Under the UK system, the average doctor (across all specialties) made about 85,000 pounds. For comparison sake, the average wage in teh UK is about 40,000 pounds, meaning the average doc makes about double the average salary.

The average salary in the US is about 30k per year.

The implication is that it would be reasonable to expect double that for the average doctor, or about 60k per year. Remember, thats across ALL specialties including neurosurgery, radiology, etc

The UK is a good system too, compared to the Canadian model. In the Canadian model, docs are lucky if they get a salary thats 30% higher than the national average.

When govt bureaucrats run healthcare and doctors complain about salary, the sanctimonious bureaucrats always reply with "what are you griping about, you make double the average income so deal with it"

Discuss amongst yourselves.....

U.S. Senators and Representatives, meanwhile, will of course continue to make $160,000 per year with a $5000 raise every year.

Can you reference your stats on Canadian physician salary? The figures I have seen indicate that their specialists earn somewhat less than those in the US, but their primary care doctors make comparable money. If they are only pulling in 30% more than the Canadian national average, then Canada must have an incredibly high national average.

Also of interest, for the first time in 30 years, more physicians are entering/returning to Canada than leaving (Source (http://news.xinhuanet.com/english/2005-08/25/content_3399381.htm)). Has our system gotten so bad that even Canada is looking appealing?

While we're at it, do you really mean "universal coverage" or are you talking about socialized medicine? Depending on how it is implemented, universal coverage in this country could be a huge boon to doctors, as we would have a source of billing for everything we do. Physicians, particularly primary care docs, spend a lot of time and resources treating people who have no insurance and cannot pay any or all of the bill. If everyone had coverage we could reap the financial benefits.

I don't have the reference here, but as an example I would point to the Canadian province of Saskatchewan, which was the first to enact the national health insurance act in 1963. The following year physicians incomes increased 35% as they were actually getting paid for all their services.

Oh, and one more thing. As of this morning, 40,000 pounds converts to $70,443 USD. The average income in the UK is significantly higher than in the US, largely because they do not have the "extremes of income" that we do. If you want to estimate what we would make under "universal coverage" then you will have to find a less absurd fudge factor.

The average income in the UK is significantly higher than in the US, largely because they do not have the "extremes of income" that we do.

Or because they pay a lot of it back to the state in taxes.

In the Canadian model, docs are lucky if they get a salary thats 30% higher than the national average.

Wrong, the average physician in Canada earned $220,000 in 2002 (Source: http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf ) and the national average income was about $35,000 (Source: http://www40.statcan.ca/l01/cst01/labor01a.htm ). Enough with your ridiculous claims already.

Or because they pay a lot of it back to the state in taxes.

Yeah, but come on. $70,443 USD/40,000 pounds vs. $30,000?

Let's examine the UK's income tax rates:

0 - 4,895 pounds ($8,584) = 0%
4,896 - 6,985 pounds ($12,250) = 10%
6,986 - 37,295 pounds ($65,410) = 22%
37,296 and up = 40%

At an income of 40,000 pounds you will shell out 7,959 pounds (19.9%) in income tax.

Per this handy income tax calculator (http://www.dinkytown.net/java/Tax1040.html), a stateside income of $70,443 will generate $13,026 in taxes (18.5%).

Granted, this ignores all deductions, as well as entitlement, state and local taxes in both countries, but I hope it illustrates that the UK's income tax system is more progressive than many give it credit for. In summary, all else being equal, I'll take 40K pounds with UK taxes over 30K dollars with US taxes any day.

Yeah, but come on. $70,443 USD/40,000 pounds vs. $30,000?

Let's examine the UK's income tax rates:

0 - 4,895 pounds ($8,584) = 0%
4,896 - 6,985 pounds ($12,250) = 10%
6,986 - 37,295 pounds ($65,410) = 22%
37,296 and up = 40%

At an income of 40,000 pounds you will shell out 7,959 pounds (19.9%) in income tax.

Per this handy income tax calculator (http://www.dinkytown.net/java/Tax1040.html), a stateside income of $70,443 will generate $13,026 in taxes (18.5%).

Granted, this ignores all deductions, as well as entitlement, state and local taxes in both countries, but I hope it illustrates that the UK's income tax system is more progressive than many give it credit for. In summary, all else being equal, I'll take 40K pounds with UK taxes over 30K dollars with US taxes any day.

Considering that, besides the ~20% income tax, the standard-rate VAT in the UK is in the 18% ballpark, it starts to get a whole lot closer. Average purchasing power between the UK/US is probably pretty similar.

Considering that, besides the ~20% income tax, the standard-rate VAT in the UK is in the 18% ballpark, it starts to get a whole lot closer. Average purchasing power between the UK/US is probably pretty similar.

Since half of my family resides in the UK, the last thing I am going to do claim that their overall tax burden is the same or lower than ours. It's not, it's higher. But "a whole lot closer"? Someone making $70K/40K pounds would have to be taxed to the tune of 57% before even making it to $30K. I'll still take the $70K in Britain.

Under the UK system, the average doctor (across all specialties) made about 85,000 pounds. For comparison sake, the average wage in teh UK is about 40,000 pounds, meaning the average doc makes about double the average salary.

The average salary in the US is about 30k per year.

The implication is that it would be reasonable to expect double that for the average doctor, or about 60k per year. Remember, thats across ALL specialties including neurosurgery, radiology, etc

The UK is a good system too, compared to the Canadian model. In the Canadian model, docs are lucky if they get a salary thats 30% higher than the national average.

When govt bureaucrats run healthcare and doctors complain about salary, the sanctimonious bureaucrats always reply with "what are you griping about, you make double the average income so deal with it"

Discuss amongst yourselves.....

If the average American doctor's salary dipped to a level that was perhaps slightly double the average American's salary (thus 60-70K for doctors), would students still go into medicine? Realistically, would there be enough people willing to take that income for the level of education and training required to reach that end point? Also, if fully trained physicians had this low of a salary, would residents make a much lower income than they do now?

Although I don't see doctors in America ever being as well paid as they were in the past, I believe that their pay can only decrease to a certain level as it becomes more economically feasible for prospective doctors to choose other professions. The quality of care will decrease if the pay decreases too much, and Americans will doubtfully accept lower standards of care from their physicians. Any thoughts? Am I wrong in my argument? This issue is of great interest to me since many doctors have flat out told me to stop being a premed (for these economic reasons) despite my desire to enter the medical profession.

Oh, and one more thing. As of this morning, 40,000 pounds converts to $70,443 USD. The average income in the UK is significantly higher than in the US, largely because they do not have the "extremes of income" that we do. If you want to estimate what we would make under "universal coverage" then you will have to find a less absurd fudge factor.

Sorry to get off the OP's original topic here, but I feel some clarifications need to be made.

I don't know about "average wage," but average per capita GDP (most commonly used by economists to measure income and wealth between countries, see the CIA World Factbook Website www.cia.gov) is much higher for the US than the UK: $40,100 vs. $29,800.

OP can you reference us your wage numbers (e.g. 40,000 pound average wage in UK or $30,000 average wage in U.S.)?

OP can you reference us your wage numbers (e.g. 40,000 pound average wage in UK or $30,000 average wage in U.S.)?

Don't hold your breath.

Wrong, the average physician in Canada earned $220,000 in 2002 (Source: http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf ) and the national average income was about $35,000 (Source: http://www40.statcan.ca/l01/cst01/labor01a.htm ). Enough with your ridiculous claims already.

Uhh newsflash, those numbers are TOTAL AGGREGATE PAYMENTS TO DOCTORS, not income figures. Those figures assume that the doctor has zero overhead, zero office expenses, zero malpractice insurance cost, zero ancillary support staff costs, zero taxes, etc.

Get back to me when you find real income numbers.

40,000 pounds is/was the average UK income? I think not. That sounds WAY high to me. I'll bet it is half that. I'll eat my words if I'm wrong but that seems very outrageous.

No matter which if any of these figures are correct- this is one reason a national health system would not work. Anything below what physicians make now is too pathetic to adequately compensate for the crap that docs have to put up with.

The chart at the bottom of the page on this link indicates the breakdown of income tax rates in the UK. Seems to me they are comparable to U.S. income tax rates. Furthermore, if you do the math based on the average total income tax paid then you will see that the average UK income is about 21k pounds give or take a few hundred. So, once again, comparable to U.S. numbers.
http://www.tutor2u.net/economics/content/topics/poverty/incomes.htm

Actually I'm wrong. That 21k pounds is the average HOUSEHOLD income not individual income... In other words, UK docs earn about 4 times the income that the average UK HOUSEHOLD earns. That, of course, is considering that the average income of a UK doc is indeed 85k pounds as asserted by the OP, and I don't know about the veracity of that assertion.

