Dying in the Safety Net.

[Womb Raider]

I am awake. I actually do give everyone the benefit of the doubt unless I have compelling evidence against it. From my experience working with people from these communities I have no reason to doubt them. See the difference between you and me is that I'd much rather give a "hand-out" to someone who doesn't deserve it than leave a good person who was just unlucky stranded. I think it is a right thing to do. But it seems like the "free loaders" bother you so much that you are willing to cut life support from everyone else who isn't but needs it just so that your family is not paying them.

I never said I'm against helping all of them. I'm not the one operating on a polar spectrum. You keep putting words in my mouth.

So the minors should be responsible for their drug addiction any more than their parents and the society? Really? I point to this specific question because a lot of drug and alcohol problems start from early age.

Drug addiction from an early age is unfortunate. However, it doesn't merit a lifetime supply of free things. You were dealt a bad hand - that's life. You have to work hard to overcome these problems. I'm not saying they don't deserve ANY help - I think helping them is a good thing, but there is a limit.

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[Euxox]

My mistake. Not wanting people to think sounded a little communist to me.

Then you still don't know what Communism is. According to Marx, an educational system that was designed the brainwash the masses was one of the tools that the bourgeoisie used to stay in control. Destroying this education system of brainwashing and opening up freedom of thought was a central goal of Communism.

No, I am not a fan of Communism, but if you can't tell the difference between Communism and totalitarianism, then you are totally unqualified to speak on the matter.

 

[notbobtrustme]

Wow is it really that high? I could have sworn it was lower... Maybe those 10 gorgeous blondes in my intro to bio class should have stayed pre-med after all.

By average pre-med, I mean those who are competitive enough to apply. There are roughly 45k applicants for ~20k seats for MD schools. If you have a 2.6 GPA and call yourself a pre-med, that doesn't count. I'm talking about students who are competitive (eg >3.4 GPA, >27 MCAT). Of that pool, roughly 50-60% won't get in.

 

[rain4venus]

Oh, so you quit your job and just write for yourself at home nowadays?

That's what I said.
That's why I have plenty of time to troll the internet.

Engineers don't quit engineering

Well I don't really suppose one would call me an engineer anymore after quitting engineering.

 

[ruralsurg4now]

That's what I said.
That's why I have plenty of time to troll the internet.

Ah, then sounds like you didn't actually quit your job, since you're saying that you're just trolling.

 

[Mr Avante]

Well I don't really suppose one would call me an engineer anymore after quitting engineering.

What's your FE score

 

[Skyforever]

Thanks for the powerful read

 

[Jabbed]

It's hard for me to want to help fund the poor's insurance when they're eating McDonalds and taco bell 24/7 for all three meals, smoking crack, shooting up, smoking a pack a day, and sitting at home doing absolutely nothing productive, living off other people. Yeah no wonder they have health problems. You want preventative care? Lets start with what we can prevent ourselves (e.g. what I listed above).

In the words of Lincoln: "You cannot help people permanently by doing for them, what they could and should do for themselves."

Sure, all poor people aren't like this - but a large amount of them are, and I don't feel bad when their health starts to deteriorate. They did it to themselves and they know it.

Do I think lazy people have a "right" to health care at the expense of the hard working? Yeah right.

This is the most ignorant thing that I've read a while. It's honestly a little disturbing that you just made such a massively offending stereotype and used it as evidence for your own hyper-polarized argument. I'm really not trying to attack you personally, but you're basically fulfilling the stereotype of the nut-job Republican.

Acknowledge a few things:
1. You come from a privileged background and have never had to face any significant hardship in your life.
2. You're a pre-med with minimal to no real world experience or knowledge. Most of your 'views' have been given to you by Fox News and Rush Limbaugh.
3. You have no idea how to fix the healthcare system. Really, how can you? You're an undergraduate whose basically just heard about how buggered the US healthcare system is. You probably don't even understand how the existing system works.

It's fine to have an opinion, but you should really acknowledge that your opinion is wholly uninformed and is mostly based on what you were exposed to rather than the result of any thoughtful and independent inquiry. Making hugely offensive blanket statements about entire socioeconomic/ethnic groups doesn't further discussion, it just pisses people off.

For the record, I voted Mccain + Romney the past two elections, so please don't accuse me of being some crazy liberal.

 

[Lya]

Ah, then sounds like you didn't actually quit your job, since you're saying that you're just trolling.

I'm just curious. I read some of your posts in medical forum, and your tone of voice in that forum is less condescending and offensive. I see that you had some residency experiences, so you are certainly older than typical pre-meds. If you find it hard to discuss things with pre-meds for whatever reason, as opposed to medical students, why do you come to pre-med forum in the first place?

 

[Lya]

Oh. My. God.

Are you serious? You have to think?! Is the sky falling? I wouldn't want people to trouble themselves and actually have to think!

I don't even know what else to say - expecting people to think isn't a BAD thing you commi.

It does take some conscious, cognitive efforts and even inconveniences to maintain the healthy diet and habits.

There are many factors we are fighting against: Sugar can be very addictive, broccoli tastes so plain and weird, diet coke tastes more appealing than just plain water, salad dressings can have lots of fat, fruits and vegetables are quite expensive for some people so eating lots of them consistently will be difficult, chocolate cakes for dessert as a reward for eating healthy entrée are very tempting, we see more advertisements about fast food restaurants and their promotions than vegetables, and etc.

 

[Mr Avante]

It does take some conscious, cognitive efforts and even inconveniences to maintain the healthy diet and habits.

There are many factors we are fighting against: Sugar can be very addictive, broccoli tastes so plain and weird, diet coke tastes more appealing than just plain water, salad dressings can have lots of fat, fruits and vegetables are quite expensive for some people so eating lots of them consistently will be difficult, chocolate cakes for dessert as a reward for eating healthy entrée are very tempting, we see more advertisements about fast food restaurants and their promotions than vegetables, and etc.

self control

 

[Lya]

I didn't even bother reading the previous pages, so I am not sure someone already mentioned these, but I think these three NYT articles are good supplemental, follow-up information.

http://www.nytimes.com/2013/10/03/h...eft-uncovered-by-health-law.html?pagewanted=1
http://www.nytimes.com/2013/10/02/business/economy/why-the-health-care-law-scares-the-gop.html?adxnnl=1&ref=general&src=me&adxnnlx=1380826482-gIrh27qKNW 8KGq224FmAA
http://www.nytimes.com/2013/11/17/magazine/switzerlands-proposal-to-pay-people-for-being-alive.html

The first two articles, although they are more than a month old, show some interesting perspectives:
2/3 of the uninsured has full time jobs by Kaiser analysis
More than 1/2 of the low-wage workers have no insurance by NYT analysis (Many poor people without insurance are not lazy by any means)
2/3 of working poor adults are living in these 26 states denying Medicaid expansion (economic disparity in health service)
6/10 of black people are in these 26 states that rejected Medicaid expansion (racial disparity in health service)
Main beneficiaries of this Medicaid expansion tend to be non-elderly, non-poorest, working adults with children. These middle-class people will be grateful to Democrats, not Republicans, so Republicans will be hard to get re-elected, so they will lose a large chunk of middle class to Democrats.

