Doesn't affirmative action enhance stereotypes in admissions?

[raindropx]

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we're not in middle school

well as @Lawper is choosing to ignore, apparently we are.

Just like any market won't function as a free market... Free market is an ideal greatest good but is always impossible to achieve in reality because of inherent human imperfections.



Arrow's central arguments were fine. The problem is they are exaggerated to justify unnecessarily extensive government intervention. It's just a subset to a flawed theory that the government is the remedy to market failure.

The underlying issue in all this is whether people who use healthcare the most should pay more, since greater consumption leads to increased demand and higher costs. It just so happened that the primary consumers are the poor and elderly.

I say yes to the second statement

 

[efle]

There are varying degrees of departure from the free market model - defense contracting and food trucks cannot be viewed similarly just for sharing the blanket quality of imperfection. Healthcare is a case of extreme departure which requires intervention to rescue from terrific waste and needless suffering.

Yes, and because the primary consumers have little to no income, you must either tax to care for them or let them suffer and die. There will always be this core element (medicare and medicaid for us) of the universal system in place as long as we live in a society that finds the latter unacceptable. All that Scandinavia has done is expand it to cover everyone, which massively reduces bureaucratic costs and increases efficiency through standardization. Yes, healthy people pay more than their share relative to their use. Boo hoo. Such is the correct path when you value all of your neighbors' health and happiness and live in a world of scarce resources. In a great society, few have too much and fewer too little.

As a side note, the method of physician and hospital payment (fee for service as opposed to DRG and salary) in the US is also atrocious, since it encourages excessive expenditure. Another lesson aside from coverage policy we would do well to learn from.

 

[Lawpy]

There are varying degrees of departure from the free market model - defense contracting and food trucks cannot be viewed similarly just for sharing the blanket quality of imperfection. Healthcare is a case of extreme departure which requires intervention to rescue from terrific waste and needless suffering.

Yes, and because the primary consumers have little to no income, you must either tax to care for them or let them suffer and die. There will always be this core element (medicare and medicaid for us) of the universal system in place as long as we live in a society that finds the latter unacceptable. All that Scandinavia has done is expand it to cover everyone, which massively reduces bureaucratic costs and increases efficiency through standardization. Yes, healthy people pay more than their share relative to their use. Boo hoo. Such is the correct path when you value all of your neighbors' health and happiness and live in a world of scarce resources. In a great society, few have too much and fewer too little.

As a side note, the method of physician and hospital payment (fee for service as opposed to DRG and salary) in the US is also atrocious, since it encourages excessive expenditure. Another lesson aside from coverage policy we would do well to learn from.

You don't think insurance fragmentation can just as well reduce healthcare costs? The larger the number of insurance companies, the better the competition, and prices lower as a result, making it affordable for all, but especially help the poor and elderly.

 

[raindropx]

You don't think insurance fragmentation can just as well reduce healthcare costs? The larger the number of insurance companies, the better the competition, and prices lower as a result, making it affordable for all, but especially help the poor and elderly.

can't they just drop patients despite obamacare

 

[efle]

It has been seen in many studies now that highest efficiency is found in single-payer. The increased waste expenditure in the bureaucracy (which is massive, think 1/4th to 1/3rd of each dollar spent) when there are many insurers, all of which are motivated by profits to deny as much coverage as possible, far outweighs the price differences.

And, of course, there is no reason for price difference to exist in the first place - for-profit businesses require motivation by competition to drive down prices, true, but single payer system is still motivated to keep prices down because that in turn keeps down taxes. In fact, as the singlepayer system aims to operate at cost rather than for profit, running the two systems with equivalent efficiency would actually make single payer cheaper even if you discounted all the waste.

 

[raindropx]

It has been seen in many studies now that highest efficiency is found in single-payer. The increased waste expenditure on the bureaucracy (which is massive, think 1/4th to 1/3rd of each dollar spent) of many insurers, all of which are motivated by profits to deny as much coverage as possible, far outweighs the price differences.