Uhh newsflash, those numbers are TOTAL AGGREGATE PAYMENTS TO DOCTORS, not income figures. Those figures assume that the doctor has zero overhead, zero office expenses, zero malpractice insurance cost, zero ancillary support staff costs, zero taxes, etc.

Get back to me when you find real income numbers.

Why don't you just give it to us? I'm curious to know.

wow..mcguyver..your the one that started the post..so why dont you show us REAL INCOME NUMBERS...ass.

Uhh newsflash, those numbers are TOTAL AGGREGATE PAYMENTS TO DOCTORS, not income figures. Those figures assume that the doctor has zero overhead, zero office expenses, zero malpractice insurance cost, zero ancillary support staff costs, zero taxes, etc.

Get back to me when you find real income numbers.

Average overhead and other expenses up here are 30%, with big savings in administrative costs since we only have to deal with 1 payer and ALL our billings are payed out; malpractice is negligible (unlike your screwed up system) since it is partly covered by the provincial health plans, and we are all covered by the CMPA for legal advice and representation meaning more big savings, especially compared to the unlucky Americans that get sued. I'm quoting income figures, which obviously don't include taxes (as opposed to take-home pay), and taxes in Canada are comparable to those in New York and other northeastern states. Yes our salaries are slightly lower than in the US, but it's nowhere near the "30% over the average income" you suggested, and frankly not dealing with HMOs or your malpractice climate is well worth it, IMO.

No matter which if any of these figures are correct- this is one reason a national health system would not work. Anything below what physicians make now is too pathetic to adequately compensate for the crap that docs have to put up with.

Lately, Praetorian, I have been agreeing with you. And I agree with you on this one, too!

"malpractice is negligible (unlike your screwed up system)"

I wonder if many Canadians realize that they benefit from the military expense the United States bears. Sure, they can get away with a semi-functional socialist system, but try not having the good ol' USA backing you up in case of any military hardship. If Canada didn't have the USA to its border, they'd have to tax the crap out of their citizens to afford defense AND would not be able to provide their healthcare system.

Also, yes many lawsuits are insane, but MANY MORE of them actually protect patients from the malpractice that doctors commit (yes, I know it's hard to believe, but doctors screw up). Personally, I like knowing that a doctor has to be extra careful and can't take anything for granted with a life. If you don't like the American system, don't practice here.

Average overhead and other expenses up here are 30%

If that's the average overhead across all specialties, consider that overhead varies tremendously from one specialty to another. In the U.S., overhead in primary care tends to be higher (50-60% of revenue) than most other specialties, and I imagine the same is true in Canada. Cognitive fields, such as psychiatry, tend to have the lowest overhead (in the 30-40% range), with many surgical subspecialties, such as orthopedics, in the 40-50% range.

I have no doubt, however, that one benefit of a single-payer system will be a reduction in overhead. To the practitioner, it may be the only benefit.

I have no doubt, however, that one benefit of a single-payer system will be a reduction in overhead. To the practitioner, it may be the only benefit.

Mind you, it would also eliminate charity care, which is not an insignificant benefit for many practicing physicians.

Mind you, it would also eliminate charity care, which is not an insignificant benefit for many practicing physicians.

Ultimately, it would depend on how physicians were compensated under a single-payer plan. If the single-payer fee schedule looked like Medicare (or, God forbid, Medicaid), we would probably not be better off, even with reduced overhead.

Ultimately, it would depend on how physicians were compensated under a single-payer plan. If the single-payer fee schedule looked like Medicare (or, God forbid, Medicaid), we would probably not be better off, even with reduced overhead.

Well duh. ;)

Well duh. ;)

I'm really not trying to state the obvious. ;) Your post suggested that eliminating charity care under single-payer would benefit physicians. However, this would only be true in the context of the bottom line. Most physicians have no qualms about providing a certain amount of free care, as long as they're making enough from paying patients to do the requisite cost-shifting.

I'm really not trying to state the obvious. ;) Your post suggested that eliminating charity care under single-payer would benefit physicians. However, this would only be true in the context of the bottom line. Most physicians have no qualms about providing a certain amount of free care, as long as they're making enough from paying patients to do the requisite cost-shifting.

From the AMA: Physicians say uninsured a major problem (http://www.ama-assn.org/ama/pub/category/15330.html)

July 21, 2005

A third of physicians said the number of uninsured patients in the United States has reached the crisis level, while 60 percent consider it a major problem, according to the results of an AMA Member Connect® Survey on the uninsured.

The members-only survey generated one of the highest responses to date for an AMA Member Connect Survey. It sought physicians' perspectives on: the severity of the uninsured problem and priority segments of the population for increased health coverage; physicians' experiences in treating the uninsured; medical students' and residents/fellows' opportunities to address the issue; and opinions on potential short-term programs for the uninsured the AMA could support.

Perhaps as evidence of the reported severity of the issue, more than a third of physicians provide five or more hours of charity care in a typical week, and 16 percent of them provide 10 or more hours per week.

Fully 87 percent of physicians provide some level of charity care in a typical week, but providing that care poses significant difficulties, the survey showed. Of the physicians who care for uninsured patients, 33 percent said ensuring prescriptions get filled ranked first among difficulties; 27 percent said securing diagnostic tests and procedures is the greatest difficulty. Securing routine follow-up care (13 percent) and obtaining specialists referrals (11 percent) were also cited as significant problems.

In addition to providing charity care, in 2004, 32 percent of physicians incurred more than $50,000 of debt for patients who did not pay for medical care, and 21 percent incurred more than $75,000 of such debt.

The survey also showed the contrasting affect the issue has on medical students and resident/fellow physicians view of their future in medicine. While 55 percent of medical students said the issue motivates them to make a difference, only 39 percent of residents/fellows were so motivated. Conversely, while 45 percent of residents/fellows said the issue of the uninsured makes them less optimistic about practicing medicine, only 30 percent of medical student said it makes them less optimistic."

My 2 cents....to fix this problem I would implement the following reforms:

Tort reform - limit the kinds of suits that can be brought to a court and limit damages for cases that are not directly due to criminal neglect (e.g. operating while intoxicated). The reform would have to include some common sense approach to healthcare in that you are sick and you could die - but we will try the medications and procedures that may or may not cure the disease. It never ceases to amaze me that patients sue because the medication they took caused some negative side effect - it happens and you have to assume the risk. A lifetime of fast food has it consequences and the medication you take could induce diabetes - your lack of concern for your healthcare is no reason for multi-million dollars lawsuits. This step alone would reduce the cost of medicine.

Anytime the federal government is responsible for a large program - budget shortfalls and losses are just charged to the taxpayer in the form of higher taxes. That said, the government should not be in the business of healthcare. The taxes that we pay for Medicare and Medicaid should be combined into a single healthcare benefit payout for all citizens. The government would pay the insurance company of your choice an annual healthcare premium that is risk adjusted. So the 70 year old with end-stage renal disease might receive 70K a year and the healthy 20 year old might receive 3 K a year in the form of premium payment to the insurance company of choice. If you did not like the company because they provided poor customer service and denied healthcare request you could switch to another company. When the government runs the healthcare system you do not have a choice and care can be compromised. Just go visit your local county hospital.

This step alone would make us more competitive in the global market since the average car has about 3000 dollars worth of healthcare expense incorporated into the cost of manufacturing. Business would save billions in healthcare cost and healthcare retirement benefits.

This could be enhanced by making a few minor changes to the current HIPAA laws and create a national clearing house for payments. Currently all insurance companies are required to accept a standardized electronic invoice for services. A few minor changes could create a clearinghouse that accepts all bills and forwards them to an insurance company and payments are sent electronically (which is in place now but not via a single entity - instead invoices are sent to the insurance company). I would also add to this function a requirement to submit patient data in an HL7 format and encrypted so that physician could access (WITH PATIENT PERMISSION) medical data such as recent x-rays, labs, CT scan, etc. This would reduce the cost of repetitive diagnostic imaging and labs. Additionally, physicians would have less overhead since the data is stored in a repository and not in their offices and the reduced paperwork and billing requirements would reduce overhead.

So your average doctor could see a patient, review records, not worry about litigation and avoid practicing defensive medicine, and get paid for their services.

So the 70 year old with end-stage renal disease might receive 70K a year and the healthy 20 year old might receive 3 K a year in the form of premium payment to the insurance company of choice.

Interesting suggestion. How do you feel about means testing for said payouts? When Bill Gates turns 70 and has ESRD will he get 70K a year?

That is an excellent point - but I think universal health coverage paid by taxes (that ol Bill already paid) would limit means testing. The current tax system is another nightmare that deserves an overhaul but is outside the scope of this discussion.

