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Health care/insurance. Give me your 2 cents.

Discussion in 'Pre-Medical - MD' started by Lindlar, Jan 5, 2009.

  1. Lindlar

    5+ Year Member

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    I was reading through a thread and came on this
    What do you think are the problems with our health care insurance systems? IS there a problem?


    Personally, I don't think there is much of a problem. I think the issues that came up were a result of general economic issues. I do think that some areas need to be restructured, particularly dealing with the problem of the uninsured using ERs as primary care centers.
     
    #1 Lindlar, Jan 5, 2009
    Last edited: Jan 5, 2009
  2. Forthegood

    Forthegood ProcrastinationAficionado
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    Holy ****. You don't think there are problems?

    46 million uninsured, doctor/nurse shortages, 50% billing going to non health care providers, HMOs (Healthcare Monemaking Organizations), Quacks, Non MD/DO introduced as Doctor in hospitals, decreasing reimbursement, increased overhead, malpractice....

    Seriously? No, really, seriously... you are joking.
     
  3. Lindlar

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    I think that the problems in the US relative to some other countries are not that bad. The 40-50 mil that are uninsured are such because they made poor decisions in life and can now not afford insurance. At least the people are made good decisions can get the health care they deserve, unlike in countries with universal health care where people who work hard, and honestly deserve that new heart can't get it because of some crazy theory that everyone should be treated the same.
    Sure, some of those 40-50 mil are uninsured not because of their own poor decisions but because of poor circumstances, and that is a tragedy, but I can't see any solution to help these people who deserve it without having to give the same help to the others that don't.
     
  4. Forthegood

    Forthegood ProcrastinationAficionado
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    Switch careers.
     
  5. Lindlar

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    Care to elaborate?
     
  6. Lindlar

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    Or perhaps you will just insult me, then never respond again because you are too incompetent to justify an answer. Don't care.
     
  7. Vihsadas

    Vihsadas No summer
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    This thread already started on the wrong foot. Stay on topic and stay civil please.
     
  8. Forthegood

    Forthegood ProcrastinationAficionado
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    No. Not even close. That is ignorant, and you should be more educated than to say such obtuse, useless generalities.

    No. Actually, some still can't. And that is not what's at stake. A change in healthcare systems would not be adopting Britains system, it would be creating our own. The argument is invalid contextually.

    So only hard workers get to live? How about prisoners? Ex-prisoners? Ex felons? Who draws the line for you. This again is ignorant and is almost Nazi-like. Do you really think you are better than other people? Who is to say that some poor person isn't that way because of a string of disadvantages and debt left by their environment and parents (if they had parents). Have you ever actually gotten to know any poor people? They are not all lazy useless bums... turns out the social safety net is not exactly a luxurious lifestyle, and offers no opportunity or self satisfaction. What value do you place on life?


    DEAL WITH IT! Do you realize how many patients you will treat as a doctor that you know full well you will never see a dime of reimbursement for?


    This sort of reckless abandon with peoples lives and inconsiderate ignorance to the world around you makes medicine bad choice for you.

    Which is why i suggest you change careers now. Your job as a physician is "to learn and serve", and you have shown a neglect for both education and service in the above.
     
  9. Forthegood

    Forthegood ProcrastinationAficionado
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    Yeah, mod is right... that sounded harsh. I disagree with you, but i don't mean it personally, I'm sure your a very caring person.

    It is frustrating though to work in a system with such huge holes, that get covered up because the people it hurts are people without a voice in our society.

    But that frustration should not be directed at you.
     
  10. Lindlar

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    First off, the point of this thread was to get other people's opinions, not to justify my own (let me get your 2 cents?). Rather than offer me your own opinion, you have attacked me, and insulted me. I realize that a large audience and anonymity is a breeding ground for stupidity, but I thought that in a forum like this, people would act a little more civilized.

    Second, I would love to continue talking about this in a civil manner, if you can manage that.

    I did not say that only hard workers get to live, I said that the people who can afford their health care take priority over those that can't. Charity can come after that.
    It's not that people are simply better than others, it's that this is the real world, some people are going to live and some are going to die. The people who should live, imo, are the fittest.
     
  11. Forthegood

    Forthegood ProcrastinationAficionado
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    I rest my case. If you don't see a problem with that attitude, there is no reason to talk about it. That is against everything i believe. People in a developed society have the right to medical care. There should be no barking order because of money.

    I did not mean to berate you, but i really really strongly disagree....
     
  12. Lindlar

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    So let's say there are two people. One is a laborer who works 8-4. He has health insurance because he works hard for the money to pay for it.

    Another is a jobless man living off of welfare. He, naturally, does not have health insurance.

    Both of these men, coincidentally, are in a car crash at the same time in the same area and are taken to the same hospital for the same injuries.