Overall, they shed light on three competing interests:
Social/moral causes to cover everyone vs. economic causes to manage the tax rate (despite 90% of insurance costs being covered using federal money in 2016 and on, covering even 10% of insurance costs can increase the tax rate) vs. political causes to prevent losing middle-class families to Democrats


The topic of the third article was mentioned in some threads, but I thought it was great to see how "poverty disappeared" and "a massive disincentive to work" was not as bad as other literatures showed. Cost is definitely an issue, so I don't envision this being implemented in the U.S. any time soon at all; however, some of the people mentioned in the original article by OP could have been benefited from this, rather than being ruled out via financial screening in hospitals.

 

[Catman21]

That's another falsehood. Eating fresh food is quite inexpensive. That's one of those lies that is circulated to justify the actions of the poor.

lolol maybe in BFE where you currently practice is fresh produce cheap, and theres a farmers market 2 miles in every direction. Let me tell you, in urban areas (where most people life FYI) fresh food is not particularly cheap. Careful with your judgement of "lies" that foxnews force feeds you everynight.

 

[Starry]

Wow this thread has exploded since I last visited.

I just want to add why having a safety net is very important for every person in America. It might sound counterintuitive, but in countries where the gap between the rich and the poor is wider, EVERYONE's health suffers. Even if you look within the US, states (usually red) with policies that favor the division between rich and poor have unhealthier populations.

Texas vs any blue state is a great example. And don't anyone say anything about Mexican immigrants bringing down bar. Immigrants on average are actually healthier than the average American when they first arrive.

These are facts, not just my opinion. Even if some people take advantage of the system, it has been proven time and time again across multiple countries and states that treating healthcare as universal improves the quality of health and life for everyone. Looking at the data, I find it difficult to see how anyone can reasonably argue the opposite.

A previous poster argued that universal healthcare will lead to worse care for everyone. This is plain wrong. Again, this is not an opinion. It's a fact.

The argument that there are limited resources and we can't take care of everyone is also wrong. America spends by far the most per capita on healthcare; yet our health indicators are miserable. We do have the resources to provide basic healthcare to everyone. Lack of resources is not a problem. It's a matter of allocation and efficiency.

There really shouldn't be a debate over whether basic healthcare should be available to everyone or not. The devil is in the details, as someone said earlier. Both Republicans and Democrats agree that healthcare needed an overhaul. ACA draws heavily from Romney's Massachusetts plan.

Edit: adding a tldr...
TLDR: The statement that universal healthcare is good for society is a fact, not an opinion.

 

[ruralsurg4now]

I'm just curious. I read some of your posts in medical forum, and your tone of voice in that forum is less condescending and offensive. I see that you had some residency experiences, so you are certainly older than typical pre-meds. If you find it hard to discuss things with pre-meds for whatever reason, as opposed to medical students, why do you come to pre-med forum in the first place?

The only reason I have a problem with pre-meds (at least on this forum) is that they talk authoritatively about things they don't know about. For example, the pre-meds on this forum write about physicians and what they "should" do or the "duty" they have and they don't know anything about what it's like being a doctor. Meanwhile, they're voting for things, such as "universal care" (which is not universal and also is just socialized medicine) without understanding the ramifications. OR, if they do understand the consequences, they then act like hypocrites. For example, I've met lots of liberal medical students ...none of whom go into primary care, if they can at all help it (some have, but only because they basically had to and grumbled about it). All the liberal medical students, who wail and moan about "greedy doctors" and "high salaries that we don't need," immediately go for high-paying specialties with little call and who only see a small percentage of patients for very narrow reasons. Good job, you hypocrites, I spit on your face.

People read this article and are like "ooo, great read!" Great read? How about you go serve some underprivileged populations, then? "Oh, uh, no, I'm going to do Plastics in Beverly Hills, but it's still a great read." LOL, ok, then nothing you think, feel, or say is relevant in any way. But luckily for them, they can still impose their hypocrisy and low-intellect on America with their vote.

 

[ruralsurg4now]

lolol maybe in BFE where you currently practice is fresh produce cheap, and theres a farmers market 2 miles in every direction. Let me tell you, in urban areas (where most people life FYI) fresh food is not particularly cheap. Careful with your judgement of "lies" that foxnews force feeds you everynight.

lolol, no, produce is cheap everywhere, despite your lack of knowledge. Try going to a supermarket tomorrow, let us know how it goes. Either that or just eat Twinkies and Ho Hos for 20 years because from what I'm told you can still grow and develop on those. Have fun watching CNN with the other two people in the country who do.

 

[rain4venus]

What's your FE score

I went to grad school instead of taking the FE exam. The job I was in after grad school didn't require the FE. I was doing nanofabrication.

There are several other ex-engineers here that are now premed.

OTOH, maybe we're all making it up for some reason (??) If you like, I could take a photo of my degree and get my references to send you a PM.

ETA: If it clears it up for you, I was never technically a PE, but most of the engineers I know are not.

 

[Lya]

The only reason I have a problem with pre-meds (at least on this forum) is that they talk authoritatively about things they don't know about. For example, the pre-meds on this forum write about physicians and what they "should" do or the "duty" they have and they don't know anything about what it's like being a doctor. Meanwhile, they're voting for things, such as "universal care" (which is not universal and also is just socialized medicine) without understanding the ramifications. OR, if they do understand the consequences, they then act like hypocrites. For example, I've met lots of liberal medical students ...none of whom go into primary care, if they can at all help it (some have, but only because they basically had to and grumbled about it). All the liberal medical students, who wail and moan about "greedy doctors" and "high salaries that we don't need," immediately go for high-paying specialties with little call and who only see a small percentage of patients for very narrow reasons. Good job, you hypocrites, I spit on your face.