Another point I saw on another post in respects to national healthcare is worth mentioning again, and again, and again...

In a national healthcare system physician may not have a choice with whom to do business with - the government would be the ONLY choice. In that scenario - our reimbursement is tired to the legislator which has a long track record of cutting reimbursement and limiting services.

In the universal healthcare scenario in my previous post, physician could choose not to do business with certain companies just as enrollee could choose to switch companies.

The government has a long track record in healthcare and most of it is abysmal - so I would say be careful what you wish for we may just get it

The idea proffered in the previous post came from a fortune magazine editorial – I cannot in good conscious take credit for the idea

That is an excellent point - but I think universal health coverage paid by taxes (that ol Bill already paid) would limit means testing. The current tax system is another nightmare that deserves an overhaul but is outside the scope of this discussion.

Outside the scope, sure, but certainly of interest. I've been pondering the benefits of a flat tax recently. The experiences that small European nations have had with it really tempts me to wonder if it could work here. The big criticism of it is that to raise equivalent revenue would require a flat tax rate that's much higher than its proponents suggest, but I dunno. If one eliminates the IRS and destroys the ease of most tax evasion, perhaps it could work.

In a national healthcare system physician may not have a choice with whom to do business with - the government would be the ONLY choice. In that scenario - our reimbursement is tired to the legislator which has a long track record of cutting reimbursement and limiting services.

Indeed, that's the kicker.

To play devil's advocate, two things. First, many (if not virtually all) insurance companies peg their reimbursement to Medicare rates. Some are higher, some are lower, but when you add it all up one could make a strong argument that doctors are effectively getting reimbursement from a single fee schedule already. The difference is that private, for-profit insurance companies have a strong incentive to make payment a miserable process for the doctors.

Also, if everyone is covered under a national plan, all of a sudden everyone is going to have a stake in its funding. That might make it very hard for politicians to cut reimbursements without significant fallout from the voters who depend on it. Despite Medicare's enormous popularity with seniors, and their high rate of voter turnout, let's face it: if you're not 65+ or getting paid by Medicare then you really don't give a rat's ass if it's slashed to pieces.

Good points - I agree with your position.

I also like the idea of a flat tax. Just think; if there was a flat tax then politicians would have to come back to the voters to raise taxes at their own political peril. As it stands now, many taxes are hidden in fees and levies, including sales tax, gasoline surcharges and all those annoying fees on your phone bill. This structure allows the government to raise money without declaring new taxes to fund all that pork.

Just think of all the billions save in IRS enforcement and accounting - the incredibly rich would pay the same 15% as the lowest wage earner and deductions would be a thing of the past. I don't think politicians have the courage to support such a radical agenda. Every accounting and lawyer lobbyist would be out in force to protect their cut of the always frustrating and complex tax season. :laugh:

Wrong, the average physician in Canada earned $220,000 in 2002 (Source: http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf ) and the national average income was about $35,000 (Source: http://www40.statcan.ca/l01/cst01/labor01a.htm ). Enough with your ridiculous claims already.

Seems awfully high. Just to clarify, are we talking Canadian dollars?

Seems awfully high. Just to clarify, are we talking Canadian dollars?

Canadian dollars, of course. With current exchange rates, $190,000 US.

Regarding GDP income averages, which were mentioned above, this is what NAtionMaster says:

#1 Luxembourg $66,463.78 per capita
#2 Norway $54,467.23 per capita
#3 Switzerland $47,999.07 per capita
#4 Ireland $45,707.17 per capita
#5 Denmark $44,742.82 per capita
#6 Iceland $41,720.45 per capita
#7 United States $39,452.74 per capita
#8 Sweden $38,480.78 per capita
#9 Japan $36,285.57 per capita
#10 Finland $35,726.02 per capita
#11 Austria $35,443.98 per capita
#12 United Kingdom $35,421.29 per capita
#13 Netherlands $35,183.76 per capita
#14 Belgium $33,754.34 per capita
#15 France $33,015.40 per capita
#16 Germany $32,929.58 per capita


If you work out taxes, you'll see that the US and UK are very similar. While there was a comment above on the Canadian doctor income not including taxes, expenses, etc., it's also the same for US doctors.

A large portion of current US expenditure pays for private jets and fancy offices for insurance executives.

Interesting ideas. A few comments:

1. Malpractice, while a significant expense to individual practitioners (and depending on specialty), only constitutes a tiny % of all health care dollars spent (on the order of 1%). So tort reform, while helpful, wouldn't really do much to control expenses.

2. With the risk-adjusted payouts by the government to the insurance companies of your choice, the incentive still exists for the insurance companies to cherry-pick the "best" customers. If I'm an insurance company, why the heck should I pick up the old guy with ESRD, even with a $70K pay-in, if I face a significant risk of incurring greater costs than the paid premiums? Too much volatility for my taste. This could result in a population of undesirable uninsured, same as today, and government may very well be the insurer of last resort, as today.

Thoughts?

My 2 cents....to fix this problem I would implement the following reforms:

Tort reform - limit the kinds of suits that can be brought to a court and limit damages for cases that are not directly due to criminal neglect (e.g. operating while intoxicated). The reform would have to include some common sense approach to healthcare in that you are sick and you could die - but we will try the medications and procedures that may or may not cure the disease. It never ceases to amaze me that patients sue because the medication they took caused some negative side effect - it happens and you have to assume the risk. A lifetime of fast food has it consequences and the medication you take could induce diabetes - your lack of concern for your healthcare is no reason for multi-million dollars lawsuits. This step alone would reduce the cost of medicine.

Anytime the federal government is responsible for a large program - budget shortfalls and losses are just charged to the taxpayer in the form of higher taxes. That said, the government should not be in the business of healthcare. The taxes that we pay for Medicare and Medicaid should be combined into a single healthcare benefit payout for all citizens. The government would pay the insurance company of your choice an annual healthcare premium that is risk adjusted. So the 70 year old with end-stage renal disease might receive 70K a year and the healthy 20 year old might receive 3 K a year in the form of premium payment to the insurance company of choice. If you did not like the company because they provided poor customer service and denied healthcare request you could switch to another company. When the government runs the healthcare system you do not have a choice and care can be compromised. Just go visit your local county hospital.

This step alone would make us more competitive in the global market since the average car has about 3000 dollars worth of healthcare expense incorporated into the cost of manufacturing. Business would save billions in healthcare cost and healthcare retirement benefits.

This could be enhanced by making a few minor changes to the current HIPAA laws and create a national clearing house for payments. Currently all insurance companies are required to accept a standardized electronic invoice for services. A few minor changes could create a clearinghouse that accepts all bills and forwards them to an insurance company and payments are sent electronically (which is in place now but not via a single entity - instead invoices are sent to the insurance company). I would also add to this function a requirement to submit patient data in an HL7 format and encrypted so that physician could access (WITH PATIENT PERMISSION) medical data such as recent x-rays, labs, CT scan, etc. This would reduce the cost of repetitive diagnostic imaging and labs. Additionally, physicians would have less overhead since the data is stored in a repository and not in their offices and the reduced paperwork and billing requirements would reduce overhead.

So your average doctor could see a patient, review records, not worry about litigation and avoid practicing defensive medicine, and get paid for their services.

good points....I think there would have to be some thoughtful consideration as to insurability and the right of an insurer to refuse a person based on health - There are many programs that currently provide insurance to the elderly and that would be a good place to look for guidance

Even though malpractice overall is small portion of overall healthcare expenditure - it can be huge portion of the individual physician expenses. A single unjustified (ambulance chasing - lotto mentality) law suit could result in huge premium increases and that is why I had mentioned it as an element of needed reform.

From the British government (http://www.britishembassy.gov.uk/servlet/Front?pagename=OpenMarket/Xcelerate/ShowPage&c=Page&cid=1025627696102&aid=1059131256447):

Visit our specific FAQ page: Can I work as a doctor in England?: FAQs

Dr Steve Atherton, Medical Advisor on International Recruitment, explains:

The National Health Service (NHS) provides comprehensive health care to everyone with a right to live and work in England. It is completely funded out of general taxation. England is experiencing the biggest change in its health services since the start of the NHS in 1948. In 2000 the Government published its vision of the future, the NHS Plan, in which it announced a massive increase in funding for the NHS. The intention being to reduce waiting times for treatment, improve facilities and allow patients more choice in where and how they are treated.

