1. Dismiss Notice
  2. Download free Tapatalk for iPhone or Tapatalk for Android for your phone and follow the SDN forums with push notifications.
    Dismiss Notice
  3. Hey Texans—join us for a DFW meetup! Click here to learn more.
    Dismiss Notice
Dismiss Notice

Interview Feedback: Visit Interview Feedback to view and submit interview information.

Interviewing Masterclass: Free masterclass on interviewing from SDN and Medical College of Georgia

Health care financing reform

Discussion in 'Pre-Medical - MD' started by Gi, Dec 5, 2001.

  1. Gi

    Gi Member
    7+ Year Member

    Joined:
    Nov 14, 2001
    Messages:
    67
    Likes Received:
    0
    I've been asked in a couple interviews (mock and real) what I think the solution is to the aproximate 40 million uninsured in this country. Just wondering what you kids out there think....
     
  2. Note: SDN Members do not see this ad.

  3. paisley1

    paisley1 Senior Member
    7+ Year Member

    Joined:
    Oct 1, 2001
    Messages:
    182
    Likes Received:
    0
    Universal Health Care--how that would be implemented though is a bit more difficult to resolve. There's an excellent book on Health Policy written by two UCSF professors that, I believe, came out this year. I highly recommend it. I can find the exact title of it if you would like.
     
  4. Gi

    Gi Member
    7+ Year Member

    Joined:
    Nov 14, 2001
    Messages:
    67
    Likes Received:
    0
    I'd like to look at that book if you can find it. I have my doubts about a universal program so it would be good to see what others have to say. (I'm not sure how it would work without lowering our current standards of care) I've heard everything from limiting licensing for docs, to mandating health insurance from employers, to abolishing Medicaid and Medicare. A lot of liberal ideas. What do you all think? I'm writing a paper as well on reforming health care for an ethics class so your ideas are greatly appreciated.
     
  5. EC

    EC

    Great question! This is actually one I've been dreading in interviews.

    What do you guys think of subsidized care for underserved groups? I also have my doubts about a completely nationalized health care plan. Our system, I think, works well for those who can afford it and have access to healthcare resources. However, it falls really short in meeting the needs of particular groups, such as the poor, many of the elderly, people with terminal illnesses where care is extremely expensive, and people in rural areas.

    Ideally a nationalized health care system would be great, because it would mean universal health coverage. However, I don't believe it would work because it would be very inefficient, time-consuming, and perhaps costly. The reason why is because in order for the government to control the entire healthcare system, they must know exactly what sorts of resources are needed in every location and for every individual. Obviously not every region or individual has the same needs. They must also know what is available in various locations. This means that they would have to acquire enormous amounts of information about the healthcare services available and what patients need...and obviously this would change pretty often. I think having the government process all of this information and administer resources would be a very slow, inefficient process.

    The reason why I think government subsidization is a good idea is because given the funds and guidance of a physician, I think people are pretty good about acquiring the medication and treatment they need. Subsidization would grant underserved groups finances to fund their care, as well as flexibility in choosing their care provider. In addition, for those who can afford a private insurer, subsidization doesn't interfere with their ability to access healthcare or choose their physician.

    In summary, I believe in a hybrid system...one that relies on private insurance for those who can afford it and heavy government subsidization for unserved groups.

    Sorry, this is such a long answer, but I've been having doubts about my thoughts on this. Let me know what you guys think.

    Nick
     
  6. Gi

    Gi Member
    7+ Year Member

    Joined:
    Nov 14, 2001
    Messages:
    67
    Likes Received:
    0
     
  7. brandonite

    Moderator Emeritus 7+ Year Member

    Joined:
    Oct 19, 2001
    Messages:
    2,264
    Likes Received:
    3
    Perhaps I can bring a bit of a different perspective to this... You all probably know that we do have socialized medicare in Canada, although there is a lot of debate about it at the moment.

    Canada spends far less on health care per capita than the US, and everyone has access to it. That said, there are a couple of serious problems.

    Firstly, there is a shortage of equipment. People have to wait up to a year to get an MRI done. It's done in a bit of a hurry in emergency cases, but a year to wait for a test is a little bit ridiculous. I've spent some time in a lot of our hospitals, and they are really short on equipment. The equipment that they do have is out of date.

    Secondly, there is a real shortage of health care professionals. Doctors and nurses are paid much less in Canada than they are in the US, so there's a steady stream of Canadians leaving Canada. This causes problems - I know someone that had to wait a year for surgery, as there was a shortage of surgeons.

    So, while there's access for all, it's not the best access.

    It's really an interesting problem. I don't think it's fair for there to be 40 million uninsured people in the US, but if I were to be sick, I would rather that I was in the US (and insured, that is...).
     
  8. Ranger Bob

    Ranger Bob Senior Member
    7+ Year Member

    Joined:
    Oct 12, 2001
    Messages:
    151
    Likes Received:
    0
    This is an interesting topic. The "disease", in my opinion, is the high and increasing cost of health care. Lack of access is just a symptom of the disease. So the question becomes, "What can we do to reduce health care costs?"