And, of course, there is no reason for price difference to exist in the first place - for-profit businesses require motivation by competition to drive down prices, true, but single payer system is still motivated to keep prices down because that in turn keeps down taxes. In fact, as the singlepayer system aims to operate at cost rather than for profit, running the two systems with equivalent efficiency would actually make single payer cheaper even if you discounted all the waste.

can you explain

 

[efle]

can you explain

Singlepayer is tax-funded, and people dislike paying taxes. Thus there is a huge emphasis from the government in places like Denmark to frequently study and improve efficiency in their healthcare - doing a good job of it wins votes.

 

[raindropx]

So the cost is split between healthy and sick for single payer through taxes. Isn't this the same case as customers for one insurance company? Would the cost decrease only because it's not for profit?

 

[efle]

So the cost is split between healthy and sick for single payer through taxes. Isn't this the same case as customers for one insurance company? Would the cost decrease only because it's not for profit?

If the government got $1, it would spend every cent on treating people. If the insurance company got $1, it would try to keep at least a few cents in profit and would spend slightly less than a dollar on treating people. This is why SP would be cheaper in theory if both were equally good at spending their cash. Further, the insurance company gets to keep more of their dollar the more people they can screw over by denying coverage, while the government will not turn people away.

The much bigger effect is in preventing the wasted time on paperwork from having many different insurers however. Public healthcare usually runs administration costs relating to insurance at a few percent up to ~6% while the admin costs for the private healthcare in the US are double that at ~12% and range up to 25-30% in the worst offenders.

Source (check out the graphs here at the bottom and here at the top)

 

[raindropx]

If the government got $1, it would spend every cent on treating people. If the insurance company got $1, it would try to keep at least a few cents in profit and would spend slightly less than a dollar on treating people. This is why SP would be cheaper in theory if both were equally good at spending their cash. Further, the insurance company gets to keep more of their dollar the more people they can screw over by denying coverage, while the government will not turn people away.

The much bigger effect is in preventing the wasted time on paperwork from having many different insurers however. Public healthcare usually runs administration costs relating to insurance at a few percent up to ~6% while the admin costs for the private healthcare in the US are double that at ~12% and range up to 25-30% in the worst offenders.

Source (check out the graphs here at the bottom and here at the top)

Makes sense! I don't see any advantages of our health care system over sp.

 

[ranob]

As aspiring doctors, shouldn't you all be in favor of increasing health care costs instead of decreasing them, since these same costs will go towards your future salaries? Increased costs also allow for increased quality of care. It's a win-win situation, for both the doctors and the patients.

 

[efle]

Makes sense! I don't see any advantages of our health care system over sp.

There are none (for the everyman), and it is just a matter of time. History is a long record of the scary progressive ideals being common sense a couple generations later. People in Scandinavia look at our stupid self-inflicted suffering from worship of the market the way we look back at trickle down economics.

 

[deleted393595]

Wow this thread is still going on!

 

[efle]

As aspiring doctors, shouldn't you all be in favor of increasing health care costs instead of decreasing them, since these same costs will go towards your future salaries? Increased costs also allow for increased quality of care. It's a win-win situation, for both the doctors and the patients.

What odd logic. The more we spend, the better it is for everyone! It's a positive feedback loop!

But more seriously, it's not a win for the patients to pay more for excessively expensive and often unnecessary tests and treatments.

You are right however that a doctor primarily interested in the biggest possible paycheck should support the biggest healthcare. Some people choose to vote in ways that do not reflect what is best for them personally. I for example would benefit from keeping tax money instead of sending it off to fund education. Yet, I vote for increased education funding.

 

[ranob]

it's not a win for the patients to pay more for excessively expensive and often unnecessary tests and treatments.

Think of the lives saved by these "unnecessary" expensive tests and treatments though. Those lives are priceless. So why are you complaining? Just accept the compensation for your great work as a doctor and continue to save lives. Once you're a doctor that is.

 

[efle]

Think of the lives saved by these "unnecessary" expensive tests and treatments though. Those lives are priceless.

Lives are not priceless. QALY have willingness-to-pay thresholds. We live in a world with scarcity, and excess is not the moral route when we are in need of dollars that can be much more effectively spent on healthiness and happiness elsewhere.

 

[ZedsDed]

Think of the lives saved by these "unnecessary" expensive tests and treatments though. Those lives are priceless. So why are you complaining? Just accept the compensation for your great work as a doctor and continue to save lives. Once you're a doctor that is.