    Should the man with health insurance take precedence over the man who doesn't, in your opinion?
     
  13. chessknt87

    Physician 10+ Year Member

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    From a pragmatic perspective, the highway robbery insurance companies commit on medical providers in terms of risk transference and dwindling reimbursements/unfair reimbursement systems despite inflation and rising demand for healthcare/legal costs associated with providing said healthcare is an enormous problem that has no end in sight. The public thinks that doctors just roll in money and dont know anything unless they are #1 in the field, so we have no public support/voice to fight back via congress. While this has very little to do with the end result, it means a lot to the people (you and me) that are responsible for that result.
     
  14. Akmidnightsun

    Akmidnightsun Won't Save the Village
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    In response to your car crash, barring differences in prior well-being and with equal potential outcomes, and, this is important, lacking the capacity to in any way treat both, the most ethical thing to do would be to flip a coin (unless you want to look at social worth).

    For problems, try reading:
    1. About administrative costs vs. medical payments (Medical Loss Ratio, a fun bit of legislation in NJ). This is my favorite, and a huge advantage of single-payer systems. Plus, imagine becoming a doctor and not having to worry about payments and paperwork - just patient care.
    2. Nickle and Dimed, or any similar book on the difficulty of surviving on minimum-wage, and then google newspaper archives for Walmart and part-time employees who are denied benefits.
    3. Any history of the American health insurance system, and how it began as a tax-benefit to employers. (After we decided social security was more important than health care as a national institution.) Employer-provided insurance is at best a perversion of economics.

    And if you still don't get it, and the adcoms aren't nice this round (I don't wish you any bad luck, to be sure) go get an MPH.
     
  15. cbrons

    cbrons Ratatoskr! *Roar*
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    You should've stuck with your guns on the more competition thing. You could've said that more competition and less middle man BS would allow the majority of those 46 million uninsured to get affordable health care. I would've rebuked any and all suggestions on the part of the interviewer that uni health care is the solution. And I would've disagreed with her when she said all that jazz about "that's how the way it is now but it doesn't work, etc."

    I also would've brought up every single thing that Forthegood said too.

    I think they'll respect you more if you aren't afraid to disagree with them. I'm sure they're used to wusses placating to them and are bored/unimpressed.
     
  16. Gut Shot

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    He, naturally, does. It's called Medicaid.

    Lindlar, you know a tiny little bit about health policy, but not enough to discuss it intelligently. I'm not trying to be an ass, I used to read and study quite a bit on this topic, and much of it is still way over my head. It's a vast and very complex subject; no matter what point you argue, there seems to be a cogent counterpoint. Hence, given the nature of SDN, this probably isn't the best forum to make entry level queries.

    I would highly recommend you go back and self-study some material to get a better fundamental grasp of our health care system. You can't go wrong with Bodenheimer's "Understanding Health Policy" (available on Amazon, used copies listed for as low as $6.50).

    He also wrote a very good four part series on health care costs for Annals of Internal Medicine. They are available free:

    Part 1
    Part 2 (select the PDF)
    Part 3
    Part 4 (select the PDF)

    I haven't read this in awhile, but The Birth of Medicare has a nice, compact explanation of how we got where we are.

    Malcolm Gladwell has a good piece on the problems with Moral Hazard.

    Finally, and just because I love it:

    [​IMG]
     
  17. 236116

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    Gross.
     
  18. ngkats

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    Your perspective here is very disturbing. I would not express this opinion during your application cycle (and I suggest you should enlighten yourself a bit if you really want to become a physician).
     
  19. 236116

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    YAY EUGENICS!!!!!

    [​IMG]
     
  20. Forthegood

    Forthegood ProcrastinationAficionado
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    When i was younger i had my first job in a hospital as a orderly of sorts. I remember one night, meeting a patient who had a outpatient procedure done with a select staff after normal business hours. I thought it odd, but figured it must have been important that we fixed his fistula.

    Turns out he was a very nice man, and I had a good conversation with him for about 10 minutes on why we both ended up doing medical related work, before his procedure.

    After the procedure, one of the anesthesiologists stopped me in the hallway and said "Yeah, that Mr. Soandso (not his real name), he seems nice right? Wrong. Every word he said to you is a lie, don't believe a thing. Under that cheery smile of him, he is a wicked, greedy person. Crazy right? First time I met him I actually thought he was a nice guy. Just don't forget, he's an admin... and therefore a business man... the enemy because both of their eyes are always looking squarely at money."

    Really changed my 19 year old, naive view of medicine. Looking back I realize how a) he got treated special because he was an admin b) he had no reason or right to be treated special c) we were short-staffed because of his medical "emergency" and could have delayed treatment on a higger priority case d) yes, he lied about everything. Turns out admins don't always get into it for the right reasons.