    The problem with government subsidies is that they tend to increase costs.

    I'd be interested in an analysis of the effects of decreasing patent protections for prescription drugs. I don't want to take away the financial incentives to create new drugs, but when you look at the profit margins of pharmaceutical companies, you have to wonder whether the system is serving the public interest.

    The idea of a single payer system is also interesting. Under this system, the government becomes like a big HMO -- possibly in a confusing hybrid arrangement with private insurers. Ideally, this would reduce costs through various economies of scale: less administrative overheard and better bargaining power with pharmaceutical companies. This idea probably has some merit, but the question is whether the unintended consequences would outweigh the benefits. I tend to think that the government would find a way to make the problem even worse than it is today.

    How about capping malpractice liability awards? As a society, we don't want to take away people's right to sue -- it's an important check on the health care system -- but many of the suits are ridiculous and really drive up costs.

    How about better funding of preventative medicine? This would probably involve some sort of government subsidy, which would tend to drive up costs, but perhaps we could fix little ailments before they become big ones, thereby creating a net cost savings.

    How about allowing "alternative practitioners" -- NP's, PA's, optometrists, midwives, etc. -- take on more responsibility for patient care? They are cheaper than docs. If you really care about reducing costs (and increasing access), you'll put your own personal interests aside and open up to this idea. Of course, the AMA tends to oppose this.

    On a related note, the AMA could stop trying to fight the nonexistent physician oversupply problem. Quit trying to restrict FMG's entering American residency programs, for example. This is yet another area where physician's organizations tend to be more a part of the problem than the solution.

    Anyway, those are just a few thoughts. I think we will find, as we go through our training, that our personal interests often run up against potential solutions to the problems with the health care system. We can be sure that the system will change a lot during the next 30 years, but whether the change is for the better remains to be seen.
     
  9. Gi

    Gi Member
    7+ Year Member

    Joined:
    Nov 14, 2001
    Messages:
    67
    Likes Received:
    0
     
  10. EpiII

    EpiII Senior Member
    7+ Year Member

    Joined:
    Oct 26, 2001
    Messages:
    279
    Likes Received:
    0
     
  11. EpiII

    EpiII Senior Member
    7+ Year Member

    Joined:
    Oct 26, 2001
    Messages:
    279
    Likes Received:
    0
     
  12. Gi

    Gi Member
    7+ Year Member

    Joined:
    Nov 14, 2001
    Messages:
    67
    Likes Received:
    0
     
  13. brandonite

    Moderator Emeritus 7+ Year Member

    Joined:
    Oct 19, 2001
    Messages:
    2,264
    Likes Received:
    3
    I watched a close family member die from cancer about a year ago now. It was really sad to see - there was a severe shortage of nurses, so there was nobody to look after her, and she could only see an oncologist (there are only a couple in my entire province) every once in a while. It's quite frustrating. I've had doctor after doctor tell me that they are so frustrated with the system. The cancer metastisized to her spine, and they didn't catch that until a week before she died, because no doctor was around to look at it.

    Socialized medicare isn't working up here right now. Either BIG money has to be put into the system (I think we only spend about 60% per capita of what the US spends), or we have to look at some kind of a hybrid system.

    The way I see it, regardless of what happens, there is going to be some inequality in the system. I know we would have jumped at the chance to pay for the medical care that my family member needed, but it's against the law up here. I realize that not all people can do that, but I see no reason why it should be illegal!

    Somebody else brought up an interesting point - about the overuse of doctors. It's hard to say whether that's a serious problem or not, because it's hard to compare it to anything. But with easy access, there are bound to be people who will overuse the system. I've read studies that say about 20-30% of all visits to GPs in Canada are useless. Think about all the wasted $$!

    I really think that the idea of a hybrid system should be looked at in both Canada and the US - to raise the bar for everyone up here, and to make sure that people aren't left behind down in the US.

    Mind you, that's just my opinion, and it's probably been colored by my personal experiences with the Canadian system...
     
  14. EpiII

    EpiII Senior Member
    7+ Year Member

    Joined:
    Oct 26, 2001
    Messages:
    279
    Likes Received:
    0
     
  15. brandonite

    Moderator Emeritus 7+ Year Member

    Joined:
    Oct 19, 2001
    Messages:
    2,264
    Likes Received:
    3
    Epi - just saw your post. I completely agree. I don't see Canada as the ideal system (as you can probably tell from my new post). There's way too much waste. I like the UK system - the hybrid idea. Some sort of system that allows people to have insurance and to make choices about their own care instead of having the government make that choice for them, and yet something to provide for those who can't afford care.
     
