As the Left marches towards single payer, how would universal Medicare affect EM compensation?

[GeneralVeers]

I understand your argument, but every time this Libertarian rallying cry comes out it just kills part of the argument for me. I understand that yes, this is why you pay taxes. Because if you don't, armed men will compel you to, or will take you to jail. Personally, I agree with several of your points. That said in many societies, such as Canada, the majority of people pay those taxes willingly knowing what they get in exchange. For those that don't want to pay for whatever socialized services that are being offered (and being taxed for), they are welcome to vote against such policies, and if the majority continues to vote in favor of policies they abhor, they can emigrate to a country which has a fiscal policy more in line with their own.

If the U.S. falls there will be no more countries to emigrate to. The reason they don't allow people to opt out, is that they require the wealthy to subsidize the poor in these programs. They know that if allowed, the wealthy and middle classes would largely opt out of these redistributionist plans. If these programs are so spectacular, and everyone loves them, then let the market decide. Give people the chance to opt out, and PROVE that these programs work for the majority of people.

Let's pose this question to people:

Option 1: Pay out of pocket and get your own health insurance through work or on the private market
Option 2: Pay $500/month tax per person in your household and the government will take care of all your health needs.....trust us!

Which do you suppose the MAJORITY of people would choose on a ballot? Only the stupid, sick, or non-tax-payers would choose the latter option.

How many Congressional Democrats waived their right to their cushy health plans and signed up themselves and their families for Obamacare? The answer is none.

Any doctor who would willingly allow the government to control their practice, or worse, control their access to healthcare is delusional.

---

Members don't see this ad.

 

[leviathan]

You don't think your private insurance company limits your care, what services or tests or doctors you have access to, any less than a public insurance progarm? Would you be surprised to hear in many cases they actually limit your care more? When you actually get sick and need the care the most, won'tt they do everything in their power to try to drop you from their insurance coverage? Or add ridiculous copays, or put ceilings on how much they're willing to pay?

I don't think cancer care or any time-critical services take any longer in Canada than the US. The outcomes are equal between both countries, and in many cases even better in Canada.

I think we've both made our points clearly and we're starting to just go in circles at this point. To be clear, I'm not even arguing about the compassionate reasons for having universal health care here. I'm arguing purely from an economic standpoint, that your system is ridiculously inefficient and more expensive than it needs to be. The wealthy still pay for all of the poor's health care in the US, you just do it through ridiculously expensive premiums, copays and deductibles etc. Not to mention you're already paying more in taxes to fund medicare and medicaid right now, than we do to fund our entire health care system. Do you not see a problem with that?

 

[leviathan]

Option 1: Pay 3-4x more money out of pocket for a private insurance plan that limits which hospitals you can go to, which doctors you can see, how often you can go see them, what tests your docs can order for you. Also better hope you don't lose your job or benefits, or suddenly you lose your coverage and you will have to declare bankruptcy. Also better enjoy arguing on the phone with your insurance company when they only cover XYZ services on the bill, or have a cap on how much it costs. Oh but bonus- you can get your knee MRI in only 1 day!

Option 2: Pay 3-4x less money through taxes for a system that guarantees coverage for you no matter what your financial status, employment status, benefits, pre-existing conditions, etc. No worry that you will lose coverage ever. Just go in, see your doctor, or go to the hospital etc. and leave without worrying about what your bill is going to be, or what your insurance company will cover. PS - if you aren't happy waiting, you can pony up a bit of extra $$$ (but still way less $ than what you'd pay in option 1) to get a private consultation.

I'd never pick option 1.

 

[VA Hopeful Dr]

?

I don't think cancer care or any time-critical services take any longer in Canada than the US. The outcomes are equal between both countries, and in many cases even better in Canada.

Not sure that's true...