    That was the day I lost hope for humanity. If there SHOULD be one place in America that is not greed-driven, it is in health care. And that chart speaks volumes of how that has changed in our lifetime.
     
  21. polofanPKP

    polofanPKP Fear the Vest
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    One of the largest issues with the uninsured in this country is among those who own their own small business. I don't think it would be stretch to say that entrepreneurs like these are those who truly helped build the country that we enjoy today. However, due to the fact that when forced to deal directly with health insurance companies (without the bargaining power of having hundreds or thousands of employees) these individuals get fleeced on everything from deductibles to co-pays to drug plans. The reality of the situation of the uninsured is that the very poor have the safety net of medicaid, the elderly have medicare, those whose companies still offer it (which is a number that falls every year) receive a private plan, but those that are often middle class, hard working people have been priced right out of health care.

    Forthegood, I agree with you completely, as physicians our job is not to judge those who we deem fit for survival it is to do all within our power to save/improve/prolong lives. Oh, and I saw that graph in a presentation late last year and almost choked on my dinner.

    Lindlar, if this is truly the way that you feel about health care then maybe it would be best to examine other options, in my opinion this is not a career that will make you happy if you are faced to act against these feelings that you have on a daily basis.
     
  22. Emmet2301

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    So for the poor people why can't Medicaid take care of them? Wasn't it made specifically for them?

    Also, would or should social worth come into play in the car crash scenario? Should someone with more social worth be treated first?

    Also about the ~46 million who are not insured why can't there be a cheap insurance made especially for them? or why not Medicaid?
     
  23. Bacchus

    Administrator Moderator Physician 10+ Year Member

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    If every poor person was using Medicaid we'd have a much bigger problem, imo.

    I would venture a guess that at any level II or I center these individuals go to will have enough physicians to take care of 2 people simultaneously.
     
  24. ngkats

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    Coming from someone with a fair amount of experience in bioethics, lets not discuss "social worth" as a way to ration health care and health care access. It's way too complicated and I'm way too tired.
     
  25. JE1986

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    1. Not everyone who is uninsured is that way because they can't afford it. People with preexisting conditions (diabetes, heart disease, stroke) are a prime example. Those conditions (which can be EXTREMELY expensive) are often excluded from the policy. What are these people supposed to do???

    2. I work in an emergency room (in registration so I deal with getting all the insurance info) and yes, many of the uninsured or people on medicaid are the people who are lazy and do not have a job. However, there are some good hardworking people that just can't afford crazy high premiums. I also get frustrated when I see a 22 year old girl on Medicaid with no job and five kids hanging off her arm waltzing in the ER to get her hangnail treated.

    So, in summary....Yes there are people who abuse the system. However, as future doctors we will have to treat these people with the same care as everyone else. They are still people and (well, most of the time) they are sick. The health care system is something that needs to be revamped. I personally do not think socialized health care is the best idea because it has not proved completely effective in other countries, but something needs to be done
     
  26. DrCio

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    One of the things I find most interesting in the general public is how Americans think they have the best heatlh care system in the world. I mean it might be expensive but at least it's the best right?? This was my thought a few years ago before I learned about the reality of our situation. US health outcomes are not the best in the world. In fact, we usually rank in the low 20s or high 30s on things like life expectnacy and infant mortality. There are infact MANY other countries that take better care of their citizens and don't spend nearly as much (as a % of their GDP) as we do. What's even more interesting to me is that almost ALL of these countries have a socialized health care system.
     
  27. Gut Shot

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    Brace yourself, someone will likely point out that infant mortality stats are difficult to comare between nations, thus missing the forest.

    They have socialized insurance systems. Relatively few have socialized systems of delivery. But I agree, many other nations do a better overall job of caring for their populations, invariably at a lower cost.
     
  28. chessknt87

    Physician 10+ Year Member

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    The statistics you quoted are not indicative of our healthcare systems effectiveness but rather trends in our population as a whole. The US eats a lot more crap than many other countries and even the ebst medicine in the world cant save us from ourselves. Placing US citizens in the #1 country's medical system is not going to prolong their lifespan any more than we can here.
     
  29. JE1986

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    The infant mortality rate data is kind skewed. The reason it is so high in our country is because we do the most we can to save the babies that are born premature. Other countries don't.

    I personally do not think that we have the best health care system in the world. Far from it. I just don't think that socialized health care is completely effective either. My mom grew up in Germany and we still have loads of family friends there that complain how messed up the health care system is. The quality of their doctors is not as good as here. And if you contract a serious illness it could take months before you are seen. And this is often too late. I just don't think our country should model our health care system after a plan that has proved itself to be subpar.
     
  30. Bacchus

    Administrator Moderator Physician 10+ Year Member

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    The reason infant mortality is creeping up is because our medicine has become more advanced technologically. More pre-term infants are being born than before because technology and medical knowledge allows this to happen. However, despite those saved, many still die from complications.

