reprehensible to me.

 

[el_duderino]

I guess we find each other morally reprehensible then. You must find medicaid itself morally reprehensible, which is interesting by itself.

 

[WhippleWhileWeWork]

I like how personal and edgy this convo got. You guys are intense.

Again, for emphasis.

 

[WhippleWhileWeWork]

In other news,

@Anastomoses is back.

 

[tdram]

That is a good thing to think about. No doubt you have a better perspective on that than I do. Why is it so expensive?

Well for one there's government price-fixing going on. Medicare pretty much determines what health services cost in this country, not supply and demand. The government also determines how many doctors can practice by tightly controlling licensing, residency spots, etc.

There's also an insane amount of regulation that drives costs up everywhere in healthcare, but we don't have any real data showing that it actually reduces mortality in any way. HIPAA compliance itself costs $9 billion a year for hospitals, and going up.

In any other market, there's a great deal of competition leading to companies finding cheaper and more efficient ways to produce things, thus driving prices down. Unfortunately, the massive amount of legislative red tape in medicine prevents that from happening. Just getting into the market is too expensive for most entrepreneurs. The FDA also has a monopoly on approving drugs, and they're not exactly the least corrupt agency. They're also extending their reach into places they don't belong, like mobile apps, for example, further driving up costs and slowing down progress.

There's also the litigious nature of this country, and the courts that award huge settlements leading to huge malpractice costs.

Just some of the reasons I can think of off the top of my head.

 

[el_duderino]

Isn't chemo, not to mention other services, significantly cheaper in places like the UK and Canada? Why is that, given the content of your post? Seems like the same forces causing it to be expensive here are also at work there, perhaps even more so.

 

[tdram]

Isn't chemo, not to mention other services, significantly cheaper in places like the UK and Canada? Why is that, given the content of your post? Seems like the same forces causing it to be expensive here are also at work there, perhaps even more so.

One of the reasons is that liability is less of an issue than it is here. Canadians are far less likely to sue, and when they do, the settlements are far smaller. That may be a cultural thing. There's also the issue that Canadians just have a lower purchasing power in general than Americans, so the prices are set lower there. While it may appear "cheaper" to us, it's not really cheaper for them. The government also sets an upper limit on the prices, which works for them, mainly because the drug companies just shift their losses from just about every other country over to the U.S. If the US also put in a price ceiling on drugs, the drug companies would be SOL.

 

[tdram]

The best solution is to let the market figure out what the prices should be on their own. The market is so complicated that there's no way any government committee could determine the optimal price for anything that would not lead to unbalanced supply and demand.

 

[BobbyB]

One of the reasons is that liability is less of an issue than it is here. Canadians are far less likely to sue, and when they do, the settlements are far smaller. That may be a cultural thing. There's also the issue that Canadians just have a lower purchasing power in general than Americans, so the prices are set lower there. While it may appear "cheaper" to us, it's not really cheaper for them. The government also sets an upper limit on the prices, which works for them, mainly because the drug companies just shift their losses from just about every other country over to the U.S. If the US also put in a price ceiling on drugs, the drug companies would be SOL.

http://www.aaos.org/news/aaosnow/sep11/managing4.asp

Canada

All Canadian physicians purchase medical liability insurance through the Canadian Medical Protective Association (CMPA).

Malpractice insurance premiums in Canada are lower than those in the United States for the following three major reasons:

The courts in Canada have set caps on medical liability awards.

Existing Canadian laws set a high hurdle for proving medical liability.

The CMPA is notorious for vigorously defending any and all medical liability suits.

Additionally, in Canada, the losing party pays approximately two-thirds of the winner’s costs. This is a significant disincentive for bringing a medical liability suit.

The Canadian Supreme Court has established guidelines for noneconomic awards at a maximum of roughly $300,000, and the types of cases in which noneconomic awards can be made is limited. In order to sue, the plaintiff must prove that the physician not only caused injury, but also violated a duty of care. Errors in judgment are generally not causes for lawsuit.



England

Physicians are not personally liable for medical liability expenses or claims and, as a result, they do not have to purchase medical liability insurance.

Because physicians are not individually liable, the NHS alone decides whether to litigate or settle each claim.

As a result, only 4 percent of all potential claims result in trials and most claims are closed in less than 18 months. In 2008, only 5,470 claims were filed.

NHS recently established a new program to address cases of negligence for claims less than approximately $28,000 and to expedite claim resolution.

 

[PL198]

^ Why the f*ck can't the US have something decent. Again, we're back to the reason that America sucks: It's filled with pieces of ****. Raging

 

[BestDoctorEver]

You can switch insurance companies if you don't like the one you have. You can't switch universal health plans because there's only one.

Not that easy as it sounds switching insurance company...

 

[el_duderino]

Not that easy as it sounds switching insurance company...

The ACA has made it a lot easier.

 

[tdram]

Not that easy as it sounds switching insurance company...

If insurance wasn't tied to your employer it would be a lot easier. the employer based system is pretty inefficient and outdated.

You should be buying your own insurance. Employers can help you pay for it, but it should be your choice, not theirs.