The Myth of Americans' Poor Life Expectancy

 

[TheTruckGuy]

If y'all are interested, Healthcare Triage did a series explaining the medical systems in nine different countries. Australia, Switzerland, Germany, Singapore, the US, the UK, Frane, Taiwan, and Canada. I wish it had also included Japan. But PBS did an hour long Frontline episode that included Japan.

Anyways, worth a watch. And I think Healthcare Triage is a great YouTube channel to keep on your youtube feed.



Sick Around The World

 

[EctopicFetus]

I understand your argument, but every time this Libertarian rallying cry comes out it just kills part of the argument for me. I understand that yes, this is why you pay taxes. Because if you don't, armed men will compel you to, or will take you to jail. Personally, I agree with several of your points. That said in many societies, such as Canada, the majority of people pay those taxes willingly knowing what they get in exchange. For those that don't want to pay for whatever socialized services that are being offered (and being taxed for), they are welcome to vote against such policies, and if the majority continues to vote in favor of policies they abhor, they can emigrate to a country which has a fiscal policy more in line with their own.

They pay them cause they have to. Not paying taxes there is just like here.

The counter to your statement is the same right. If you want more socialized services vote those people in. Vote for more socialized stuff. If you dont like the current system leave to another country.

Do you guys who really want a single payer realize that even very blue and rich states couldn’t do it cause of the costs and they were gonna try to dump a large portion of those costs on the federal govt.

The real question is why do we have a federal dept of education? Our federal govt has become so bloated it is disgusting. I prefer more local government. I abhor the fact that someone in California can send money to support a candidate in West Virginia.

 

[EctopicFetus]

Vermont health care reform - Wikipedia

Oddly Bernie and his Bros couldn’t enact it.. why? Cause it costs too much.. This is for a relatively wealthy state. Vermont is 19th in per capita income and a relatively low COL.

I find the discussion of a single payer out of touch with reality. Want to see political unrest. Fund the cost for a single payer. Let people know how much their taxes would have to go up.

 

[GeneralVeers]

Vermont health care reform - Wikipedia

Oddly Bernie and his Bros couldn’t enact it.. why? Cause it costs too much.. This is for a relatively wealthy state. Vermont is 19th in per capita income and a relatively low COL.

I find the discussion of a single payer out of touch with reality. Want to see political unrest. Fund the cost for a single payer. Let people know how much their taxes would have to go up.

No...but you see this time it will be different! We can continue to provide unlimited healthcare for all Americans, and do it for free just by taxing the evil rich! They will gladly hand over 70%, 80% or even 90% of their salaries just to help the common good......

Also for you Canada lovers: https://www.ctvnews.ca/health/health-care-wait-times-hit-20-weeks-in-2016-report-1.3171718

20 weeks to get "medically necessary cancer care". Count me out of an evil system like that. I want no part of any of it. Here are some other gems:

• Neurosurgery: 46.9 weeks
• Orthopaedic surgery: 38
• Ophthalmology: 28.5
• Plastic Surgery: 25.9
• Otolaryngology: 22.7
• Gynaecology: 18.8
• Urology: 16.2
• Internal medicine: 12.9
• Radiation oncology: 4.1
• General surgery: 12.1
• Cardiovascular: 8.4
• Medical oncology: 3.7

 

[el_duderino]

There's no reason anyone has to pay more than they already do, frankly. We can take all the money currently paid into the insurance system and fully fund single payer that way.

 

[EctopicFetus]

There's no reason anyone has to pay more than they already do, frankly. We can take all the money currently paid into the insurance system and fully fund single payer that way.

You do know that hospitals lose money on all the medicare admissions. I think i linked that earlier. If that happens..... we will have no hospitals. Is that the kind of system we want.

Let me be very blunt about this due to the relative anonymity. We spend a lot on health care per capita. Now take into account that some percentage of people dont even have insurance. Would that per capita spending go up? Of course cause more people would have insurance. IS that good or bad? Thats up to you.