    We do have the "best" healthcare. However, access to that care and compliance with that care are mediocre.
     
  31. Gut Shot

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    Congratulations, you've missed the forest.

    Look at it this way. For the amount spent in this country on health care, every citizen could receive automatic, comprehensive coverage (including prescriptions) with little out of pocket expense. Because our "system" is a cobbled-together mess with perverse incentives and enormous structural inefficiences, we don't have this opportunity. The fact that defending our system requires contortionist apologetics is nothing to be proud of.
     
  32. Gut Shot

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    Told you.
     
  33. chessknt87

    Physician 10+ Year Member

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    That is no excuse to ignore social factors that are absolutely necessary when comparing different societies. Japanese and Americans are not so similar that we can discount all other health factors besides life span and cost per person.
     
  34. Retsage

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    If only there was a way to punch people in the face over the Internet. :(
     
  35. 236116

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    Working on it.
     
  36. ngkats

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    Right on.
     
  37. DrCio

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    There are of course many other factors to look at when evaluating heatlh care systems, and certainly I'm not qualified to do any of that. However the WHO has done so and we rank pretty darn low. That was the only point I was trying to make.

    http://www.photius.com/rankings/healthranks.html
     
  38. Gut Shot

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    Check back in about seven years, when you've had more of a chance to see things in action.

    Edit: Okay, that was a little abrupt and unsatisfying. Here, tell you what, go ahead and explain to me how the WHO methology succeeds or fails to adequately account for social factors in establishing their health rankings.

    My point: our system sucks.

    Your point: comparing health care systems between countries is complex.

    True-true, unrelated. (Get used to that phrase, BTW. You'll hear it again as an M3)
     
    #38 Gut Shot, Jan 5, 2009
    Last edited: Jan 5, 2009
  39. closer23

    closer23 Liberal
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    #39 closer23, Jan 5, 2009
    Last edited: Dec 2, 2009
  40. Gut Shot

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    No one in this thread, or at the WHO, has asserted that life span and cost are the only two factors by which health care systems should be measured. The infamous rankings (found in the World Health Report 2000) were an enormously complex undertaking, and few would deny that the results are imperfect. That's why I, personally, try to steer clear of them.

    I'm not sure whose authority I'm appealing to, other than to saying "Don't believe me? Fine. See for yourself." If you can expose my misguided logic, by all means. I'm waiting.
     
  41. closer23

    closer23 Liberal
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    #41 closer23, Jan 5, 2009
    Last edited: Dec 2, 2009
  42. Gut Shot

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    My edit was almost two and a half hours ago, and my problem with chessknt87's post was one of relevance, not truth.

    I prefer to think of it as an appeal to reality.
     
  43. closer23

    closer23 Liberal
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    #43 closer23, Jan 5, 2009
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  44. Retsage

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    Except the WHO rankings look at such things as doctors per capita, nurses per capita, beds per capita, etc, etc. Guess what, America isn't first in any of these, even though 16% of the GDP is spent on healthcare (a much greater proportion than in the countries that are first). So please, cut out the cheeseburger argument.

    Take a class in Research Methods and all of a sudden you know how to design better studies than the rest of the world. :rolleyes:
     
    #44 Retsage, Jan 5, 2009
    Last edited: Jan 5, 2009
  45. chessknt87

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    I have not seen any of these ranking in this thread aside from the offhanded references to them after I posted. I was specifically directing my comments at DrCio's post which indicated that the US healthcare system is not good because we dont rank near the top in terms of life expectancy/infant mortality, to which I responded that social factors are significant and contribute to both of those statistics just as much as our healthcare system does.
     
  46. Gut Shot

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    You can dismiss with the stats the DrCio was relying on, but I don't find the argument inherently illogical (unless you pose that it's impossible to draw a meaningful comparison between the health care systems of two countries with numeric data).
     
  47. enjoydrywax

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    Do physicians in these countries make roughly the same amount as US doctors do currently? You know, after normalizing for other factors. Or I guess: are they of the same socioeconomic status as doctors here in America?
     
  48. Gut Shot

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    Social factors like the prevalence of smoking?

    Greece (38%)
    Andorra (35.9%)
    Germany (35%)
    France (34.5%)
    Switzerland (33.5%)
    Spain (33.4%)
    Japan (33.1%)
    Luxembourg (33%)
    Netherlands (33%)
    Ireland (31.5%)
    Norway (31.5%)
    Denmark (30.5%)
    Belgium (28.0%)
    UK (26.5%)
    Israel (28.5%)
    Canada (25%)
    United States (20.8%)
     
  49. Gut Shot

    10+ Year Member

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    You should take this question to a new thread. This one is going haywire enough.
     
  50. SB100

    7+ Year Member

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