To achieve these ambitious plans the NHS plan promised an extra 9,500 doctors by March 2004. Although the number of students going to medical school has been increased it will be many years before they become specialists and family doctors. In the meantime there are not enough doctors in post - graduate training to meet the March 2004 targets, so the NHS needs to recruit doctors from outside the United Kingdom to work as specialists and family doctors in England. In England hospital specialists are called consultants and family doctors are known as general practitioners (GPs). Doctors are needed in most specialities and there are vacancies throughout England. The specialities in which we have the most vacancies are:

- General practice;
- Psychiatry;
- Histopathology;
- Clinical radiology;
- Anaesthetics;
- Orthopaedic surgery;
- Ophthalmology;
- General Internal medicine.

The NHS is a good employer with very attractive working conditions that include:

- National pay and conditions, i.e. same salary and conditions wherever you work in England.
- 6 weeks annual leave plus public holidays and up to 40 days study leave every 3 years.
- For consultants, salaries start at €80,000 per year and go up to €105,000 in the fifth year. There are opportunities to earn more.
- For general practitioners the average salary in 2001 was €99,000.
- Attractive and reliable pension arrangements.
- The right to do private practice without losing your NHS salary.
- Contracts of employment that are permanent but you can negotiate a fixed term contract.

In England once a doctor has completed hospital specialist training he / she applies to become a hospital consultant. There is only one level of consultant and so each consultant practices autonomously and without supervision. The consultant works with a team that includes doctors in training, nurses and therapists (e.g. physiotherapists, etc.). Usually the consultant is the head of the team. The approach to treatment and clinical practice is made by agreement within the team.

The practice of family medicine in England and Italy is very similar. Doctors, when they are qualified as general practitioners, apply to join a family practice where they work with other GPs, community nurses, nurse specialists, and therapists to provide comprehensive health care for a local community. A number of family practices join together to form a Primary Care Trust (PCT). The PCT manages the delivery of family medical services in a particular community and commissions secondary care from the local hospital.

GPs in England are either self-employed or paid a salary by the employer, the PCT. The self-employed GP has a contract to provide a range of services with the PCT.

Historically, the exchange rate is about 1.5 dollars to the pound. These number would seem to suggest that it is more lucrative to be a GP in Britian, but less so to be a specialist. Which is reasonable set of incentives, since GPs are what everyone wants more of these days.

Also note the eight weeks paid vacation per year, lifetime employment, and ability to work on the side. Not a bad deal.

France, lifted from a blogger with his **** together (I was impressed):

France:

Da' basics: France has a basic system of public health insurance that, as of January 2000, covers everybody in the nation. Before then, portions of the population lacked insurance. The reimbursement rates are wholly uniform, despite the fact that there are actually three health care funds, a main one covering most workers, and then one for the self-employed and one for agricultural workers.


As that hints, the health care is occupationally based. It's paid for through employer and employee contributions (much like Social Security), in addition to personal income taxes. The latter have been increasing in recent years.

The funds are private entities under the joint control of employers and unions, which are in turn supervised by the state. As might be expected, that doesn't work particularly smoothly, and there's a constant battle for authority and control. Creative tension, one might kindly call it. The funds are mandatory, no one may opt-out, and they're not allowed to compete with each other nor micromanage care.

The public system covers around 75% of total costs. Half of the rest is paid out-of-pocket and the remaining is made up by supplementary insurance companies. About 85% of the French have some form of private insurance, which pays for the various procedures and equipment the public insurance doesn't wholly cover. This of course led to inequality, so in January 2000, a means-tested public supplementary insurance program came online in order to ensure that the poor got top care.

France is the only country where access to care is unlimited. Patients can see as many doctors as they damn well please. They don't need referrals to see specialists, and there's basically no gatekeepers at all (this is going to change, recent reforms mandate a principal doctor -- a gatekeeper -- if you want full reimbursement).

The health care system is mainly under state control. The state plans out hospitals, the allocation of specialized equipment, etc. Some of this is done at the regional level, a trend which seems to be increasing. The hospitals offer about 8.4 beds per 1,000 people (America, btw, offers 3.6. Ouch.) The public sector provides 65% of the beds, private hospitals -- which operate on a fee-for-service basis -- make up the rest, and primarily concentrate on surgeries. French citizens choose which one to go to and get the same reimbursement at either. How's that for choice? Not good enough? The French also get to choose their physicians, their physicians get to choose where they practice, and there's patient-client confidentiality.

Problems: France still has class and geographical disparities in their health care outcomes. They're not nearly what ours are, but they exist nonetheless. In addition, various hospitals offer varying levels of care, health costs are rising (again, not as much as here, but still significantly), and physicians often don't feel they're paid enough for their services, leading to a number of recent strikes. As it is, French physicians only make US $55,000, about 1/3rd what their American counterparts pull in.

Yes, but are we better? Right, you say, that's all very not interesting. But how do we stack up with France? Better? Worse?

Yeah, the second one. France's health care system bodyslams us on most every metric. Beyond the beds per 1,000 stat mentioned above, France has more doctors per 1,000 people (3.3 vs. 2.4), spends way less, has 3.2 more physician visits per capita (6 in France vs. 2.8 in America, which probably accounts for the better preventive care in France), has a much higher hospital admission rate, and beats us handily on the most important measure: potential years of life lost. American women lose 3,836 years per 100,000, while American men give up 6,648 in the same sample size (yes, we get screwed). In France, the comparable numbers are 2,588 years for the women and 5,610 for the men. Still not great, but quite a bit better.

So France spends less, gets more, and does so through a public-private hybrid that's heavily, heavily public. Socialized medicine sure is scary.

Sources:
A Conservative Convert to Socialized Medicine by David Burgess. Link.
OECD frequently requested data. Link.
The Health Care System Under French National Insurance: Lessons for Health Reform in the United States by Victor Godwin. Link.
The French Health Care System. Link.


$55,000. OUCH. Silver lining number one: in terms of results, it kicks our cowboy-hat-wearing asses.

Silver lining number two: the fact that French physicians under "socialized medicine" make between one-third to one half what English physicians make under "socialized medicine." Which illustrates the fallacy of taking one country and extrapolating from that what physicians must make under any scheme of universal care. Clearly, there is no necessary relationship between universal care and physician salaries.

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some points worth mentioning...

doctors make to much, hummm? After 11+ years of school with zero savings towards retirement, nauseating debt and a reduce work window - the comments are meritless.

Government healthcare and grey waiting rooms and drab government officials - go visit your local under-funded over-taxed county hospital.

Anything Ted Kennedy recommends should be immediately ignored.

I am no expert on the tax rates of the countries in question and the national spending per capita on individuals as they pertain to outcomes and longevity. One thing is clear America is fat and that has a huge toll on health and the cost of healthcare.

Anytime you start talking about preventative care - all of the eye of newt and slippery elm freaks start promoting their agenda as if that is the answer - less science and more absurd "alternative" treatments (e.g. add H2O2 to your asthmatics child's bath to increase oxygenation ??? - thank you N.D)

Why copy a system full of problems this is America - we have corupt politicians with agenda that do not include their constituents concerns. I am sure that each of those utopian healthcare systems in Europe has their dark side and it is pointless to import their baggage.

Our politicians do not have the spine to implement sensible healthcare reform when so many lobbyist say otherwise - no more 3 million dollar law suits because you were depressed, took Effexor, ate Twinkies and got diabetes! How will lawyers siphon off the majority of the lottery winnings leaving the "victim" with a few bucks and a bag of Twinkies if there is reform?

Then there are us evil doctors dedicating 11 years of our lives to serve "humanity" as we endure verbally abusive patients, long hours, reduced reimbursement and 10 hours of paper work and phone calls for 37.50 from the insurance company. They might take away this dream job if there is reform...

I think of all the times between jobs where I have had to consider my family's needs and being uninsured was not an option - but then I realized I had a responsibility. I don't know - does the guy on the corner with the "work for food" sign really care if he has health insurance, he apparently doesn’t care he is unemployed? And before you go off on his victim status - I have had to endure some really crappy jobs -BECAUSE I had obligations. What is his excuse?

Rant done

Anything Ted Kennedy recommends should be immediately ignored.

And that, finally, is what all the anti-universal care arguments boil down to: knee-jerk right-wing partisanship that ignores the facts. :laugh:

Call me right wing if I want to protect my income, avoid excessive taxes (paying for those that don't feel inclined to), and avoiding more government intervention where they clearly have a long track record of failure.

If you think you are not paying enough taxes you should volunteer to pay more, you could redistribute your wealth. As for me, social security will be non existent, and Medicare will eventually go through some dramatic changes because the current system is unsustainable and both parties are to blame. I see it as my personal responsibility to fund my own retirement and my children's education.