Huh? If they are unnecessary then they are, by definition, not saving lives. Or at the very least doing so in a redundant or inefficient manner.

 

[raindropx]

As aspiring doctors, shouldn't you all be in favor of increasing health care costs instead of decreasing them, since these same costs will go towards your future salaries? Increased costs also allow for increased quality of care. It's a win-win situation, for both the doctors and the patients.

That defeats the entire purpose of making health care more accessible...
There are more important things in life than our paychecks

 

[ranob]

That defeats the entire purpose of making health care more accessible...
There are more important things in life than our paychecks

That's the whole point. Those patients can take a hit on their paychecks. After all, we're the ones saving their very lives! Now what could be more important than that?

Edit: Make health care more accessible? The government should subsidize it some more. Increase medicare funding, etc.

efle see my edit. You're the one who advocated a single payer system right?

 

[raindropx]

That's the whole point. Those patients can take a hit on their paychecks. After all, we're the ones saving their very lives! Now what could be more important than that?

That would mean tax increase on top of everything

 

[efle]

That's the whole point. Those patients can take a hit on their paychecks. After all, we're the ones saving their very lives! Now what could be more important than that?

And in this world, what happens when a patient can't pay?

 

[ranob]

Lives are not priceless. QALY have willingness-to-pay thresholds. We live in a world with scarcity, and excess is not the moral route when we are in need of dollars that can be much more effectively spent on healthiness and happiness elsewhere.

That's exactly why single payer systems don't work. Health care is scarce. It's not a public service that can be provided to everyone. The most moral way to dispense healthcare is to provide it to the highest bidder. At least in my view. Which is basically the system we have right now: if you want quality healthcare, you need to pay a premium for it.

Edit: I'd love to hear any viable alternatives. So far we've got: single payer system A, that makes low-quality healthcare accessible to everyone, but also prevents anyone from seeking out the higher-quality "expensive" tests and treatments. Or single payer system B, that raises taxes to provide everyone with high-quality healthcare. I guess A makes sense if each life is valued at exactly $999.99, or some other arbitrary figure, and not a single cent more. And B makes perfect sense if you don't mind the tax increase. Under the current system, you're free to assign whatever value you want to your life: however much you're willing to pay for medical care.

 

[efle]

The most moral way to dispense healthcare is to provide it to the highest bidder

 

[ZedsDed]

That's exactly why single payer systems don't work. Health care is scarce. It's not a public service that can be provided to everyone. The most moral way to dispense healthcare is to provide it to the highest bidder. At least in my view. Which is basically the system we have right now: if you want quality healthcare, you need to pay a premium for it.

Edit: I'd love to hear any viable alternatives. So far we've got: single payer system A, that makes low-quality healthcare accessible to everyone, but also prevents anyone from seeking out the higher-quality "expensive" tests and treatments. Or single payer system B, that raises taxes to provide everyone with high-quality healthcare. I guess A makes sense if each life is valued at exactly $999.99, or some other arbitrary figure, and not a single cent more. And B makes perfect sense if you don't mind the tax increase. Under the current system, you're free to assign whatever value you want to your life: however much you're willing to pay for medical care.

The person you are speaking to isn't alerted when you edit. It might be easier just to type up a new comment.

 

[efle]

That's exactly why single payer systems don't work. Health care is scarce. It's not a public service that can be provided to everyone. The most moral way to dispense healthcare is to provide it to the highest bidder. At least in my view. Which is basically the system we have right now: if you want quality healthcare, you need to pay a premium for it.

Edit: I'd love to hear any viable alternatives. So far we've got: single payer system A, that makes low-quality healthcare accessible to everyone, but also prevents anyone from seeking out the higher-quality "expensive" tests and treatments. Or single payer system B, that raises taxes to provide everyone with high-quality healthcare. I guess A makes sense if each life is valued at exactly $999.99, or some other arbitrary figure, and not a single cent more. And B makes perfect sense if you don't mind the tax increase. Under the current system, you're free to assign whatever value you want to your life: however much you're willing to pay for medical care.