 

[deleted480308]

If insurance wasn't tied to your employer it would be a lot easier. the employer based system is pretty inefficient and outdated.

You should be buying your own insurance. Employers can help you pay for it, but it should be your choice, not theirs.

indeed, most people forget that the reason we have this employer-based-insurance mess is because of the stupid government wage controls set in place during the war

government doesn't help the situation

 

[deleted480308]

Probably. But this is inevitable in any system. Even in this scenario there are a lot of things that would be covered that wouldn't be for someone with no coverage at all.

It's madness to look around at what we can do in this country then shrug and tell some 30 year old minimum wage laborer that he's SOL for chemo he can't afford. We can do better than that.

It's crazy to tell a 30yr old minimum wage laborer they can't have something that costs 3 times what they make each year? Why is that crazy?

What's crazy is to tell me that because I've worked 50+hrs a week in a stressful management job and still went to school full time at night to get into med school that I now have to pay for everyone who didn't put the thought/effort into their financial situation...

 

[styphon]

http://www.aaos.org/news/aaosnow/sep11/managing4.asp

Canada

All Canadian physicians purchase medical liability insurance through the Canadian Medical Protective Association (CMPA).

Malpractice insurance premiums in Canada are lower than those in the United States for the following three major reasons:

The courts in Canada have set caps on medical liability awards.

Existing Canadian laws set a high hurdle for proving medical liability.

The CMPA is notorious for vigorously defending any and all medical liability suits.

Additionally, in Canada, the losing party pays approximately two-thirds of the winner’s costs. This is a significant disincentive for bringing a medical liability suit.

The Canadian Supreme Court has established guidelines for noneconomic awards at a maximum of roughly $300,000, and the types of cases in which noneconomic awards can be made is limited. In order to sue, the plaintiff must prove that the physician not only caused injury, but also violated a duty of care. Errors in judgment are generally not causes for lawsuit.


........

Wow... Considering our representatives are biased towards lawyers - I have no hope for a similar system in the US.

 

[el_duderino]

It's crazy to tell a 30yr old minimum wage laborer they can't have something that costs 3 times what they make each year? Why is that crazy?

What's crazy is to tell me that because I've worked 50+hrs a week in a stressful management job and still went to school full time at night to get into med school that I now have to pay for everyone who didn't put the thought/effort into their financial situation...

1) Because it's inhuman.

2) I keep forgetting that all poor people, and even lower middle class people, are in their situation because they didn't put effort into their financial situation. I'm glad you keep reminding me.

 

[deleted480308]

1) Because it's inhuman.

2) I keep forgetting that all poor people, and even lower middle class people, are in their situation because they didn't put effort into their financial situation. I'm glad you keep reminding me.

1) it is not inhuman to expect people to pay for the services/goods they receive. anything that deviates from that is either theft or voluntary charity.

2) If you are a mentally/physically able 30yr old adult who has been working your entire life as a minimum wage employee in America, no...you haven't been putting thought or effort into your financial situation. Fast food restaurants start higher than that and if you've worked at a fast food place for a year and haven't been promoted that's on you. The larger picture is that it doesn't matter if I run out of money due to poor planning, laziness, pirates, or evil leprechauns stealing from me....I don't have a right to make you pick up my slack.

 

[DermViser]

1) Because it's inhuman.

But rationing medical care is fine and dandy with you.

 

[el_duderino]

But rationing medical care is fine and dandy with you.

We're not arguing against each other here. You want rationing just as much as I do. Your version of rationing means "you get nothing other than emergency care if you can't afford it, and can have whatever you want if you can." Mine is "you get some minimum level of basic care, well beyond emergency-only, if you can't afford it, and can have whatever you want if you can."

 

[tdram]

2) I keep forgetting that all poor people, and even lower middle class people, are in their situation because they didn't put effort into their financial situation. I'm glad you keep reminding me.

So you're saying that effort is worthless? Why are you in med school then? Why not just sit at home and take a government handout? Why will you get paid more than everyone else putting in the "same" effort?

You don't think it has anything to do with poor financial planning, spending more than you earn, having kids you know you can't afford, not paying attention in school and getting educated or learning a trade/skill and just pure laziness? How many people out there work 80 hour weeks?

You have no idea how many 22 year old moms I've seen with 5 kids, no job, no education, no skills, sitting at home collecting welfare. Why is it my responsibility to fix her mess? The idea that I owe her something because I busted my ass to get educated and gain skills I can use to make money, while she just sat around getting knocked up is offensive.

 

[el_duderino]

So you're saying that effort is worthless?

You're taking after DermViser in the wild imagination department.

 

[tdram]

You're taking after DermViser in the wild imagination department.

I'm talking about reality. In America of all places, there's no excuse for being in a minimum wage job your whole life. Look at Asian immigrants. They came here from halfway around the globe, poor, not even knowing the language, not knowing the culture, having no connections, having no idea how the system works, being discriminated against heavily throughout history, and they have risen up to become among the most successful people in this country. That itself proves that if you work hard enough and smart enough, you can succeed here.