We can easily point to the diabetic who now has renal failure due to poorly controlling his DM. We can just as easily point out the people who waste money to get a pregnancy test in the ED.

Reality is covering everyone will cost more. Do you know why? Simple.. it is more than what we do now and that takes into account the "profit" from health insurers. FWIW much of the profit they make comes from administering medicare advantage and medicaid.

Much of the profit of Cigna is running ERISA plans. For those who dont know outside of healthspring which is cigna medicare advantage 85% of their business is literally just adminstering self funded plans for companies, citiy and state governments. Meaning cigna isnt even acting as an insurance company. I really dont like insurance companies. They are scum. I have negotiated contracts with BCBS, Cigna, Aetna United and Humana. Some are better than others. None care if I can feed myself. Medicare and Medicaid care even less.

 

[el_duderino]

Assuming it actually does, so what if covering everyone will cost more?

Is it not worth it?

 

[GeneralVeers]

Assuming it actually does, so what if covering everyone will cost more?

Is it not worth it?

No. For three reasons:

1. Single payer with no ability to opt-out is immoral, and potentially harmful to your health (as I have pointed out).

2. If it bankrupts the country in the process it is definitely not worth it.

3. Our salaries would necessarily decline......a lot. Unless any of you know jobs in Canada where I can make $500K+ as I do in the U.S.

 

[el_duderino]

Single payer is not immoral, and it will not bankrupt the country.

I don't care if your salary goes down, if it means millions of people will have access to health care beyond going to the ED and never paying the bill. I'm not going to cry over your $500,000 a year salary taking a hit.

It's frankly disgusting that you're complaining about your $500k+ salary going down in order to ensure everything American has health care. Where is your humility and humanity.

 

[d2305]

 

[namethatsmell]

No. For three reasons:

1. Single payer with no ability to opt-out is immoral, and potentially harmful to your health (as I have pointed out).

2. If it bankrupts the country in the process it is definitely not worth it.

3. Our salaries would necessarily decline......a lot. Unless any of you know jobs in Canada where I can make $500K+ as I do in the U.S.

1) Is it immoral to fund the military? Is it immoral to fund the fire department? Is it immoral to fund the building of public roads and bridges?

2) Agreed. It would be a dumb exercise if it did.

3) Few pit docs in the US make north of $500k, though I'm glad you've found a way. There's no way to know how government subsidized care would impact our salaries. My guess is that when taking into account taxes and cost of living the average Canadian EM doc has a similar QOL/lifestyle as the average US EM doc. Additionally, would you ascribe a dollar value to not having to deal with press ganey and med-mal worries? I certainly would.

 

[VA Hopeful Dr]

Single payer is not immoral, and it will not bankrupt the country.

I don't care if your salary goes down, if it means millions of people will have access to health care beyond going to the ED and never paying the bill. I'm not going to cry over your $500,000 a year salary taking a hit.

It's frankly disgusting that you're complaining about your $500k+ salary going down in order to ensure everything American has health care. Where is your humility and humanity.

In frankly amazing debt getting the education to be a physician that we all know won't get wiped away even if our pay gets cut by 50%

Also, sorry to say this, not everyone deserves free healthcare even if we could easily fund it with no major changes to the massive number of people currently making a living under the current system or the even more massive number of patients who have come to expect things a certain way.

 

[el_duderino]

not everyone deserves free healthcare

This is to me a total failure in core values. There's no middle ground when our fundamental principles are incompatible.

 

[VA Hopeful Dr]

This is to me a total failure in core values. There's no middle ground when our fundamental principles are incompatible.

I'm mildly insulted you call it a failure as opposed to just something you can't understand with your value system, but whatever floats your boat.

When I see the diabetic with an A1c of 14 who has already had their foot amputated, gets q6m injections into their eyes for their retinopathy, has stage 4 CKD and yet still drinks 2 liters of not diet Mountain Dew every day... well, let's just say I get a bit peeved that my taxes go towards the several thousand dollar injections, several hundred dollar insulin, and God knows how expensive amputations.