People read this article and are like "ooo, great read!" Great read? How about you go serve some underprivileged populations, then? "Oh, uh, no, I'm going to do Plastics in Beverly Hills, but it's still a great read." LOL, ok, then nothing you think, feel, or say is relevant in any way. But luckily for them, they can still impose their hypocrisy and low-intellect on America with their vote.

Very true. I see your point there and thanks for sharing your thoughts.

I think that many times when we actually consider delving into caring for the underserved, we then realize the actual magnitude of many obstacles that we considered purely in the past as abstract or intellectual concepts. These obstacles can be outside our control, and because of them, we tend to justify our decisions and consider more seriously other specialties and locations with higher salary. I think that this inconvenience of changing or enduring such obstacles (like low funding, fewer physicians and other professionals, not an ideal place to raise families, far more exhausting cases than other places, etc.) is the reason, not that those liberal students are two-face individuals with lies. What are your thoughts?

Realistically speaking, I do not see universal healthcare being implemented in the U.S. Even the public option/insurance in the health insurance marketplace had been omitted in PPACA, so the influence of for-profit corporations is very real. And these corporations will not suddenly become nonprofit at least for decades to come, in my opinion. The pool of clients for insurance enlarged, and further privatization seems to be inevitable. What are your views on current healthcare, its future, and universal healthcare, as someone who went through medical school and beyond?


Hopefully, as you share your thoughts and experiences, we as pre-meds will realize things along the way and become less authoritative than we currently are.

 

[rain4venus]

Ah, then sounds like you didn't actually quit your job, since you're saying that you're just trolling.

There are multiple definitions of the term " to troll." Perhaps it was poor word choice due to the association between message boards and one particular definition. I didn't mean that I was flamebaiting or being insincere; I was using the more classic dictionary definition. Of course, I wouldn't expect you to be familiar with that usage, since you're not a writer or anything. http://www.merriam-webster.com/dictionary/troll

It's true that I didn't quit my job to be a writer. I had to quit my job due to a move, and soon after I decided to make writing my new "job" even though it's unlikely to ever make money. If it makes you feel better, I also tutor a couple hours a week. Yet somehow that's not where I get my identity or self-worth.

My whole point is that there are plenty of people out there that if they were guaranteed an income whether they worked or not, they would be perfectly happy to stay at home and not work and find other ways to spend their time. Think about the entire category of trophy wives that spend their days at the gym, salon, mall, etc...

 

[Lya]

Wow this thread has exploded since I last visited.

I just want to add why having a safety net is very important for every person in America. It might sound counterintuitive, but in countries where the gap between the rich and the poor is wider, EVERYONE's health suffers. Even if you look within the US, states (usually red) with policies that favor the division between rich and poor have unhealthier populations.

Texas vs any blue state is a great example. And don't anyone say anything about Mexican immigrants bringing down bar. Immigrants on average are actually healthier than the average American when they first arrive.

These are facts, not just my opinion. Even if some people take advantage of the system, it has been proven time and time again across multiple countries and states that treating healthcare as universal improves the quality of health and life for everyone. Looking at the data, I find it difficult to see how anyone can reasonably argue the opposite.

A previous poster argued that universal healthcare will lead to worse care for everyone. This is plain wrong. Again, this is not an opinion. It's a fact.

The argument that there are limited resources and we can't take care of everyone is also wrong. America spends by far the most per capita on healthcare; yet our health indicators are miserable. We do have the resources to provide basic healthcare to everyone. Lack of resources is not a problem. It's a matter of allocation and efficiency.

There really shouldn't be a debate over whether basic healthcare should be available to everyone or not. The devil is in the details, as someone said earlier. Both Republicans and Democrats agree that healthcare needed an overhaul. ACA draws heavily from Romney's Massachusetts plan.

Edit: adding a tldr...
TLDR: The statement that universal healthcare is good for society is a fact, not an opinion.

I am curious about your thoughts after reading the second NYT article I posted above.

The reasons you listed mainly fall under social causes to cover everyone. I fully agree that it is possible in an economic sense, but just simply stating that something is a fact or is good, although I agree, does not lead to the universal healthcare in the U.S. Universal healthcare has been advocated for nearly 100 years in the U.S., but it has not been successful at all. There are many conflicts of interests that you will have to address, like for-profit corporations lobbying against anything that will move the current system away from the privatization of healthcare.

How would you suggest getting there from where we are now?

 

[rain4venus]

2/3 of working poor adults are living in these 26 states denying Medicaid expansion (economic disparity in health service)

I like how the "answer" to the supreme court ruling that the mandatory medicaid expansion was unconstitutional was just to deny health insurance to the poorest people in those 26 states rather than at least expanding the subsidies to cover them as well.

 

[ruralsurg4now]

I think that many times when we actually consider delving into caring for the underserved, we then realize the actual magnitude of many obstacles that we considered purely in the past as abstract or intellectual concepts. These obstacles can be outside our control, and because of them, we tend to justify our decisions and consider more seriously other specialties and locations with higher salary. I think that this inconvenience of changing or enduring such obstacles (like low funding, fewer physicians and other professionals, not an ideal place to raise families, far more exhausting cases than other places, etc.) is the reason, not that those liberal students are two-face individuals with lies. What are your thoughts?

Right, but that's my entire point. The very medical students who demand that "someone" take care of underprivileged or underserved communities just want "someone" to do it ...but not them. So they vote for "someone" to do it and then walk away with a self-satisified, smug attitude like "well, I did my part. I voted for that guy to do it!" If someone "feels" that certain people should get medical care and forces the rest of us to take sensitivity training about it, then guess what? My demand is that THEY are part of that solution. You want people in the ghetto to get medical treatment from compassionate physicians who can relate to their circumstances for low pay while not "judging" them for being crack addicts with HIV? Then there's the job. You can fill it. Until they do, they can STFU as far as I'm concerned.

Moreover, all of us physicians who are forced to deal with endless regulations and regulatory bodies, as well as the fact that we're being forced out of private practice into hospital employment have the same ignoramuses to thank. They're like "oh, it's OK for us to control doctors, we have good intentions and anyways they're making good money so who cares what they think?" Then these same people become physicians and suddenly they're like "what, I have to deal with this Medicare paperwork and I don't get reimbursed for a year? Who did this? Oh, right, I DID." Who cares? All they know is to write "I wish everyone was on Medicare 4 free" on Internet forums. Great, now go take care of all those patients. Enjoy your 15 minutes for new patients and double-booked schedules because YOU WANTED IT. Oh, wait, you want to go into Dermatology to escape your wishes that you imposed on all the rest of us? What a surprise!