  16. Gi

    Gi Member
    7+ Year Member

    Joined:
    Nov 14, 2001
    Messages:
    67
    Likes Received:
    0
     
  17. Gi

    Gi Member
    7+ Year Member

    Joined:
    Nov 14, 2001
    Messages:
    67
    Likes Received:
    0
     
  18. brandonite

    Moderator Emeritus 7+ Year Member

    Joined:
    Oct 19, 2001
    Messages:
    2,264
    Likes Received:
    3
    Epi might be able to answer this better than I can, but the UK has something of a hybrid. They have a health care system that everyone is a member of (like us in Canada) called the National Health Service (or something like that), but people can also have their own health care insurance to cover there own costs.

    Did I get that right?
     
  19. Ranger Bob

    Ranger Bob Senior Member
    7+ Year Member

    Joined:
    Oct 12, 2001
    Messages:
    151
    Likes Received:
    0
     
  20. I dont think I know as much as many of you guys but here are my thoughts:

    Single-runner, single-payer (government socialized insurance) but with the people who have more money can buy added coverage from private insurance companies. So if under the current system.... you can get an MRI in one day if you have $$$$$.... you can do the same in the new system. But everyone would have that minimum level of care. I am not sure if I am repeating what anyone else said (havent read them all).
     
  21. UCMonkey

    UCMonkey Senior Member
    7+ Year Member

    Joined:
    Aug 26, 2001
    Messages:
    511
    Likes Received:
    0
    With regard to how MediCal works...

    In my opinion, not very well. I worked in the ER of a private hospital for a while and saw the problems with medi-cal. While it may give people some form of coverage, it still lags way behind what private insurance provides. In general, people with medi-cal are shunted to county facilities for their care, and these facilities are often understaffed, underfunded, and overcrowded. Additionally, many private docs are unwilling to accept medi-cal patients because it pays so little as compared to private insurance (similar, I think, to the US vs. Canadian health systems). It also STILL leaves a significant portion of the population uncovered.

    That said, medi-cal is still better than nothing for those that have it.
     
  22. paisley1

    paisley1 Senior Member
    7+ Year Member

    Joined:
    Oct 1, 2001
    Messages:
    182
    Likes Received:
    0
    Hi gi, sorry for taking so long to reply back. The name of the book I mentioned earlier is: "Health Policy: Crisis and Reform in the U.S. Health Care Delivery System". The editors are Charlene Harrington and Carroll Estes.
     
  23. Gi

    Gi Member
    7+ Year Member

    Joined:
    Nov 14, 2001
    Messages:
    67
    Likes Received:
    0
    What would forcing companies to insure ALL (even part time) employees do to the market? I know of a large number of people who work 39 hours a week so they don't get health insurance. If we raised minimum wage and employers took out a small percent to go for health insurance, it seems that this would cut down drastically on the number of uninsured.
     
  24. edmadison

    edmadison 1K Member
    10+ Year Member

    Joined:
    Feb 27, 2001
    Messages:
    2,086
    Likes Received:
    70
    Status:
    Attending Physician
    gi,

    The answer to your question is that it would put many small businesses out of business. Do you have any idea how expensive health insurance is? It can be as much as $4000 per year in some areas! That means if you have a kid pumping gas for 6 bucks per hour for 10 hours a week, the cost to the employer is more than doubled!

    Ed
     
  25. Gi

    Gi Member
    7+ Year Member

    Joined:
    Nov 14, 2001
    Messages:
    67
    Likes Received:
    0
    I do know how much health insurance costs. More than refering to small business, a large national chain store in GF has over 130 employees. Most work 39.5 hours/week, 5 work full time and get benefits.

    The question is, would it be feasible to raise min wage, take a percentage out of a paycheck and place it in some kind of fund for those without health insurance so they have some coverage (group policy)? A large percentage of part-time workers will be covered already by parents, a spouse, or student health so the number is not as drastic as some may imagine.

    An employer could offer a group policy for their employees. If people are not having to pay medical bills %100 out of pocket, that will increase spending overall and in most cases, will help small business. I agree, some businesses will probably be hurt, but would the benefit of having a huge number gain health insurance outweigh that? Maybe.

    Obviously, outside aid would have to be employed to offer finiancial assistance to small businesses. If people have private insurance, where they pay a deductable, they tend not to misuse the system so much. I'm not proposing this as a solution, maybe part of a bigger plan... it's an alternative idea to just expanding governmental ran health coverage.

    What do you think a feasible solution is?[
     
  26. warpath

    warpath Officer Cadet
    7+ Year Member

    Joined:
    Dec 2, 2001
    Messages:
    187
    Likes Received:
    0
     
  27. Thewonderer

    Thewonderer Senior Member
    10+ Year Member

    Joined:
    Oct 20, 2001
    Messages:
    853
    Likes Received:
    20
     
  28. Gi

    Gi Member
    7+ Year Member

    Joined:
    Nov 14, 2001
    Messages:
    67
    Likes Received:
    0
    Thanks for the comparison b/w countries. That definitely helped!
     
  29. bebe

    bebe Member
    7+ Year Member

    Joined:
    Aug 13, 2001
    Messages:
    76
    Likes Received:
    0

Share This Page