Its not like the COPD'er who still smokes, as goodness knows tobacco is insanely addictive. But damnit, switch to diet at the very least. I have seen doing that and changing literally nothing else drop an A1c 4-6 points.

 

[leviathan]

Your own post says med onc was 3.7 weeks, not 20 weeks, for cancer care. Are you trying to be deceptive?
Cancer outcomes in Canada are on par, with some areas outperforming the US (vs insured Americans). Orthopedic care, neurosurg etc do take longer. As I said, if you want your hip done immediately, you could pay out of pocket, and you'll still be paying way less money than if you had to buy a US insurance plan and its associated copays and deductibles and caps etc.

The per capita costs in the US are already sky high for numerous reasons. One of them is that all the uninsured people are still getting healthcare; they just end up not paying the bills and then insured people end up paying way higher bills for everything and higher premiums etc. This is to cover their own care and the care of people who hospitals had to absorb the costs due to lack of insurance. Of course as mentioned people without health insurance are racking up higher bills when they finally do get sick and are forced into the ER and then ICU or CCU or on dialysis etc. Then there's the issue of ridiculous overhead and administrative costs. Then there's the costs of pharmaceuticals, and lack of ability to get bulk discounts due to the hundreds of insurance providers. I should also mention that rationing happens in reverse - it costs way more money $$$$ to get expedited care for things that could wait a few months. It costs way more money that every single town of 5,000 people has its own MRI scanner and cath lab and other services, rather than centralizing it for efficiency. The list goes on and on for why the system is inefficient and bloated.

I'm making my point purely from an economic standpoint that you would pay way less money with single-payer model, and if you add a private second tier you still get the benefits of expedited care if you don't want to wait.

 

[hundreddaysoff]

I'm mildly insulted you call it a failure as opposed to just something you can't understand with your value system, but whatever floats your boat.

When I see the diabetic with an A1c of 14 who has already had their foot amputated, gets q6m injections into their eyes for their retinopathy, has stage 4 CKD and yet still drinks 2 liters of not diet Mountain Dew every day... well, let's just say I get a bit peeved that my taxes go towards the several thousand dollar injections, several hundred dollar insulin, and God knows how expensive amputations.

Its not like the COPD'er who still smokes, as goodness knows tobacco is insanely addictive. But damnit, switch to diet at the very least. I have seen doing that and changing literally nothing else drop an A1c 4-6 points.

Ditto pretty much everyone over 90 with comorbidities who rolls into the ER. You had a good run, dammit!

I'm pretty agnostic on this issue, but I do have one strong opinion: if we go with single-payer, then we need a death panel too. Preferably an independent death panel wholly comprised of Swiss people.

 

[VA Hopeful Dr]

Ditto pretty much everyone over 90 with comorbidities who rolls into the ER. You had a good run, dammit!

I'm pretty agnostic on this issue, but I do have one strong opinion: if we go with single-payer, then we need a death panel too. Preferably an independent death panel wholly comprised of Swiss people.

Honestly? Wipe out student loan debt, institute death panels, don't increase my taxes, cut my pay by no more than 25% and I could potentially get behind single payer.

 

[VA Hopeful Dr]

Your own post says med onc was 3.7 weeks, not 20 weeks, for cancer care. Are you trying to be deceptive?
Cancer outcomes in Canada are on par, with some areas outperforming the US (vs insured Americans). Orthopedic care, neurosurg etc do take longer. As I said, if you want your hip done immediately, you could pay out of pocket, and you'll still be paying way less money than if you had to buy a US insurance plan and its associated copays and deductibles and caps etc.