 

[Mr Avante]

I went to grad school instead of taking the FE exam. The job I was in after grad school didn't require the FE. I was doing nanofabrication.

There are several other ex-engineers here that are now premed.

OTOH, maybe we're all making it up for some reason (??) If you like, I could take a photo of my degree and get my references to send you a PM.

ETA: If it clears it up for you, I was never technically a PE, but most of the engineers I know are not.

Don't worry. That clears up any doubt, now I know why you left engineering.

 

[Lya]

Right, but that's my entire point. The very medical students who demand that "someone" take care of underprivileged or underserved communities just want "someone" to do it ...but not them. So they vote for "someone" to do it and then walk away with a self-satisified, smug attitude like "well, I did my part. I voted for that guy to do it!" If someone "feels" that certain people should get medical care and forces the rest of us to take sensitivity training about it, then guess what? My demand is that THEY are part of that solution. You want people in the ghetto to get medical treatment from compassionate physicians who can relate to their circumstances for low pay while not "judging" them for being crack addicts with HIV? Then there's the job. You can fill it. Until they do, they can STFU as far as I'm concerned.

Moreover, all of us physicians who are forced to deal with endless regulations and regulatory bodies, as well as the fact that we're being forced out of private practice into hospital employment have the same ignoramuses to thank. They're like "oh, it's OK for us to control doctors, we have good intentions and anyways they're making good money so who cares what they think?" Then these same people become physicians and suddenly they're like "what, I have to deal with this Medicare paperwork and I don't get reimbursed for a year? Who did this? Oh, right, I DID." Who cares? All they know is to write "I wish everyone was on Medicare 4 free" on Internet forums. Great, now go take care of all those patients. Enjoy your 15 minutes for new patients and double-booked schedules because YOU WANTED IT. Oh, wait, you want to go into Dermatology to escape your wishes that you imposed on all the rest of us? What a surprise!

I agree.

So how would you address a lack of physicians in underserved areas?

Do you think the high level of bureaucracy and paperwork in hospitals is simply inevitable? Or can we do something about it?

 

[rain4venus]

I think that many times when we actually consider delving into caring for the underserved, we then realize the actual magnitude of many obstacles that we considered purely in the past as abstract or intellectual concepts. These obstacles can be outside our control, and because of them, we tend to justify our decisions and consider more seriously other specialties and locations with higher salary. I think that this inconvenience of changing or enduring such obstacles (like low funding, fewer physicians and other professionals, not an ideal place to raise families, far more exhausting cases than other places, etc.) is the reason, not that those liberal students are two-face individuals with lies. What are your thoughts?

Fun aside: My mom works in a rural medically underserved area and the hospital just had to pay a massive settlement because they were paying doctors too much money, thereby drawing physicians away from surrounding areas. (i.e. areas that were less needy and therefore had less demand)

 

[ruralsurg4now]

I agree.

So how would you address a lack of physicians in underserved areas?

Do you think the high level of bureaucracy and paperwork in hospitals is simply inevitable? Or can we do something about it?

No, the bureaucracy and paperwork is NOT inevitable, it's a product of the regulatory agencies that people and politicians have demanded. All the people who say "oh, this or that country has better medical care than America" seem to be oblivious to the fact that none of those countries have any of our regulatory bodies or paperwork or electronic health records or litigation. "Oh, that's fine for them, but not for here." Oh, didn't you just say that they were awesome? If you eliminated all the administration, all of the regulatory bodies with their bureaucracies, all of the associated people who are just in the hospital to inspect things, and all of the lawyers, you'd free up physicians to actually work AND you'd probably cut over half of the cost of healthcare, if not more. Of course, you'd also lose the total control you have over doctors, which is why it would never fly.

And if you want physicians to work in underserved areas, you pay them to work there. (I've never heard of a hospital being sued for overpaying doctors, as rain4venus said, but going back to my point about litigation, it wouldn't surprise me since everyone sues everyone else for anything.) And if you can't get people to work in a place, guess what? Then nobody works there. That's how life goes. If that upsets people, then they are welcome to go work in rural Montana or an Indian reservation in Arizona. Don't let the door hit you on the way out.

 

[Womb Raider]

Acknowledge a few things:
1. You come from a privileged background and have never had to face any significant hardship in your life.
2. You're a pre-med with minimal to no real world experience or knowledge. Most of your 'views' have been given to you by Fox News and Rush Limbaugh.
3. You have no idea how to fix the healthcare system. Really, how can you? You're an undergraduate whose basically just heard about how buggered the US healthcare system is. You probably don't even understand how the existing system works.

Assumptions. Whatever helps you sleep at night.

 

[Starry]

I am curious about your thoughts after reading the second NYT article I posted above.

The reasons you listed mainly fall under social causes to cover everyone. I fully agree that it is possible in an economic sense, but just simply stating that something is a fact or is good, although I agree, does not lead to the universal healthcare in the U.S. Universal healthcare has been advocated for nearly 100 years in the U.S., but it has not been successful at all. There are many conflicts of interests that you will have to address, like for-profit corporations lobbying against anything that will move the current system away from the privatization of healthcare.

How would you suggest getting there from where we are now?

My point was that some people in this thread are arguing against universal healthcare because they don't think there are any benefits. That view is clearly wrong.

Our current nation-wide political climate is not conductive to any answers. Just like you posted in the article, people are willing to block good ideas for strategic and political reasons, regardless of the people they hurt. In addition, as ruralsurg4now said, as a lowly pre-med I shouldn't be so oblivious as to say "someone" needs to do it and then put a finger to my nose and say, "Nose goes." I hope I'm not making that mistake, and therefore my answer to your question is "I don't know."

However, on an individual level, I do intend to work to become the best doctor I can be, and eventually I want to become a leader in a community. Then, I will certainly know more and be able to do more to impact underserved populations. My non-medical interests lie in analyzing incentives and strategic use of information technology, which I think could hold some answers.

 

[Jabbed]

Assumptions. Whatever helps you sleep at night.

Tell me I'm wrong.

Your offensive comments + political views + stiffler profile pic fulfill a stereotype.

 

[Lya]

Assumptions. Whatever helps you sleep at night.

If interested, check out a documentary called "A Place at the Table." It illustrates the level of poverty in the U.S. and some perspectives about why eating fruits and vegetables might be difficult for some people.

http://www.magpictures.com/aplaceatthetable/

 

[Womb Raider]

If interested, check out a documentary called "A Place at the Table." It illustrates the level of poverty in the U.S. and some perspectives about why eating fruits and vegetables might be difficult for some people.

http://www.magpictures.com/aplaceatthetable/

Yes, I'm not denying the problem exists.