Case study: Denmark. Singlepayer universal coverage, higher healthcare quality than USA for the everyman while also far, far more cost-effective. A small private sector exists to cater to the rich and to take overflow from waitlists should it be necessary (covered by government in this case). Taxes are high (not just due to healthcare, they also have entirely covered education at all levels, extremely good unemployment and social programs, etc) and yet the country is thriving, productive, among the happiest, and people are proud of their extremely egalitarian society.

You never answered my question before: what happens in your world to people that can't afford treatment?

 

[ranob]

@Zeds didn't realize that, thanks

what happens in your world to people that can't afford treatment?

They are provided with low-quality treatment for free by the government (medicaid/medicare). If they can't afford the experimental, excessively expensive tests and treatments, then they have to take their chances with the cheap, tried and tested ones. My world is the same as the status quo in America. I'm not seeing any compelling reasons to switch to a single payer system.

A small private sector exists to cater to the rich and to take overflow from waitlists should it be necessary (covered by government in this case).

Correct me if I'm wrong, but isn't this not a single payer system, since one must pay out of pocket to receive high quality health care? It sounds a lot like what we have here. That's not to say there aren't many other factors that account for the higher healthcare efficiency of Denmark over the US.

 

[efle]

The status quo in America is very bad for very many people.

Single payer means the government will pay for all healthcare, and in Denmark the government does pay some 97+% of healthcare expenses. A very tiny minority with the extra money seeks elective treatment or an "improved experience" at private hospitals, but every citizen is guaranteed free public healthcare, making them a public singlepayer system.

So you support the existence of a program that provides millions with low-quality tax-based treatment. I've given some evidence that growing that program to cover many more people can both improve quality and cut costs for people compared to what they had to pay to insurance corporations. People with piles of cash that wish to seek elective treatment or options that are vastly more expensive with little return (the QALY threshold for public care systems are generally tens of thousands of dollars per QALY) remain free to do so. So what's your reasoning for preferring the US status quo to the Danish?

 

[ranob]

The status quo in America is very bad for very many people.

Single payer means the government will pay for all healthcare, and in Denmark the government does pay some 97+% of healthcare expenses. A very tiny minority with the extra money seeks elective treatment or an "improved experience" at private hospitals, but every citizen is guaranteed free public healthcare, making them a public singlepayer system.

So you support the existence of a program that provides millions with low-quality tax-based treatment. I've given some evidence that growing that program to cover many more people can both improve quality and cut costs for people compared to what they had to pay to insurance corporations. People with piles of cash that wish to seek elective treatment or options that are vastly more expensive with little return (the QALY threshold for public care systems are generally tens of thousands of dollars per QALY) remain free to do so. So what's your reasoning for preferring the US status quo to the Danish?

If I'm understanding you correctly, you're saying the US should increase medicaid/medicare funding and allow more people to enroll in it, so that it can become more like Denmark? I have no problem with that. The thing is, you believe that this will result in healthcare costs and taxes decreasing. I suspect the opposite outcome will occur. Regardless, this discussion is pointless since the US isn't changing its healthcare system anytime soon. Believe what you like, but there are tons of other factors that contribute to health care costs besides the number of people enrolled in and amount of coverage provided by medicaid. These factors can easily account for the supposed superiority of the Denmark healthcare system over that of the US.

 

[Favour517]

You are missing the point.

a. It's impractical, inefficient, and unrealistic to match every patient with a doctor sharing a similar skin color and ethnicity "to put them at ease."

b. A free clinic is just that. It represents nothing more.

b. Do you honestly believe a patient with a malignant tumor would put a priority on the surgeon sharing the same skin color? I guarantee the patient would want the most COMPETENT surgeon available. Skin color and ethnicity are important to academics in Ivory Towers, not to patients whose lives are at stake.

Are you trying to suggest that URM's arent as competent? In order to become a doctor, one has to pass all boards, so obviously they have been deemed competent. All your comments stink of arrogance. You need to re-evaluate your attitude.

 

[Favour517]

A) Is it just me or does it look like someone photoshopped a backpack on that woman's sweater?
B) I'm a little confused on what point you guys are trying to make by posting the humongous pictures? That white people aren't perfect?

The point is that all races commit crimes, not just blacks.