Apparently, you see the government responsible for healthcare, and maybe everything else. That equates to higher taxes and more government waste, surely you have heard of pork barrel spending. It is idealist to think the government would reform and become responsible like many of the citizens of this country. Today they are just spending and leaving future generations (my kids) with the bill. This is the only consistent behavior demonstrated by both parties - The only solution is to keep them out of your wallet. You may not agree and think the government should spend more on social programs...that is what makes this country great, you can disagree and not end up in a ditch with a bullet in your head (circa pol pot)

Which leads me to my rightful opinion that nothing good comes from Ted Kennedy

Call me right wing if I want to protect my income, avoid excessive taxes (paying for those that don't feel inclined to), and avoiding more government intervention where they clearly have a long track record of failure.

This thread is about physician salaries under universal care. The fact that you can't talk about that without babbling about Ted Kennedy illustrates that you are an ideologue, not a problem solver. And as your wont, you are ignoring the facts:

1. Universal care is cheaper.
2. It is the present system that has a long track record of failure. Universal care beats the US system in every metric.

If you have some useful information about the thread topic, I'm all ears. If it's just the usual right-wing whining about Big Brother, believe me, we've heard it all before.

Can't talk about physician salaries without dragging in Pol Pot . . . why do I bother?

Physician salaries under Medicare are often cut or held at previous year’s levels because of budgetary crisis created by our elected officials.

A strictly single payor source that includes government run facilities (e.g. county hospitals) with absolutely no choice by physicians as to who they do business with is a bad system - because as our fees are cut we have nowhere else to go - except complain to "elected" officials who do not have our interest as a primary concern.

Social medicine supporters are quick to point to our enlightened European brothers but fail to mention the tax structure (top bracket in France 50%) and the increasing cost or poor services

In France they have a mix of private and state funded systems that are enacting gatekeepers and struggle with cost

The UK system does not rely on the technology that has come to be expected in this country - try and get a CT scan in the NHS system - you might die first.

These countries can only manage cost overruns by increasing taxes, we have seen that in the Medicare & Medicaid systems here in the US and it can only get worse. Governments are more likely to increase taxes then force system improvements

I have no problem combining Medicaid, Medicare and employer contributions for current workers (not retirees) and funding a single payor risk adjusted system where a choice of insurance companies, physicians, and hospitals are part of the deal. Physicians can choose not to do business with insurance companies that have poor reimbursement practices for physician payment (try that with the government)

I don't think the European systems of socialized medicine are in the best interest of physicians , a French doctor makes 55K US, I would never be able to repay my loans, A UK doctor makes more but the NHS system lacks resources

Everyone is quick to bash the US system of healthcare but it is the best in the world and we should create a universal healthcare system that rivals that healthcare system. I don't think copying another system is very innovative.

People will point out how France has better outcomes, we have different populations and there is always the French paradox - America is fat and is only getting fatter. I would like to see apple to apple comparisons of say CAD outcomes in both systems with comparable patients and comorbity, then I might be convinced French healthcare is superior to US healthcare.

It all boils down to political will and there is a severe lack of imitative in Washington.

Regarding GDP income averages, which were mentioned above, this is what NAtionMaster says:

#1 Luxembourg $66,463.78 per capita
#2 Norway $54,467.23 per capita
#3 Switzerland $47,999.07 per capita
#4 Ireland $45,707.17 per capita
#5 Denmark $44,742.82 per capita
#6 Iceland $41,720.45 per capita
#7 United States $39,452.74 per capita
#8 Sweden $38,480.78 per capita
#9 Japan $36,285.57 per capita
#10 Finland $35,726.02 per capita
#11 Austria $35,443.98 per capita
#12 United Kingdom $35,421.29 per capita
#13 Netherlands $35,183.76 per capita
#14 Belgium $33,754.34 per capita
#15 France $33,015.40 per capita
#16 Germany $32,929.58 per capita


If you work out taxes, you'll see that the US and UK are very similar. While there was a comment above on the Canadian doctor income not including taxes, expenses, etc., it's also the same for US doctors.

A large portion of current US expenditure pays for private jets and fancy offices for insurance executives.


Thanks for the good info. Who knew people lived so well in Iceland?!

I wonder if many Canadians realize that they benefit from the military expense the United States bears. Sure, they can get away with a semi-functional socialist system, but try not having the good ol' USA backing you up in case of any military hardship. If Canada didn't have the USA to its border, they'd have to tax the crap out of their citizens to afford defense AND would not be able to provide their healthcare system.

I love it when jingoistic Americans bring up this point. :laugh:

You know what, if it wasn't for the US, most, if not all, of the military hardships Canada is supposedly shielded from probably wouldn't even exist if it wasn't for the US and its policies. Attacking Canada is akin to attacking Greenland--no one in their right mind would care to invade and attack Greenland!

I love it when jingoistic Americans bring up this point. :laugh:

You know what, if it wasn't for the US, most, if not all, of the military hardships Canada is supposedly shielded from probably wouldn't even exist if it wasn't for the US and its policies. Attacking Canada is akin to attacking Greenland--no one in their right mind would care to invade and attack Greenland!

For a second I misread that as "no one in their right mind cares about Canada." :laugh:

The above reference to French doctor's earnings is inaccurate, and is actually the lowest average for primary care doctors (it represents the bottom earnings).

The following is the summary of selected countries from May 2004 for NERA (National Economic Research Associates)
Hospital Doctors Primary Care
Highest average Lowest average Highest average Lowest average All

Australia 203,132* 59,789 86,226* 60,641 65,252
Canada 154,3153 * 117,197* 117,191* 81,0173 * 101,667
Denmark 73,2364 49,278 106,251 71,090 52,324
France 116,0775 104,056 67,221 57,319 61,441
Germany 56,455 35,465 71,443 55,426
Italy 81,414 74,300
Netherlands 175,155 64,053 92,226 57,064
New Zealand 118,276 81,103
Spain 67,785 42,254 46,012 35,407
Sweden 56,816 56,543 61,221 56,816
UK 127,285 * 102,964* 92,118
USA 267,993 165,1129 151,682 136,260 126,648

Sorry about the formatting, it's from a PDF converted to txt. The first two columns are the highest and lowest averages for hospital doctors (specialists) and the third and fourth columns are the highest and lowest averages for primary care doctors (GPs, Family Practice).

As you can see, it varies widely. Mostly, I think that public sector salaries are determined by local policies regarding private enterprise, etc., but even that doesn't hold up. I am in Ireland which has far higher public sector salaries that are higher than both US and UK (private or public).

So "universal" or "social" health care has nothing to do with earnings potential. It is more to do with local lobbying and political influence by doctors that get you high salaries in a public service health system. Ireland's public service pays far in excess of the above salaries and has a mix of public and private service, with unlimited public service and free prescriptions (e.g., for psychiatric patients, and so on) and also half of the country has voluntary private health insurance. Overall, the salaries are around double the US (for residents and specialists). It is a universal health system with parallel private care if you can pay for it.

A public health care system is essential in a civilised world. What you get paid depends on your negotiating skills with the people who pay you.

I love it when jingoistic Americans bring up this point. :laugh:

You know what, if it wasn't for the US, most, if not all, of the military hardships Canada is supposedly shielded from probably wouldn't even exist if it wasn't for the US and its policies. Attacking Canada is akin to attacking Greenland--no one in their right mind would care to invade and attack Greenland!

Yep, you're absolutely right man. The United States created Nazi Germany, the Soviet Union, Red North Korea, and all the other tyrannical governments that existed BEFORE there was a United States. Or maybe it was President Bush. War has not existed for thousands of years, and man has not been seeking power at the expense of others for even more. But then again, maybe it's all America's fault :rolleyes: If you don't like "jingoistic" Americans, don't come here. We don't care. Most Americans are good people that sympathize with the rest of the world.

What no response to my post refarrell - quick to label my a right wing zealot but not ready to respond to my position on salaries?

That is the problem with left wing zealots - quick to dismiss but where is your plan - other than increase taxes? :laugh:

2 done 7 more to go and hell week is over....

If you have some useful information about the thread topic, I'm all ears. If it's just the usual right-wing whining about Big Brother, believe me, we've heard it all before.

Can't talk about physician salaries without dragging in Pol Pot . . . why do I bother?[/QUOTE]

What no response to my post refarrell - quick to label my a right wing zealot but not ready to respond to my position on salaries?