The per capita costs in the US are already sky high for numerous reasons. One of them is that all the uninsured people are still getting healthcare; they just end up not paying the bills and then insured people end up paying way higher bills for everything and higher premiums etc. This is to cover their own care and the care of people who hospitals had to absorb the costs due to lack of insurance. Of course as mentioned people without health insurance are racking up higher bills when they finally do get sick and are forced into the ER and then ICU or CCU or on dialysis etc. Then there's the issue of ridiculous overhead and administrative costs. Then there's the costs of pharmaceuticals, and lack of ability to get bulk discounts due to the hundreds of insurance providers. I should also mention that rationing happens in reverse - it costs way more money $$$$ to get expedited care for things that could wait a few months. It costs way more money that every single town of 5,000 people has its own MRI scanner and cath lab and other services, rather than centralizing it for efficiency. The list goes on and on for why the system is inefficient and bloated.

I'm making my point purely from an economic standpoint that you would pay way less money with single-payer model, and if you add a private second tier you still get the benefits of expedited care if you don't want to wait.

And you'd pay even less than single payer if it was actually a free market system for elective stuff.

But who wants to actually talk about that?

 

[namethatsmell]

Honestly? Wipe out student loan debt, institute death panels, don't increase my taxes, cut my pay by no more than 25% and I could potentially get behind single payer.

Enforce mandatory prosecution for patients who threaten or assault a health care worker.

And while we're at it, include federal tort claims act coverage for all docs. How much longer do we need to be the whipping boys/girls for problems of other people's creation?

 

[miacomet]

FWIW, per the Koch brothers' study, it seems as though the majority of Americans are in favor of some sort of government run/single payer system.

 

[hoot504]

FWIW, per the Koch brothers' study, it seems as though the majority of Americans are in favor of some sort of government run/single payer system.

Problem is, most people understand "single payer" about as well as they understand the chest pain bringing them into my ER.

 

[miacomet]

Problem is, most people understand "single payer" about as well as they understand the chest pain bringing them into my ER.

True. But Medicare beneficiaries are purported to be happier with their service than those with private insurance.

 

[hoot504]

True. But Medicare beneficiaries are purported to be happier with their service than those with private insurance.

We're not just talking about putting everyone on Medicare. You basically just illustrated my point. Orchestrating single-payer means essentially demolishing our healthcare system overnight and replacing it with something entirely different.

Wait lists, massive tax increases, (eventual) death panels.

Let's see how satisfied people are then.

 

[RustedFox]

Things I hate to hear patients say:

"But something HAS to be wrong!"

 

[EctopicFetus]

This is to me a total failure in core values. There's no middle ground when our fundamental principles are incompatible.

Let me ask you a question. What are you doing about it? Put your money where your mouth is. Find 2-3 families that are the working poor and pay their health insurance premiums. If everyone who thinks this idea kicks ass would do it imagine the change. This would be a private deal.

Maybe you can even start a non profit that does this.

Why must you take from me? I think anyone with 2 functioning brain cells and a tiny bit of work ethic in this economy can make $16/hr. For an individual thats 32k a year. Those jobs come with beenfits. Im talking working in a factory type work.

Have a spouse 64k. If you are disabled the government got you.

 

[EctopicFetus]

One unintended consequence of Obamacare was the states rapidly trying to get patients on Disability. Obama was good enough to disable a lot of americans.

See NPR article.. Ill include the graph below. Obama the Maimer

http://apps.npr.org/unfit-for-work/

 

[miacomet]

We're not just talking about putting everyone on Medicare. You basically just illustrated my point. Orchestrating single-payer means essentially demolishing our healthcare system overnight and replacing it with something entirely different.

Wait lists, massive tax increases, (eventual) death panels.

Let's see how satisfied people are then.

Lots of people are talking about Medicare for all, and Medicare indeed fits the definition of a single-payer system for the population it serves. I don't think it has death panels, although the taxes for it are certainly not cheap.

 

[boomshaketheroom]

One unintended consequence of Obamacare was the states rapidly trying to get patients on Disability. Obama was good enough to disable a lot of americans.