What about the people living in poverty that have a brand new smartphone, drive on brand new thousand dollar rims, and order pizza every night so that they can spend their free time watching movies on their 90" plasma TV?

Should we group these people into the same category as those (presumably) described in the documentary? If we do, and support the people who don't deserve to be supported (IMO), then what is stopping the hard working individuals to just say "screw it" and start acting like the lazy people?

 

[Reckoner]

No, the bureaucracy and paperwork is NOT inevitable, it's a product of the regulatory agencies that people and politicians have demanded. All the people who say "oh, this or that country has better medical care than America" seem to be oblivious to the fact that none of those countries have any of our regulatory bodies or paperwork or electronic health records or litigation. "Oh, that's fine for them, but not for here." Oh, didn't you just say that they were awesome? If you eliminated all the administration, all of the regulatory bodies with their bureaucracies, all of the associated people who are just in the hospital to inspect things, and all of the lawyers, you'd free up physicians to actually work AND you'd probably cut over half of the cost of healthcare, if not more. Of course, you'd also lose the total control you have over doctors, which is why it would never fly.

And if you want physicians to work in underserved areas, you pay them to work there. (I've never heard of a hospital being sued for overpaying doctors, as rain4venus said, but going back to my point about litigation, it wouldn't surprise me since everyone sues everyone else for anything.) And if you can't get people to work in a place, guess what? Then nobody works there. That's how life goes. If that upsets people, then they are welcome to go work in rural Montana or an Indian reservation in Arizona. Don't let the door hit you on the way out.

I understand it's frustrating for you as a physician to have students make claims about how you should or shouldn't practice. That sucks. But I don't think there's any data to support what you're saying here. According to p. 73 of this analysis, the US spent $145 billion on administrative costs in 2006 (most recent year I could find). Yes, that's a lot, but even if you somehow cut every penny of it, that's a very small percentage of the roughly 2 trillion we spent overall on healthcare that year. And this paper (might be behind a paywall, sorry!) found the total costs of liability and defensive medicine to be about 2.4% of overall healthcare costs.

Should we try to reduce the costs associated with administration and litigation? Absolutely. Will it cut healthcare costs in half? Probably not.

 

[Lya]

No, the bureaucracy and paperwork is NOT inevitable, it's a product of the regulatory agencies that people and politicians have demanded. All the people who say "oh, this or that country has better medical care than America" seem to be oblivious to the fact that none of those countries have any of our regulatory bodies or paperwork or electronic health records or litigation. "Oh, that's fine for them, but not for here." Oh, didn't you just say that they were awesome? If you eliminated all the administration, all of the regulatory bodies with their bureaucracies, all of the associated people who are just in the hospital to inspect things, and all of the lawyers, you'd free up physicians to actually work AND you'd probably cut over half of the cost of healthcare, if not more. Of course, you'd also lose the total control you have over doctors, which is why it would never fly.

And if you want physicians to work in underserved areas, you pay them to work there. (I've never heard of a hospital being sued for overpaying doctors, as rain4venus said, but going back to my point about litigation, it wouldn't surprise me since everyone sues everyone else for anything.) And if you can't get people to work in a place, guess what? Then nobody works there. That's how life goes. If that upsets people, then they are welcome to go work in rural Montana or an Indian reservation in Arizona. Don't let the door hit you on the way out.

The first point is, in short, about more autonomy for physicians with less regulations. It is a similar, although somewhat different, argument that I made in another thread:

http://forums.studentdoctor.net/threads/physician-burnout-article.1038281/#post-14557411

NickNaylor at the very end of the thread responded that the motives and self-interests of insurance companies in part shape how the management of hospitals is structured (which is often inefficient and convoluted, as you stated), and sometimes the business and management aspect of medicine becomes as a priority in the healthcare system, rather than serving the patients and placing them as a higher priority.

Do you think that is the case as well? In other words, in order to change the regulatory bodies and administrations, we need to reform our current payment and reimbursement model by addressing insurance companies and, perhaps, even Medicare/Medicaid, rather than simply trying to change hospital administrations? Do you think the current trend towards the performance- and value-based payment model will reduce the paperwork and bureaucracy?

Yes, I'm not denying the problem exists.

What about the people living in poverty that have a brand new smartphone, drive on brand new thousand dollar rims, and order pizza every night so that they can spend their free time watching movies on their 90" plasma TV?

Should we group these people into the same category as those (presumably) described in the documentary? If we do, and support the people who don't deserve to be supported (IMO), then what is stopping the hard working individuals to just say "screw it" and start acting like the lazy people?

There are exceptions. Even wealthy high students manage to receive federal grants and public, need-based scholarships for their college.

You should also check out a non-fiction book, Poor Economics, by two MIT professors. They illustrate why the poor often invests money on entertainment equipments, rather than education or healthy meals. Just like any other human beings, the poor also values immediate financial returns and pleasures, like pizza and plasma TVs. At least, after reading this book, I would not blame their "poor" decisions for not deserving the support, but rather those "poor" decisions seemed necessary, even inevitable, to endure and persevere in the context of their circumstances.

The third NYT article I posted above illustrated that just because we give free money to all people every month (at least for Swiss citizens), the incentive to work hard did not decrease as much as we would expect. In other words, the level of supports should be somewhat basic and minimum, so that you can live fairly well receiving some supports for the poor, but not "well enough" without some hard work. So if "lazy" people want to live "well enough," they will be discouraged from stopping their hard work. But again, all of this discussion is purely conceptual, and I don't think the U.S. will see such interventions and supports for the poor anytime soon. Rather, the budget for food stamps, for example, kept getting cut.

 

[BlueLabel]

Tell me I'm wrong.

Your offensive comments + political views + stiffler profile pic fulfill a stereotype.

SDN profile picture = crucial window into the soul of men

Excellent observation.

 

[rain4venus]

Tell me I'm wrong.

Your offensive comments + political views + stiffler profile pic fulfill a stereotype.

SDN profile picture = crucial window into the soul of men

Excellent observation.

Not to mention that his earlier post was complaining about WombRaider's stereotyping. I'm hoping he meant for the one you quoted here to be ironic...

 

[Womb Raider]

The third NYT article I posted above illustrated that just because we give free money to all people every month (at least for Swiss citizens), the incentive to work hard did not decrease as much as we would expect. In other words, the level of supports should be somewhat basic and minimum, so that you can live fairly well receiving some supports for the poor, but not "well enough" without some hard work. So if "lazy" people want to live "well enough," they will be discouraged from stopping their hard work. But again, all of this discussion is purely conceptual, and I don't think the U.S. will see such interventions and supports for the poor anytime soon. Rather, the budget for food stamps, for example, kept getting cut.