 

[Favour517]

The biggest issue with modern affirmative action is that professional schools are essentially admitting to certain demographics that they are lesser qualified, statistically, to compete against an average. Culturally, that's a major insult to demographics - instead of raising the bar for everyone and expecting the very best, we lessen it for others while keeping it higher for the majority. When white applicants with great scores are being denied even for interviews at certain schools over black or Hispanic applicants with significantly lesser statistics, what you're doing is (1) perpetuating the very stereotypes that keep demographics down and (2) writing a false narrative for pre-professional students that they can be admitted, regardless of race, if they do x, y, and z..

1) orm's arent being passed up for urm's. If youre really good, you wouldnt be passed up. Even if we abolished AA, there would still be thousands of qualified whites and Asians that wouldnt get in. 2. the reason why their stats are less qualified has more to do with challenges they faced. given the same resources as their white counterparts, they will succeed

 

[efle]

If I'm understanding you correctly, you're saying the US should increase medicaid/medicare funding and allow more people to enroll in it, so that it can become more like Denmark? I have no problem with that. The thing is, you believe that this will result in healthcare costs and taxes decreasing. I suspect the opposite outcome will occur. Regardless, this discussion is pointless since the US isn't changing its healthcare system anytime soon. Believe what you like, but there are tons of other factors that contribute to health care costs besides the number of people enrolled in and amount of coverage provided by medicaid. These factors can easily account for the supposed superiority of the Denmark healthcare system over that of the US.

Taxes would certainly rise, but in trade people would no longer have to buy insurance. If you look at the WHO study I linked earlier you'll see it isn't a Denmark vs US effect - on average across many countries of each type, private healthcare administration soaks up three times as much expense as public. Believe what you want but it is inevitable. Single payer is just too much more efficient.

 

[raindropx]

Taxes would certainly rise, but in trade people would no longer have to buy insurance. If you look at the WHO study I linked earlier you'll see it isn't a Denmark vs US effect - on average across many countries of each type, private healthcare administration soaks up three times as much expense as public. Believe what you want but it is inevitable. Single payer is just too much more efficient.

So taxes would cover everything? No copays or such? I am also wondering whether quality of health care would decrease

 

[efle]

So taxes would cover everything? No copays or such? I am also wondering whether quality of health care would decrease

No copay, it is entirely free at point of use for all citizens. Scandinavian countries currently have superior quality as well as better cost efficiency. There's really no reason that being able to much more quickly and easily bill should harm quality.

 

[raindropx]

No copay, it is entirely free at point of use for all citizens. Scandinavian countries currently have superior quality as well as better cost efficiency. There's really no reason that being able to much more quickly and easily bill should harm quality.

But in guessing it doesn't cover all kinds of treatments...what about treatments that are not for health per se such as in vitro fertilization and certain plastic surgery. It wouldn't be fair to take taxes for optional treatments that don't aim to improve health in my opinion.
Is there a quantification of how much money would be saved?

 

[efle]

But in guessing it doesn't cover all kinds of treatments...what about treatments that are not for health per se such as in vitro fertilization and certain plastic surgery. It wouldn't be fair to take taxes for optional treatments that don't aim to improve health in my opinion.
Is there a quantification of how much money would be saved?

Actually you get multiple state-paid attempts at in vitro. Purely cosmetic plastics isn't covered but remains available in the small private sector to those with money seeking it. Willingness to pay threshold is tens of thousands of dollars per QALY. Check the WHO paper for comparative expense on administrating each type of system.

 

[raindropx]

Actually you get multiple state-paid attempts at in vitro. Purely cosmetic plastics isn't covered but remains available in the small private sector to those with money seeking it. Willingness to pay threshold is tens of thousands of dollars per QALY. Check the WHO paper for comparative expense on administrating each type of system.

Each of those in vitro attempts would be $30k-50k...you would be okay with taxes going toward that?

Thanks for source

 

[raindropx]

Well I guess paying for others is similar to how insurance has become now, so it wouldn't be different in that aspect

 

[efle]

Scandinavian societies prize egalitarian ideals - everyone should be happy and healthy, and that includes allowing people seeking happiness from children to use modern medicine to try and help them get there. I am absolutely OK with that practice being tax funded.