That is the problem with left wing zealots - quick to dismiss but where is your plan - other than increase taxes (I would actually like to here it - other than its cheaper)? :laugh:

...that is what makes this country great, you can disagree and not end up in a ditch with a bullet in your head (circa pol pot)



Martin L. King
JFK
Malcolm X
Robert Kennedy
Medgar Evers
All the less popular assassinated leaders

I guess you are right, they did not end up in a ditch ;)

it is an important distinction :D

My 2 cents....to fix this problem I would implement the following reforms:

Tort reform - limit the kinds of suits that can be brought to a court and limit damages for cases that are not directly due to criminal neglect (e.g. operating while intoxicated). The reform would have to include some common sense approach to healthcare in that you are sick and you could die - but we will try the medications and procedures that may or may not cure the disease. It never ceases to amaze me that patients sue because the medication they took caused some negative side effect - it happens and you have to assume the risk. A lifetime of fast food has it consequences and the medication you take could induce diabetes - your lack of concern for your healthcare is no reason for multi-million dollars lawsuits. This step alone would reduce the cost of medicine.

Anytime the federal government is responsible for a large program - budget shortfalls and losses are just charged to the taxpayer in the form of higher taxes. That said, the government should not be in the business of healthcare. The taxes that we pay for Medicare and Medicaid should be combined into a single healthcare benefit payout for all citizens. The government would pay the insurance company of your choice an annual healthcare premium that is risk adjusted. So the 70 year old with end-stage renal disease might receive 70K a year and the healthy 20 year old might receive 3 K a year in the form of premium payment to the insurance company of choice. If you did not like the company because they provided poor customer service and denied healthcare request you could switch to another company. When the government runs the healthcare system you do not have a choice and care can be compromised. Just go visit your local county hospital.

This step alone would make us more competitive in the global market since the average car has about 3000 dollars worth of healthcare expense incorporated into the cost of manufacturing. Business would save billions in healthcare cost and healthcare retirement benefits.

This could be enhanced by making a few minor changes to the current HIPAA laws and create a national clearing house for payments. Currently all insurance companies are required to accept a standardized electronic invoice for services. A few minor changes could create a clearinghouse that accepts all bills and forwards them to an insurance company and payments are sent electronically (which is in place now but not via a single entity - instead invoices are sent to the insurance company). I would also add to this function a requirement to submit patient data in an HL7 format and encrypted so that physician could access (WITH PATIENT PERMISSION) medical data such as recent x-rays, labs, CT scan, etc. This would reduce the cost of repetitive diagnostic imaging and labs. Additionally, physicians would have less overhead since the data is stored in a repository and not in their offices and the reduced paperwork and billing requirements would reduce overhead.

So your average doctor could see a patient, review records, not worry about litigation and avoid practicing defensive medicine, and get paid for their services.

Most of these proposed reforms would almost surely result in insurance companies snatching up the profits by decreasing physician payout.

Good points - I agree with your position.

I also like the idea of a flat tax. Just think; if there was a flat tax then politicians would have to come back to the voters to raise taxes at their own political peril. As it stands now, many taxes are hidden in fees and levies, including sales tax, gasoline surcharges and all those annoying fees on your phone bill. This structure allows the government to raise money without declaring new taxes to fund all that pork.

Just think of all the billions save in IRS enforcement and accounting - the incredibly rich would pay the same 15% as the lowest wage earner and deductions would be a thing of the past. I don't think politicians have the courage to support such a radical agenda. Every accounting and lawyer lobbyist would be out in force to protect their cut of the always frustrating and complex tax season. :laugh:

Flat tax won't work. 15% of a poor person's income is next to meaningless and leaves them hurting. 30% or more of a rich person's income is substantial revenue and will not harm the rich person.

National sales tax is better. Only tax what is spent, with necessities like food and water and shelter being exempt. Then poor people could save money tax-free while big spending by the rich and middle class produces the revenue, and at any point any person could chose to save their money and not be taxed for it.

This also makes it impossible for people to hide their income behind shell companies/deductions/etc etc because their income would be irrelevant. They pay tax on every dollar they spend.

Spend 1000/year pay taxes on 1000/year. Spen 100,000,000 a year pay taxes on 100,000,000 a year.

This will never happen because it puts the tax burden primarily on those who can afford it but who also happen to have all the power.

Flat tax probably will happen because it very strongly favors the rich who will get a massive tax break dropping from 30-ish% to 15% or whatever it ends up.

The government does the same in the form of not approving increases or holding flat Medicare reimbursement. It may not be "profits" per se but their inefficiency and waste are comparable sequestering of dollars

Which ever tax is fine - the poor are exempted from both (Minimum income requirement). The problem is that the "rich" do not pay taxes - a survey of taxes returns showed that trust funds, investment schemes, and tax loop holes allow some to avoid their responsibility.

A flat tax (15%) makes no exception, so a person making 100,000 pays 15,000 dollars and a person making 30,000 pays 4500 dollars. All the deductions are eliminated....

Problem is, seen your phone bill lately? Half a dozen little taxes, same for home owners, gasoline, and then there is all of those fees. If the government went to a flat tax or value added tax then there would have to be true reform otherwise new taxes would be levied in the form of fees and increased sales and property tax.

I would prefer a single tax (what ever it is) so that the government would have to justify tax increases. I have to decide if I am going into debt for any given month because I have limited resources. The government has the seemingly unlimited resources of the public to balance their spending spree

there's no way the avg. canadian physician made $220,000 in '02. it just can't be true, that would be above avg.

The problem is that the "rich" do not pay taxes - a survey of taxes returns showed that trust funds, investment schemes, and tax loop holes allow some to avoid their responsibility.


Can you show a link to such a study? I've worked in the industry, and while this is a popular sentiment among laymen, it has little bearing on reality. The rich pay taxes on their income, often at the highest rates. They do make use of better advisors, and so take advantage of whatever credits and deductions they are expressly entitled to under the tax code - which is passed by Congress. But the net percent the rich pay is frequently still higher than that paid by other classes. In fact, the sector with the largest amount of owed but unpaid income taxes is the middle class. As for "investment schemes" and "loop holes", there have been many attempts at partnership investment vehicles over the years to allocate deductions and losses to those individuals who financially could best use then (aka tax shelters), but there are not many legal ones one can use today - they for the most part dried up a decade or two ago. And FYI, Trust funds constitute money earned by prior generations, for which taxes ALREADY have been paid at the highest rates. Just like if your father gave you $100 of his after tax money.
The rich and poor are equally allowed to take any deduction or credit permissible under the tax code and regs -- that is the law, so you cannot suggest that someone following the law that congress passed is "avoiding responsibility".

I recently read an article that said over 50% of government revenue comes from the top 5% of taxpayers. The bottom 50% of taxpayers pay something that amounts to like 5% of total revenue. I just don't understand when we complain about policies that "give tax breaks to the rich, screw the poor". It just doesn't make sense. Both rich and poor use roads, schools, police, etc. I just don't understand the notion that all people deserve to live a comfortable life, regardless of the choices that they make. In certain situations, you just have to let some people drown.

Another thing that confuses me (extremely so): all the right-wing traditionalist, Christian Repulicans who claim to follow Jesus and such don't support the progressive economic agenda. If you are truly Christian, why the hell aren't you hardcore economic liberal. Screw that, why aren't you a communist? Jesus is akin to the antiChrist when it comes to Laissez-Faire advocates. And all the liberal athiests out there are the ones who whine the loudest when we trim 0.1% off of Medicaid. WHY DO YOU CARE ABOUT ALL THE MISFORUTUNATE STRANGERS OUT THERE IF YOU ARE NOT RELIGOUS!?!?!?! Is it because when you grew up mommy told you to share? Is it your college professors who convinced you that it is cool to support government social programs? Without religion, government policy promoting equality is not just unjust, it is simply stupid because it lacks a foundation.

Anyway, I'll try and find the article.

The rich don’t pay there fair share was in reference to a book (I did not read) but read the reviews - Do As I Say (Not As I Do)
Profiles in Liberal Hypocrisy

I realize that any one that makes over 100K a year is going to pay the majority of the taxes. I was not implying that the rich get an undeserved tax break – though I can see where my wording would lead to this ambiguity. I was just trying to advocate a fairer tax system where we would not spend billions in enforcement and taxed by fees, and additional state and property taxes. I would rather pay a single higher tax rate than an artificially low tax rate that is rife with “hidden” taxes. I am all for keeping my money and encouraging those on the dole to go work for their money.

I recently read an article that said over 50% of government revenue comes from the top 5% of taxpayers. The bottom 50% of taxpayers pay something that amounts to like 5% of total revenue. I just don't understand when we complain about policies that "give tax breaks to the rich, screw the poor". It just doesn't make sense.

Seems pretty screwed up that so few pay so much while so many pay so little, doesn't it? But let's look at the wealth distribution in this country circa 1998:

http://www.osjspm.org/graphics/wealth1.gif

Makes a little more sense now, I hope.

Makes a little more sense now, I hope.

Nope, still doesn't make sense. I understand that a small proportion of society holds a largely disproportionate amount of wealth. Thing is, from a "pay for performance" standpoint, wealthy people are paying tons of money and getting next to nothing in return. This is what I don't understand.