I just skimmed the article, but do they intend to replace all the other government aid (food stamps, disability, etc...) with the free paycheck?

Although an interesting proposition, I do not think it would have it's intended effect on our population.

Call me a pessimist, but there's more to escaping poverty than having money. Look at the percentage of professional athletes that run out of money. It's about knowing how to handle your money responsibly - not cash flow. If anything, I think this would make the problem worse.

 

[Mr Avante]

the amount of economics/politics phds in this thread is too damn high

 

[ruralsurg4now]

I understand it's frustrating for you as a physician to have students make claims about how you should or shouldn't practice. That sucks. But I don't think there's any data to support what you're saying here. According to p. 73 of this analysis, the US spent $145 billion on administrative costs in 2006 (most recent year I could find). Yes, that's a lot, but even if you somehow cut every penny of it, that's a very small percentage of the roughly 2 trillion we spent overall on healthcare that year. And this paper (might be behind a paywall, sorry!) found the total costs of liability and defensive medicine to be about 2.4% of overall healthcare costs.

Should we try to reduce the costs associated with administration and litigation? Absolutely. Will it cut healthcare costs in half? Probably not.

If you buy their numbers (and let's do that for the sake of argument, even though their firm is a liberal one), then those costs you are talking about are simply the actual administration of Medicare and Medicaid. That completely ignores all of the other bureaucracies and administrative costs that we have built into healthcare. If you go to any hospital you want right now, the number of administrative workers is staggering -- people whose entire job is to constantly have meetings every day with one another. Every single department has administrators and they all report to other administrators. You're kidding yourself if you think the cost of bureaucracy in healthcare is a paltry $145 billion.

With regards to your paper, you're also incorrect. It's funny because people desperately want to say that lawyers and litigation have almost no impact on medical costs. Fine, then let's take your word for it. So if you eliminate that, then there should be no problem, right? I mean, apparently nobody ever sues because there is no financial impact, so nobody should miss having no lawsuits, right? It's not like we don't have cadres of lawyers suing drug companies, hospitals, physicians, and advertising on television and radio for anyone they can get while hospitals and doctors maintain armies of counter-lawyers, right?

 

[ruralsurg4now]

My point was that some people in this thread are arguing against universal healthcare because they don't think there are any benefits. That view is clearly wrong.

Actually, your saying so doesn't constitute proof, but thanks for your opinion. Universal healthcare is laughable.

 

[ruralsurg4now]

NickNaylor at the very end of the thread responded that the motives and self-interests of insurance companies in part shape how the management of hospitals is structured (which is often inefficient and convoluted, as you stated), and sometimes the business and management aspect of medicine becomes as a priority in the healthcare system, rather than serving the patients and placing them as a higher priority.

Do you think that is the case as well? In other words, in order to change the regulatory bodies and administrations, we need to reform our current payment and reimbursement model by addressing insurance companies and, perhaps, even Medicare/Medicaid, rather than simply trying to change hospital administrations? Do you think the current trend towards the performance- and value-based payment model will reduce the paperwork and bureaucracy?

The performance-based payments we have today are not about performance. They're enacted by people who don't understand medicine. It's basically a form of control. Let me explain. We currently have a culture where urinary tract infections are considered "not acceptable." Now, you may say "that's wonderful, we shouldn't accept them." But that's silly because, no offense, people get urinary tract infections ...EVEN if you don't see a doctor or go to a hospital. But for some reason, if you get one in a hospital, then it's "not acceptable" and you get paid less. That's stupidity, not concern for performance. It's easy for people who don't actually practice medicine to say "I'll take any metric I want and then demand that there's an improvement next year ...and then the next, and so on. And if there isn't, then I will penalize you." Oh, well, then why don't you reimburse me five months faster every year, or else pay a penalty? And then at some point the reimbursement should be instantaneous, right? Which will be awesome!!

 

[ruralsurg4now]

Oh, by the way, do you know how to definitively prevent ventilator-associated pneumonia? Extubate the patient and let them die. They asphyxiated, but at least they didn't get iatrogenic pneumonia! Can I get paid now?

 

[Starry]

Actually, your saying so doesn't constitute proof, but thanks for your opinion. Universal healthcare is laughable.

What I said is not my opinion. I am not claiming that universal healthcare is good "just because I said so." I am no expert. However, there are countless studies that prove that your conclusion is wrong.

Just a look at the numbers can reveal a lot.

This is a random website but a comparison of these numbers to WHO's website shows a close correlation.
http://researchmaniacs.com/Country/LifeExpectancyUniversalHealthcare.html

This is just life expectancy. Other measures such as infant mortality, obesity, and mortality from other diseases are also depressing.

The US's position is terrible and terrifying considering how we have some of the best doctors, most advanced technology, and highest standard of living in the world. Among developed countries, we are failing miserably.

There is also data that shows that this is NOT because of culture or how Americans are "lazy." There are also studies that show Americans, rich and poor, work very hard compared to other countries.

Even sociologists here in Texas, the reddest of red states, home of Ted Cruz, agree that ALL people are healthier in states/nations with a wide and reliable safety net, even when other factors like economics and standard or living are controlled for. We are accountable and affected by each other, whether we like it or not.

Debate about HOW we can improve our system is healthy. Arguments dismissing a need for improvement are ignorant and regressive.

I just want for this thread to be framed around HOW to implement change rather than bashing the poor or dissing universal health care. As physicians or future physicians, we should all realize that the benefits of universal healthcare outweigh the costs. And again, this is not an opinion.

This is a fact.

 

[Reckoner]

If you buy their numbers (and let's do that for the sake of argument, even though their firm is a liberal one), then those costs you are talking about are simply the actual administration of Medicare and Medicaid. That completely ignores all of the other bureaucracies and administrative costs that we have built into healthcare. If you go to any hospital you want right now, the number of administrative workers is staggering -- people whose entire job is to constantly have meetings every day with one another. Every single department has administrators and they all report to other administrators. You're kidding yourself if you think the cost of bureaucracy in healthcare is a paltry $145 billion.

With regards to your paper, you're also incorrect. It's funny because people desperately want to say that lawyers and litigation have almost no impact on medical costs. Fine, then let's take your word for it. So if you eliminate that, then there should be no problem, right? I mean, apparently nobody ever sues because there is no financial impact, so nobody should miss having no lawsuits, right? It's not like we don't have cadres of lawyers suing drug companies, hospitals, physicians, and advertising on television and radio for anyone they can get while hospitals and doctors maintain armies of counter-lawyers, right?