See NPR article.. Ill include the graph below. Obama the Maimer

http://apps.npr.org/unfit-for-work/

Yet the graph show disability applications dropping starting before the ACA was enacted, and a net reduction in unemployment rate in the only two years of Obama's presidency represented on the graph.

See the graphs below for how things went after 2011.

 

[VA Hopeful Dr]

Yet the graph show disability applications dropping starting before the ACA was enacted, and a net reduction in unemployment rate in the only two years of Obama's presidency represented on the graph.

See the graphs below for how things went after 2011.

I'm sure that's not because a lot of people got on disability and so stopped applying (if you're unfamiliar, if you get turned down you can just apply again next year and every year until you either get disability or stop trying).

 

[boomshaketheroom]

I'm sure that's not because a lot of people got on disability and so stopped applying (if you're unfamiliar, if you get turned down you can just apply again next year and every year until you either get disability or stop trying).

If thats what the graphs are implying why not say that in the post? The number of disability recipients has increased steadily since 1970 i believe, you're sarcastically implying that the growth rate has increased in a significant way since obamacare started.

 

[VA Hopeful Dr]

If thats what the graphs are implying why not say that in the post? The number of disability recipients has increased steadily since 1970 i believe, you're sarcastically implying that the growth rate has increased in a significant way since obamacare started.

Nope, merely suggesting that the significant decrease in applications could be partly explained by the immediately preceding increase in awards.

 

[GeneralVeers]

Why can't we make the single-payer voluntary? Vote "D" and you get automatically signed up for Medicare-for-all, and you get a 10% surtax on ALL income. That way the people who vote for this nonsense will be the one who have to suffer the consequences. Don't steal from my, and sign me up for crappy government-run care just so you can feel good about yourselves.

 

[miacomet]

Why can't we make the single-payer voluntary? Vote "D" and you get automatically signed up for Medicare-for-all, and you get a 10% surtax on ALL income. That way the people who vote for this nonsense will be the one who have to suffer the consequences. Don't steal from my, and sign me up for crappy government-run care just so you can feel good about yourselves.

Question- Medicare taxes are far below 10% of even just earned income. Curious as how 10% would be necessary to fund Medicare for all, or for all who want it? Also wonder what you plan on doing at 65- will you buy private insurance?

 

[miacomet]

Interesting hypothetical for you: Would you be willing to take a 50% pay cut in order to have a more "moral" society that provides free healthcare to everyone?

If they pay off my loans, insulate me from liability, and don't make me work nights, sure. Canadian EM docs earn about the same without such crushing debt. So do docs in Oz, and they work almost no nights. Neither group deals with the same level of liability that we do. I'd be OK with either of those jobs.

 

[miacomet]

OF course because their population has a higher level of education/basic knowledge and a lower level of entitlement.

Actually, it's so hard to get a PMD in Canada people go to the ER for lots of things. Australia has a huge alcohol problem reflected in their ER visits. I think the difference is that, at least in Australia, you can just say "come back tomorrow at 9 am for your xray, bye-bye" instead of doing it all after hours.

 

[VA Hopeful Dr]

If they pay off my loans, insulate me from liability, and don't make me work nights, sure. Canadian EM docs earn about the same without such crushing debt. So do docs in Oz, and they work almost no nights. Neither group deals with the same level of liability that we do. I'd be OK with either of those jobs.

And that, to me, is part of the problem. We'll never get all of that if we go single payer.

I also don't think we'll get similar earning. If we go Medicare-for-all, I know what that pays primary care and I'll either have to see 40 patients/day or take a decent pay cut.

 

[miacomet]

Simply, we arent france or new zealand. Those countries (esp new zealand) are homogenous. White people look at the black people in the ghettos and think. Why do I want to pay for them? The Amish say I dont want to participate at all. Meanwhile france passed a Burka ban. The swiss are all white. To become a citizen in teh Netherlands you have to b

We can and should look at what is best from the world and see what can be applied here. The truth is the answer is close to 0.