Nope, still doesn't make sense. I understand that a small proportion of society holds a largely disproportionate amount of wealth. Thing is, from a "pay for performance" standpoint, wealthy people are paying tons of money and getting next to nothing in return. This is what I don't understand.

If you don't think that wealthy people are getting anything in return, then I just can't help you, my boy.

If you don't think that wealthy people are getting anything in return, then I just can't help you, my boy.

Well, the rich pay more taxes to eg use the same roads, provide public education for children (which they don't use), provide for public transportation and other infrastructure (also which they largely do not use). So they pay their 40% taxes (or whatever the top rate is now), on a whole lot more income, to get access to the same services, which they, by and large don't even use. The poor pay taxes at a 15% or lower rate on less money and get access to the same public infrastructure. Notwithstanding the wealth distribution, I'm not sure who's getting the short end of the stick here.

Well, the rich pay more taxes to eg use the same roads, provide public education for children (which they don't use), provide for public transportation and other infrastructure (also which they largely do not use). So they pay their 40% taxes (or whatever the top rate is now), on a whole lot more income, to get access to the same services, which they, by and large don't even use. The poor pay taxes at a 15% or lower rate on less money and get access to the same public infrastructure. Notwithstanding the wealth distribution, I'm not sure who's getting the short end of the stick here.

Oh spare me. If you're not sure who is getting the short end of the stick then become poor. Enjoy lower taxes and all the public transportation you've been missing out on!

Oh spare me. If you're not sure who is getting the short end of the stick then become poor. Enjoy lower taxes and all the public transportation you've been missing out on!

I meant the short end of the stick in terms of taxes, not life. They are distinct and not necessarilly related systems. The point of taxes is not to redistribute the wealth and play Robin Hood. It is to pay for services that everybody needs.

I meant the short end of the stick in terms of taxes, not life. They are distinct and not necessarilly related systems. The point of taxes is not to redistribute the wealth and play Robin Hood. It is to pay for services that everybody needs.

Excellent point Law2Doc.

I have a great idea - if you hate being poor then get a job and a better education. I started out with no advantages and worked full time through undergraduate & graduate school - I worked and paid of my loans. I still work while in medical school (not as much) because I have OBLIGATIONS that are not excused because of (pick a problem).

I started out cleaning carpets many years ago and knew that it was not something I could do my entire life. I applied for loans and went to school. Who in this country cannot apply for federal student loans and grants (excluding felons and drug convictions) and get an education? I gave up a lot of free time and deferred way too much of my life but no one said you can't do it - I would be the only one who would be responsible for my failure.

But social liberals feel it is okay to perpetuate economic dependence with welfare and a bazillion other social programs with no expectation of job training or education. It is no wonder so many people can not lift themselves from poverty - they don't have to. I made a decision to seek and education and so could the "poor"....

What no response to my post refarrell - quick to label my a right wing zealot but not ready to respond to my position on salaries?

I can enjoy talking to right-wing zealots. You are not worth my time because you have consistly ignored facts and statistics which challenge your fantasy life; you produced nothing while I was following the thread but ad hominium, unsupported assertions, and straw man distortions of other's arguments. You say you produced some data on salaries -- I didn't see it, because when someone repeatly wastes my time with arrogance and whining, I go elsewhere.

So I'm done with your "Pol Pot is coming" nonsense. You're an ignorant and irresponsible fool, and I hope when you get out into the real world you'll learn better.

PS: I checked the post, and your "position" was more of the same. No research, not a single source, just the usual paranoia. Maybe someday you will learn that a list of talking points lifted wholesale from Fox News is not a "position" let alone an argument.

I meant the short end of the stick in terms of taxes, not life. They are distinct and not necessarilly related systems.

Yes, and the wealthy take more than their fair share of benefit from taxes, so forgive me if I don't see their plight.

Bill Gates, for instance, pays more in taxes than you an I will make in a thousand years. Is he getting the shaft if he sends his kids to private school, doesn't ride the bus and doesn't drive every highway in the nation? Hell no, and here is an example to illustrate my reasoning:

1. Where would Bill Gates be without Microsoft?

2. Where would Microsoft be without the public infrastructure that our taxes pay for?

While Mr. Gates does not directly use billions of dollars in public services funded with his tax money, he wouldn't have those billions in the first place if the nation had dirt roads, an uneducated workforce and no public utilities. Given his poor eyesight and slight physical attributes, he might instead be peddling Sperm whale oil from the back of a horse-drawn carriage.

So yes, Billy shells out a much higher proportion of his income to taxes than one of his entry-level programmers. Is this unfair? I think not. After all, if the police force disbands due to lack of funds, who has more sh!t to steal?

But social liberals feel it is okay to perpetuate economic dependence with welfare and a bazillion other social programs with no expectation of job training or education.

Could you name some of these bazillion social programs that have no expectation of job training or education? Oh, and this might come as a shock, but the welfare program was gutted about a decade ago. There are no more imaginary welfare queens, so you can rest easy.

you are entitled to your opinion but social entitlement programs are a huge portion of the GDP - so who is getting all this money?

I can enjoy talking to right-wing zealots. You are not worth my time because you have consistly ignored facts and statistics which challenge your fantasy life; you produced nothing while I was following the thread but ad hominium, unsupported assertions, and straw man distortions of other's arguments. You say you produced some data on salaries -- I didn't see it, because when someone repeatly wastes my time with arrogance and whining, I go elsewhere.

So I'm done with your "Pol Pot is coming" nonsense. You're an ignorant and irresponsible fool, and I hope when you get out into the real world you'll learn better.

PS: I checked the post, and your "position" was more of the same. No research, not a single source, just the usual paranoia. Maybe someday you will learn that a list of talking points lifted wholesale from Fox News is not a "position" let alone an argument.

French tax rate

http://www.frenchentree.com/fe-legal/DisplayArticle.asp?ID=711

I was responding to YOUR post on the French healthcare system - it was an OPINION! I do not feel compelled to validate each breath with a stack of useless statistics. I do not believe in socialized medicine therefore I have an opinion as to why not. Talk about waste of time.

My position on reform (risk adjusted payments) was from a fortune magazine editorial - look it up.

I have these beliefs because I have worked in the "real world" the last 20 years - where do you think my position came from? Social medicine and socialism have no place in a capitalistic society - I am tired of paying taxes so someone can avoid responsibility.

I am sure after you become a physician and 50% of your salary is consumed by taxes you will be glad to give up the rest to fund your socialistic utopia....

Oh spare me. If you're not sure who is getting the short end of the stick then become poor. Enjoy lower taxes and all the public transportation you've been missing out on!


LOL :thumbup:

you are entitled to your opinion but social entitlement programs are a huge portion of the GDP - so who is getting all this money?

Who said anything about entitlement programs? Earlier you were talking about a bazillion social programs "with no expectation of job training or education." Sure doesn't sound like Social Security or Medicare, which are by far the two biggest entitlement programs (and are both funded by regressive payroll taxes).

Here are my numbers for the federal budget outlays of 2003:

Social security - 22%
Non-defense discretionary - 20%
National defense - 17%
Medicare - 11%
Debt service - 9%
Other mandatory - 8%
Medicaid - 7%
Other income-tested entitlements - 6%

Total = 100%

So if you're not referring to SS or Medicare, where are these bazillion social programs hidden?

So if you're not referring to SS or Medicare, where are these bazillion social programs hidden?

This is what I am referring to. I don't know about oldman.

46% for entitlement spending in a trillion dollar budget equates to bazillion...with no end in sight.

Social security reform blocked...
Healthcare reform deadlocked in partisan politics
State spending on healthcare related spending trending upwards - I would think California would be a good example of a Medicaid system with financial problems.

So if there is no reforms slated for entitlement programs then were will these spending increases stop?

My point is that a single payer system is viable and I think important to the future of healthcare and our ability to maintain our incomes.

I am more fiscally oriented and find the current spending spree in Washington a serious lapse in judgment - this money can only come from one place increased taxes or cuts in programs.

The government just approved to not reduce or hold steady physician payments under Medicare - that is what we have to look forward to as physicians. Medicare is the largest payer of healthcare for the elderly and we will have a constant battle to maintain reasonable reimbursement. There is no other choice for healthcare reimbursement so we will be forced to accept what ever the government decides is reasonable. When Medicare leads other insurances companies follow and we will end up with reduced reimbursement for service rendered...

A long answer to a simple post but I wanted to clarify my opinion on one facet of socialized medicine and the difficulties we might face. There are many other points and my previous post may provide some details.