I've never heard that criticism of McKinsey before, but perhaps it's true. According to them those costs include overhead within the private sector as well. Which other bureaucracies and administrative costs are you referring to? And do you have a different source showing that litigation has a greater effect on costs?

It's not that I don't believe these things could be true (and I totally agree that both should be reduced). I just think you're oversimplifying, and you aren't providing any real data to convince me otherwise.

 

[SunsFun]

Right, but that's my entire point. The very medical students who demand that "someone" take care of underprivileged or underserved communities just want "someone" to do it ...but not them. So they vote for "someone" to do it and then walk away with a self-satisified, smug attitude like "well, I did my part. I voted for that guy to do it!" If someone "feels" that certain people should get medical care and forces the rest of us to take sensitivity training about it, then guess what? My demand is that THEY are part of that solution. You want people in the ghetto to get medical treatment from compassionate physicians who can relate to their circumstances for low pay while not "judging" them for being crack addicts with HIV? Then there's the job. You can fill it. Until they do, they can STFU as far as I'm concerned.

Moreover, all of us physicians who are forced to deal with endless regulations and regulatory bodies, as well as the fact that we're being forced out of private practice into hospital employment have the same ignoramuses to thank. They're like "oh, it's OK for us to control doctors, we have good intentions and anyways they're making good money so who cares what they think?" Then these same people become physicians and suddenly they're like "what, I have to deal with this Medicare paperwork and I don't get reimbursed for a year? Who did this? Oh, right, I DID." Who cares? All they know is to write "I wish everyone was on Medicare 4 free" on Internet forums. Great, now go take care of all those patients. Enjoy your 15 minutes for new patients and double-booked schedules because YOU WANTED IT. Oh, wait, you want to go into Dermatology to escape your wishes that you imposed on all the rest of us? What a surprise!

Surprisingly, I understand your point. The flaw in your reasoning is that you take an absolutist approach and don't consider changing the system as a goal. You care about uninsured - go into primary care and work for free. Care about the poor - donate all your extra income to charity helping homeless. Environmentalist - don't use any utilities and move into the woods.

I don't think access to healthcare and other types of safety net should be contingent only on individuals caring about this problem and in a position to help. We as a society through political and social movement should make progress to set up a system that addresses those problems in a meaning way on a larger scale. One man or charity club effort will not solve the problem.

 

[Starry]

Surprisingly, I understand your point. The flaw in your reasoning is that you take an absolutist approach and don't consider changing the system as a goal. You care about uninsured - go into primary care and work for free. Care about the poor - donate all your extra income to charity helping homeless. Environmentalist - don't use any utilities and move into the woods.

I don't think access to healthcare and other types of safety net should be contingent only on individuals caring about this problem and in a position to help. We as a society through political and social movement should make progress to set up a system that addresses those problems in a meaning way on a larger scale. One man or charity club effort will not solve the problem.

Fantastic analysis. Expressed exactly what I feel, and why I want to position myself in the future so I can be involved in this movement.

I'll also hop into the argument about healthcare litigation. I have family in Taiwan, where the environment is not so litigious. I have heard stories about lack of protection of patient rights. As an American, I think, "That is so unfair!" But there, many people just have to suck it up and move on. When they hear about the USA's legal system, many people I have talked to express envy.

Therefore, I am proud of our justice system. Although it has its flaws, I highly appreciate the USA's desire for justice for all.

 

[ruralsurg4now]

What I said is not my opinion.

Not only is it your opinion, but it's also wrong.

 

[ruralsurg4now]

Surprisingly, I understand your point. The flaw in your reasoning is that you take an absolutist approach and don't consider changing the system as a goal. You care about uninsured - go into primary care and work for free. Care about the poor - donate all your extra income to charity helping homeless. Environmentalist - don't use any utilities and move into the woods.

I don't think access to healthcare and other types of safety net should be contingent only on individuals caring about this problem and in a position to help. We as a society through political and social movement should make progress to set up a system that addresses those problems in a meaning way on a larger scale. One man or charity club effort will not solve the problem.

No, it's not an absolutist approach. It's a reasoned one. If you care about the poor, then the liberal approach is to simply make other people pay for them. It's the same with literally every issue: "I care, so you will pay." If you're an environmentalist, then why shouldn't you move into the woods? You mean I have to listen to some guy blabber at me about fossil fuels while they're driving a car, using electricity, and living in a large house? Why?

I have to listen to someone talk about the need for universal healthcare and lecture me about my salary while they avoid the inner cities or the rural areas? Why?

No, that's not absolutism. It's an expectation that you put your money where your mouth is. Emphasis on YOUR money. It's why liberalism is so cowardly. One just cares and make fantastic posts and then someone else has to suffer for their caring. Instead of actually helping the poor, they just lap up stories about someone who does and that makes them great people. Nope. It makes them pathetic.

 

[Starry]

Not only is it your opinion, but it's also wrong.

Well, I didn't expect to change your mind. I have to admit that your disregard for an evidence-based conclusion is disappointing, but then again it's my fault for expecting anything from you. I just hope some readers of this thread would find the statistics I presented convincing.

 

[ruralsurg4now]

Well, I didn't expect to change your mind. I have to admit that your disregard for an evidence-based conclusion is disappointing, but then again it's my fault for expecting anything from you. I just hope some readers of this thread would find the statistics I presented convincing.

Don't worry, I didn't expect to change your mind, either, which is why I didn't waste my time writing a lengthy reply.

 

[Lya]

I just skimmed the article, but do they intend to replace all the other government aid (food stamps, disability, etc...) with the free paycheck?

Although an interesting proposition, I do not think it would have it's intended effect on our population.

Call me a pessimist, but there's more to escaping poverty than having money. Look at the percentage of professional athletes that run out of money. It's about knowing how to handle your money responsibly - not cash flow. If anything, I think this would make the problem worse.

At what income level for each region do you draw a line between having enough money with poor financial management and vice versa? How does one know that better money management is more needed than more cash flow? How do we know that our "spending money responsibly" is better than their "spending money responsibly?" The poor knows they have less money to work with, and I think their financial decisions are simply as good (and bad) as ours.