They are paying top dollar? Serious question. If you are an ED attending you will know that the MOST entitled people we deal with are the medicaid patient who pay NO dollars. Makes me think of the PJ o'rourke quote " If you think health care is expensive now, wait until you see what it costs when it’s free."

New Zealand is 74.9% European heritage, 14.9% Maori, 11.8% Asian, and 7.4% Pacific Islander. Seems fairly diverse. Canada has a higher percentage of foreign-born residents and citizens than the US. I don't think they issue is demographics, but, as you point out, racism.

 

[miacomet]

And that, to me, is part of the problem. We'll never get all of that if we go single payer.

I also don't think we'll get similar earning. If we go Medicare-for-all, I know what that pays primary care and I'll either have to see 40 patients/day or take a decent pay cut.

You may be right, but why do you think Australia and Canada docs can get all that, but we can't?

 

[VA Hopeful Dr]

You may be right, but why do you think Australia and Canada docs can get all that, but we can't?

Because the lawyers already have too strong a hold on Congress.

Plus the democrats would use all their political capital to get single payer, none left over to give free doctor school.

 

[GeneralVeers]

Because the lawyers already have too strong a hold on Congress.

Plus the democrats would use all their political capital to get single payer, none left over to give free doctor school.

Correct. We would get Medicare for all, but still have unlimited medical liability (depending on state), still have patient satisfaction, still have "quality metrics", and have less control over our practice, have higher taxes, AND likely a pay cut. Sounds great!

 

[miacomet]

Because the lawyers already have too strong a hold on Congress.

Plus the democrats would use all their political capital to get single payer, none left over to give free doctor school.

Ha, maybe. But note that in our current government-run systems, the VA and the IHS, you are very insulated from liability.

 

[miacomet]

Correct. We would get Medicare for all, but still have unlimited medical liability (depending on state), still have patient satisfaction, still have "quality metrics", and have less control over our practice, have higher taxes, AND likely a pay cut. Sounds great!

That would suck. But this is conjecture- we don't really know what would happen.

 

[GeneralVeers]

That would suck. But this is conjecture- we don't really know what would happen.

Actually we do. Lawyers aren't going to give up their ability to sue. They donate more money than we do, and control the legislation. The government also would likely expand "quality" measures because it is one of the easiest ways to refuse payments to doctors and hospitals.

 

[miacomet]

Actually we do. Lawyers aren't going to give up their ability to sue. They donate more money than we do, and control the legislation. The government also would likely expand "quality" measures because it is one of the easiest ways to refuse payments to doctors and hospitals.

Then why aren't the lawyers chomping at the bit to sue Kaiser, the VA, and the IHS? Why have so many states had such success with malpractice caps, including the two biggest, Texas and California? In my state, hospitals and private practices make patients sign an arbitration agreement, so suing is tough. We just don't know what would happen.

 

[iqe2010]

Some of the countries that have universal healthcare also have free college and medical school. So the docs can actually afford to only be paid 150k/year.

A reduction in salary in the US would have to also accompany reduction in medical school tuition. If not, medicine would simply not be worth it. It would turn into teaching.

 

[VA Hopeful Dr]

Then why aren't the lawyers chomping at the bit to sue Kaiser, the VA, and the IHS? Why have so many states had such success with malpractice caps, including the two biggest, Texas and California? In my state, hospitals and private practices make patients sign an arbitration agreement, so suing is tough. We just don't know what would happen.

Those caps are usually noneconomic only. And why do you think so few other states have made laws like that?

Suing the VA is super hard, same with IHS as you have to follow the Federal Torts Claims Act which has stricter rules the regular medical malpractice.

As for suing Kaiser... San Fernando Valley woman wins $28 million against Kaiser Permanente – Daily News

Class Action Lawsuit against Kaiser

And those are just the first 2 Google results