I wouldn't be too terribly worried about the whole Medicare thing as a physician. In the long term, if government limits physician reimbursement too drastically, the majority of doctors will simply stop accepting Medicare and move away from geriatric care in general. People who can afford to pay out of pocket will receive the best care from private providers. People who must rely on Medicare will get substandard care from docs who can't compete in the private market, or they will be unable to find a provider that accepts Medicare (and thus go without treatment). Both are good things. The more government restricts physician reimbursement due to budget crises, the more the public will realize what a sh*tty system we have. Fortunately for many US docs, the collapse of the Medicare system is ultimately a good thing.

Yes, and the wealthy take more than their fair share of benefit from taxes, so forgive me if I don't see their plight.

Bill Gates, for instance, pays more in taxes than you an I will make in a thousand years. Is he getting the shaft if he sends his kids to private school, doesn't ride the bus and doesn't drive every highway in the nation? Hell no, and here is an example to illustrate my reasoning:

1. Where would Bill Gates be without Microsoft?

2. Where would Microsoft be without the public infrastructure that our taxes pay for?



Havarti you seem to be arguing that wealth can't exist (or can't exist nearly to the amount that it does in our society) in a system without social welfare. Is this your argument? If it is, please say so. Let me also make clear that by no means are any of us here arguing for anarchy. We aren't trying to eliminate taxes used to fund basic government infrastructure such as roads and highways. We aren't trying to eliminate national defense. Hell, we aren't even trying to eliminate a public education budget (although it sure as hell should be changed: privative all schools and give everyone a voucher reflecting the federal education budget). Infrastructure is a good thing. Defense is a good thing. Equality of opportunity is a good thing. Chronic wealth redistribution and social safety nets are not. Removing responsibility from individual citizens is not. Yes, Bill Gates would still have made his millions without Social Security, without Medicare, and without agricultural subsidies. These are the things that anger me (and many other limited-government proponents). With all the talk of turning viewpoints into straw-man arguments, I find this one particularly egregious.

I wouldn't be too terribly worried about the whole Medicare thing as a physician. In the long term, if government limits physician reimbursement too drastically, the majority of doctors will simply stop accepting Medicare and move away from geriatric care in general. People who can afford to pay out of pocket will receive the best care from private providers. People who must rely on Medicare will get substandard care from docs who can't compete in the private market, or they will be unable to find a provider that accepts Medicare (and thus go without treatment). Both are good things. The more government restricts physician reimbursement due to budget crises, the more the public will realize what a sh*tty system we have. Fortunately for many US docs, the collapse of the Medicare system is ultimately a good thing.

I agree with you and it is a good point. My contention would be that it (Medicare) has been in financial trouble for years with little political interest. The system is in need of an overhaul and there seems to be to much partisan ranker to fix the problem.

I still strongly advocate for a single payer choose your insurance company system with risk adjusted payments. The government in my opinion is a poor provider of healthcare.

I agree with you and it is a good point. My contention would be that it (Medicare) has been in financial trouble for years with little political interest. The system is in need of an overhaul and there seems to be to much partisan ranker to fix the problem.

I still strongly advocate for a single payer choose your insurance company system with risk adjusted payments. The government in my opinion is a poor provider of healthcare.

I'm still somewhat unconvinced that a single payer system will truly limit costs. Seniors will continue to lobby Congress to increase federal outlays to cover increasingly inclusive and extravagant insurance premiums. We also maintain two middlemen between care providers and patients: the government (whos interests do not reflect that of consumers as a whole), and insurance companies (whos interests do not reflect that of consumers as a whole). Most people are unable to stomach the concept of returning to a system where consumers simply make a choice between fee for service and private insurance (which I believe caters to consumer demand to the point, as well as maximizing cost-effective treatment). In addition, as long as the government, and not consumers, are dictating the magnitude of health care expenditures, physicians will not be compensated for the market value of their services (be it above or below true value).

Another idea that has been advanced (which I believe has significant merit) is to have federal coverage for catastrophic health insurance. This means significant deductibles to deter overuse of government funds for non-catastrophic treatment. While this idea sounds good in theory, I think that it would deteriorate quickly in practice. This is because Congress will always have impetus to perpetually reduce deductibles until we return to the system we have today (or end up with a completely socialized healthcare system). Again, we end up with the same old problem: consumers completely shielded from the direct cost of their care and an unsustainable budget conundrum.

The idea of a single payer system is to have a single payer &, therefore, cut out the multiple insurers (aka middle men). Our confused American hybrid cost 16% of GDP while delivering worse care by any societal measure than Western Europe. These countries spend on average 8% of GDP.
The VA is an excellent model of an efficient single payer.

The VA is an excellent model of an efficient single payer.

It's also an excellent example of the pitfalls of single-payer.

Most veterans choose to receive their care outside the VA system, which in and of itself speaks volumes. It's not that the VA provides poor care, but it provides rationed care. As a result, many patients prefer to receive their care in the private sector. Fortunately, they have that option.

Those who remain within the VA system typically wait much longer for specialist appointments and diagnostic studies compared to patients in the private sector.

The private sector provides a "safety net" for VA patients, in much the same way that the U.S. provides a safety net for Canada. If either system were the sole option for its beneficiaries, costs would skyrocket, and the systems would likely implode.

46% for entitlement spending in a trillion dollar budget equates to bazillion...with no end in sight.

I hate to nitpick here, but earlier you said a bazillion programs. Now you're saying two programs (Medicare and SS) that consume 42% of the budget equates to a bazillion. Which is it?

Social security reform blocked...

For the best. It would have cost over a trillion to shift over to even a partly privatized SS system. Most of the projected problems with SS would vanish if they would lift the income cap on the SS payroll tax.

So if there is no reforms slated for entitlement programs then were will these spending increases stop?

When the last boomer dies.

For the best. It would have cost over a trillion to shift over to even a partly privatized SS system. Most of the projected problems with SS would vanish if they would lift the income cap on the SS payroll tax.


Hrm. Your solution is to tax the wealthy more for something they don't benefit from. Over a trillion to shift to partly privatized SS system? If we cancel the payroll tax, disallow any new entrants into the system, raise income taxes enough to fund current benefits, and guarantee benefits to retirees who have already payed into the system, how can we not be saving money? We certainly have a brighter future. And we don't have the government playing nanny.

According to www.TheApprenticeDoctor.com, a medical professional can make up to $300 000 in the USA?

wow..mcguyver..your the one that started the post..so why dont you show us REAL INCOME NUMBERS...ass.


hahaha

Hrm. Your solution is to tax the wealthy more for something they don't benefit from.

Yep. The percentage of elderly living below the poverty line has fallen from 35% in 1960 to 10% today. Given that the average income of the top 5% has increased 80% since 1979 (correcting for inflation), I don't have a single problem with making payroll taxes less regressive.

raise income taxes enough to fund current benefits,

Looks like both our solutions involve taxes. The difference is that mine could actually come to pass (someday), while you're position (essentially phasing out SS) has virtually no popular or political backing whatsoever.

But hey, if you want to eliminate SS and Medicare then you should take the lead. When your folks get old and infirm, have them move in with you and then pay for their medical care. The government nanny might not be looking so bad.

some points worth mentioning...

doctors make to much, hummm? After 11+ years of school with zero savings towards retirement, nauseating debt and a reduce work window - the comments are meritless.



Ah, there's the rub. Canadian medical schools cost much less than American ones. I believe the same is true for Europe. Also, the cost of living (housing, especially) in large American cities is beyond ridiculous when compared to here. I expect to graduate med school (assuming I am accepted) with about 30-60k of debt, total. I've been working and supporting myself through my undergrad and so have only a 4k loan so far, taken this last year (mainly from paranoia) because I reduced my work hours. I am taking 5 upper-level science classes now, along with my job, getting good grades, and figure I can try to keep working through the first two years of med school. (If that doesn't work, I'll wind up closer to the 60K debt mentioned above.) As a resident you are paid, and here it is slightly more than the average salary (40K or so) and since I am used to living on 15-20, I expect to start reimbursing easily. The trick is - don't be greedy! Don't expect to have the same lifestyle your parents had; the economy is different now, esp. the massive yet long-lasting housing bubble and skyrocketing consumer debt (good ol' "relative deprivation" at work). Don't become a doctor in order to get rich. I expect to work until I am at least 70, not because I'll need to but because this is my passion and I can't imagine giving it up easily as long as I have my health. And any system which screws a huge segment of the population (i.e. U.S. health care) is one I wouldn't feel comfortable being a part of. (I worked down there for 4 years in the health care field, so before you start calling me uninformed, think twice). I will make half as much here, maybe, but I will sleep twice as soundly. (And the same applies to taking big pharma's bribes, by the way).

-Cat