I understand your point, however. Even some doctors often don't know how to manage financially. But in the context of the poor, I am not sure how much their lives will improve simply by managing their money better. How much money do we need to invest in order to educate them on this? How much return will we have if we spend the same amount of money by simply distributing them to each household? Even if we can make them spend money on whatever we want them to, how do we guarantee that their quality of life and life satisfaction will improve? An interesting area to investigate, but this has to be done after understanding why certain people spend their money in a certain way. The book, "Poor Economics," discusses this aspect, and you might find this book very intriguing.

If you buy their numbers (and let's do that for the sake of argument, even though their firm is a liberal one), then those costs you are talking about are simply the actual administration of Medicare and Medicaid. That completely ignores all of the other bureaucracies and administrative costs that we have built into healthcare. If you go to any hospital you want right now, the number of administrative workers is staggering -- people whose entire job is to constantly have meetings every day with one another. Every single department has administrators and they all report to other administrators. You're kidding yourself if you think the cost of bureaucracy in healthcare is a paltry $145 billion.

With regards to your paper, you're also incorrect. It's funny because people desperately want to say that lawyers and litigation have almost no impact on medical costs. Fine, then let's take your word for it. So if you eliminate that, then there should be no problem, right? I mean, apparently nobody ever sues because there is no financial impact, so nobody should miss having no lawsuits, right? It's not like we don't have cadres of lawyers suing drug companies, hospitals, physicians, and advertising on television and radio for anyone they can get while hospitals and doctors maintain armies of counter-lawyers, right?

Do you know any unbiased, non-liberal sources you recommend?

I have to agree with you that just because something does not cost much, it does not mean that it is not important. Although litigation costs are not a large pie of healthcare costs, malpractice reform has influences beyond the cost management. Dr. Gawande's "Better" has a chapter about this, and the current malpractice system is so inefficient that it also heavily affects physicians' satisfaction in their practices, among many other areas. It is lucky if they did not lose their licenses. However, when for-profit corporations get sued, they can pay billions of dollars for their penalty, because they can easily recover that cost in a month and keep doing whatever they were doing without ever apologizing to anyone. The negative effect of this inefficient litigation system is much greater on physicians than on institutions.

The performance-based payments we have today are not about performance. They're enacted by people who don't understand medicine. It's basically a form of control. Let me explain. We currently have a culture where urinary tract infections are considered "not acceptable." Now, you may say "that's wonderful, we shouldn't accept them." But that's silly because, no offense, people get urinary tract infections ...EVEN if you don't see a doctor or go to a hospital. But for some reason, if you get one in a hospital, then it's "not acceptable" and you get paid less. That's stupidity, not concern for performance. It's easy for people who don't actually practice medicine to say "I'll take any metric I want and then demand that there's an improvement next year ...and then the next, and so on. And if there isn't, then I will penalize you." Oh, well, then why don't you reimburse me five months faster every year, or else pay a penalty? And then at some point the reimbursement should be instantaneous, right? Which will be awesome!!

I can see that hospitals would use that model as another layer of control, taking away more autonomy from physicians. So the people who don't understand medicine (hospital administrations) enact such payment model (as suggested by PPACA) simply in order to maximize the reimbursement rates? Insurance companies work on the other side in order to minimize the reimbursements and maximize the amount of money that they can keep? And physicians are in between dealing with both worlds?

Is there any positive change that we can expect from this current PPACA? It sounds like things will get worse for physicians.

What I said is not my opinion. I am not claiming that universal healthcare is good "just because I said so." I am no expert. However, there are countless studies that prove that your conclusion is wrong.

Just a look at the numbers can reveal a lot.

This is a random website but a comparison of these numbers to WHO's website shows a close correlation.
http://researchmaniacs.com/Country/LifeExpectancyUniversalHealthcare.html

This is just life expectancy. Other measures such as infant mortality, obesity, and mortality from other diseases are also depressing.

The US's position is terrible and terrifying considering how we have some of the best doctors, most advanced technology, and highest standard of living in the world. Among developed countries, we are failing miserably.

There is also data that shows that this is NOT because of culture or how Americans are "lazy." There are also studies that show Americans, rich and poor, work very hard compared to other countries.

Even sociologists here in Texas, the reddest of red states, home of Ted Cruz, agree that ALL people are healthier in states/nations with a wide and reliable safety net, even when other factors like economics and standard or living are controlled for. We are accountable and affected by each other, whether we like it or not.

Debate about HOW we can improve our system is healthy. Arguments dismissing a need for improvement are ignorant and regressive.

I just want for this thread to be framed around HOW to implement change rather than bashing the poor or dissing universal health care. As physicians or future physicians, we should all realize that the benefits of universal healthcare outweigh the costs. And again, this is not an opinion.

This is a fact.

The implementation will be nearly impossible.

As I said before, many presidents advocated universal healthcare for nearly 100 years. It took this long to get to PPACA and Medicare/Medicaid. Republicans will lose a large chunk of middle-class families' supports to Democrats, private insurance companies will heavily lobby against that universal healthcare notion even before being brought up for the potential agenda, and raising tax rates will be a concern (although some people would rather pay much higher taxes if they don't have to pay premiums). Our ideals have almost zero power in the eyes of politicians and corporations.

Surprisingly, I understand your point. The flaw in your reasoning is that you take an absolutist approach and don't consider changing the system as a goal. You care about uninsured - go into primary care and work for free. Care about the poor - donate all your extra income to charity helping homeless. Environmentalist - don't use any utilities and move into the woods.

I don't think access to healthcare and other types of safety net should be contingent only on individuals caring about this problem and in a position to help. We as a society through political and social movement should make progress to set up a system that addresses those problems in a meaning way on a larger scale. One man or charity club effort will not solve the problem.

What would you suggest to change the system as a whole? Who are major participants within political and social movements?

Fantastic analysis. Expressed exactly what I feel, and why I want to position myself in the future so I can be involved in this movement.

I'll also hop into the argument about healthcare litigation. I have family in Taiwan, where the environment is not so litigious. I have heard stories about lack of protection of patient rights. As an American, I think, "That is so unfair!" But there, many people just have to suck it up and move on. When they hear about the USA's legal system, many people I have talked to express envy.

Therefore, I am proud of our justice system. Although it has its flaws, I highly appreciate the USA's desire for justice for all.

Dr. Gawande's "Better" will be something you might find interesting to read.

Our current legal system is very inefficient, time-consuming, emotionally exhausting, and costly for medical cases. If there is even a formal/informal appealing process, prior to lawsuits, that patients don't necessarily need to find lawyers to understand what happened and why something happened, we can still preserve that protection of patient rights without always relying on courts. But realistically, I am not sure if any malpractice reform will take place anytime soon.