 

[raindropx]

How would this make health care accessible for the illegal immigrants who can't pay taxes? And I've heard physicians complain about all the restrictions placed on them through Medicare

 

[efle]

How would this make health care accessible for the illegal immigrants who can't pay taxes? And I've heard physicians complain about all the restrictions placed on them through Medicare

In both systems there is no coverage for poor illegal aliens.

Medicare is very much imperfect. Singlepayer does not necessitate the system be like Medicare, all it means is the government eventually pays. The DRG abd salaried doctors system adopted in several EU countries is an example of a very different payment system than Medicare that remains single payer/government funded.

 

[RhinB]

In both systems there is no coverage for poor illegal aliens.

Medicare is very much imperfect. Singlepayer does not necessitate the system be like Medicare, all it means is the government eventually pays. The DRG abd salaried doctors system adopted in several EU countries is an example of a very different payment system than Medicare that remains single payer/government funded.

I've been reading through this thread and I love your view on healthcare and agree with most of it.

JW on a sidenote - where did you accumulate your knowledge on healthcare? Classes? Individual research?

And what are you thoughts on Singapore's healthcare system? Taking taxes and their "Health Savings" accounts? Medisave, Medifund, and Eldershield?

 

[efle]

I've been reading through this thread and I love your view on healthcare and agree with most of it.

JW on a sidenote - where did you accumulate your knowledge on healthcare? Classes? Individual research?

And what are you thoughts on Singapore's healthcare system? Taking taxes and their "Health Savings" accounts? Medisave, Medifund, and Eldershield?

I lived in Scandinavia for a semester and have taken classes in European medical practice and policy, healthcare economics, and taken several classes taught by physicians at hospitals there that gave a great insider glimpse. Also got to travel in Austria and Hungary and learn from physicians there about their respective systems and opinions (the latter especially interesting as they had been in the communist sphere until a few decades ago). Absolutely incredible opportunity that I now recommend to everyone considering time abroad. Before all of this I had very little knowledge outside of what I study.

We did touch briefly on Singapore. It works shockingly well! If I recall correctly however you are up the creek if you're unlucky and have multiple or long term expensive treatments, even if the QALY per dollar ratio remains good, and I took issue with that. The ability to buy much better hospital conditions also struck me as problematic since the same physicians and staff serve the different levels and bias towards the higher payers is inevitable. Better to avoid extremely close proximity like that and instead have a universally equal quality care system plus a sepaeated tiny private option for the people with money that desire special treatments.

 

[raindropx]

Sounds like an awesome opportunity

 

[ranob]

the reason why their stats are less qualified has more to do with challenges they faced. given the same resources as their white counterparts, they will succeed

By resources, do you mean SES? If so, how would admitting URMs to med school provide them with "the same resources as their white counterparts?" Most likely scenario is that they will continue to perform worse than their white counterparts throughout med school just as they did throughout college since they continue to face "challenges" that magically reduce their scores on standardized tests. Like substance abuse. Or not having any erasers to edit their answers on the scantron! (Turns out that last one happens to whites too..)

 

[Glazedonutlove]

~

 

[efle]

Urm do score lower

 

[ranob]

how would admitting URMs to med school provide them with "the same resources as their white counterparts?"

Challenges may include never being encouraged by parents to focus on academics or working many jobs to pay for college as urm are most likely to be lower ses.
These may not seem like a big deal to you and I am not claiming that every urm student faces this but they are huge hurdles nevertheless

Also, it's not that urm necessarily score lower. Entrance to medical school is easier for them because increasing diversity is the whole point of aa

Sounds to me like they will continue to face these same challenges in med school? Also, I'm not talking about URMs as a race. I'm talking about the subset that matriculates to med school. Members of this group do necessarily score lower on standardized exams than their white counterparts.

 

[efle]

They score lower as a race too, stereotype threat and whatnot

 

[raindropx]

Sounds to me like they will continue to face these same challenges in med school? Also, I'm not talking about URMs as a race. I'm talking about the subset that matriculates to med school. Members of this group do necessarily score lower on standardized exams than their white counterparts.

So what is your point? Base everything on meritocracy? (Would be much more fair imo)
I believe this is done in ca