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That doesn't make any sense

Middle class Americans can’t afford to go in the exchanges without the employer sponsored subsidies that most people rely on for their insurance. They have to take the insurance their company offers and they can’t afford to do anything else. Nor do most people have the ability to change jobs for healthcare benefits, that’s an unrealistic expectation. There’s nothing free market in our healthcare system.
 
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greatnt249

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You would be able to vote out politicians who don’t push the reforms you want. There’s at least the possibility of accountability that doesn’t exist now.

Right, it's just as simple as voting out those politicians. Who do you think is heavily lobbying those politicians to begin with? Do you really think the majority of politicians have the interests of the middle class in mind?
 
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Right, it's just as simple as voting out those politicians. Who do you think is heavily lobbying those politicians to begin with? Do you really think the majority of politicians have the interests of the middle class in mind?

Healthcare lobbying should be illegal to start with. That’s a reform that’s possible even without single payer.
 
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Everyone is making decent points in this thread.
Two is correct but not why you think. Office visits are billing for higher complexity because a) we're actually billing for what we do (historically we've been undercoding) and b) because with EMR its easier to hit what you need to get those higher levels. I have passed every audit 100% in the 8 years I've been in practice and my codes are significantly higher complexity than most of my peers.
Agree, but there's also more nuance. When I started practicing, no one really cared that much about RVU's. The hospital was doing just fine. Over time, the reimbursement per RVU has dropped (along with rising costs). This has pushed hospitals (and private offices) to try to maximize their income. If you want to increase income/RVU's, there's only two solutions -- see more patients, or bill higher codes for what you're already doing. Most people don't want to just work harder. So there's now a drive to get the highest code possible for what we all do.

PCP’s like yourself should be the highest paid physicians outside of surgeons; an ounce of prevention will save a pound of treatment. These ridiculous costs are generally not from primary care.
This is not actually correct. From an individual standpoint, it's true. It's much more cost effective to get a colonoscopy every 10 years than be treated for colon cancer. Absolutely. Not to mention that getting a colo is a whole lot more pleasant than getting chemo. But from a population standpoint, it's not true at all. In almost all cases, it's more expensive to treat everyone's mild chronic disease to prevent the rarer severe diseases. You actually need pounds of prevention to save ounces of treatment. Screening colonoscopies are not cost saving when applied to a population (although that obviously depends upon the cost of the colo and the cost of treatment). Still worth doing at a population level, because it extends live and reduces suffering.

Much of the cost in healthcare is actually from the primary care setting. Labs, imaging, PT, office visits, etc. Although they may be low ticket items, the volumes are huge.

Again, physicians are not the problem here and don’t represent the largest healthcare costs, but why is a clinic charging for more than what they provided? You guys are all defending the illogical, and the more you discuss healthcare costs, the more illogical it all is revealed
The costs are illogical. And they are driven by this crazy system we have -- it doesn't matter what the prices are because insurers have fixed amounts they pay, providers set prices high to ensure maximum payment, and there are strange loopholes where these insanely high prices are paid, yet hospitals also must provide care to people who can't pay or have insurance that doesn't even cover costs -- hence they try to squeeze as much out of the margins as they can. I don't think you'll get much argument about that here.

But a single payer (the gov't) just trades this problem for a whole set of new problems. Perhaps you think that new set of problems is better than the current set -- and that's fine. But thinking that we can just "fix prices" and all will be well is fanciful.

Also, it's often said that "doctors are not the problem with the cost of healthcare". Depending upon whom you ask the problem is either doctors, lawyers, insurance companies, pharma, or other middlemen. In reality, it's all of us. Healthcare is expensive because all of us are trying to squeeze profit out. We often talk about waste in healthcare, but remember that every dollar of waste is someone else's income. Every group likes to point to the boogeyman in another group who "makes too much", but it's really all of us. If we really want to fix the cost of healthcare we need to reform medmal, develop some way to pay for everyone's care in a fair manner (or decide that if you can't pay, you don't get it), and temper patient expectations -- not everyone will get everything right when they want it. Earlier in the thread was a post suggesting we should decrease futile care -- but there's no good way to define futile.

This problem is incredibly complicated. Pulling on any one thread is likely to tie the rest of it in knots. Untangling the whole thing will make many people unhappy -- in fact it might make everyone unhappy. Simplistic answers won't work.
 
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NotAProgDirector

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Healthcare lobbying should be illegal to start with. That’s a reform that’s possible even without single payer.
You posted this while I was typing my post. This is a great example of a simplistic solution that isn't feasible. How exactly are you going to define healthcare lobbying, and how are you going to make it illegal? And if you actually had a single payor gov't system, then essentially any change would all be healthcare lobbying. How exactly are you going to decide how much an office visit is paid? Who decides? Who decides who gets to decide?

I see what you're trying to say. Somehow healthcare lobbying seems wrong. But the only way to get lobbying out of the equation is to remove the govt from paying for healthcare at all. But then, that's the end of your single payor plan.
 
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Again, physicians are not the problem here and don’t represent the largest healthcare costs, but why is a clinic charging for more than what they provided? You guys are all defending the illogical, and the more you discuss healthcare costs, the more illogical it all is revealed to be.

So it’s obviously not a “contract” in the traditional sense then, yes?
You do realize under a government controlled system physicians would be the ones most negatively affected even if "they aren't the problem". Just look up current medicare billing codes and compare it to private practice. I'll give one example: for an ENT to put tubes in medicare will pay 170-250ish but pp pays 800ish, that's a substantial difference. And with a m4a system where the gov is the only one setting the price, that medicare rate for tubes will PLUMENT, as it will for every other procedure and office visit. All while nancy pelosi, mitch mcconel, and chuck shummer and other aristocratic politicians get rich off of doctors hard work and education.
 
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ChordaEpiphany

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You do realize under a government controlled system physicians would be the ones most negatively affected even if "they aren't the problem". Just look up current medicare billing codes and compare it to private practice. I'll give one example: for an ENT to put tubes in medicare will pay 170-250ish but pp pays 800ish, that's a substantial difference. And with a m4a system where the gov is the only one setting the price, that medicare rate for tubes will PLUMENT, as it will for every other procedure and office visit. All while nancy pelosi, mitch mcconel, and chuck shummer and other aristocratic politicians get rich off of doctors hard work and education.
Given this user is not a doctor, this will not be a very convincing argument. The average person sees doctor salaries and equates that to other salaries they know. They think they can compare the salary of a doctor, after 8 years of post-secondary education and 3-10 years working at slave wages for 90+ hours/week, to the salary of someone in sales, computer science, finance, or even law. Doctors miss out on so much investment opportunity early in life due to loans and long training pathways that the $200-400k salaries people see are really equivalent to $100k-200k in lifetime earnings. The reason doctors today are rich is because they are born rich and because they are essentially forced to be financially responsible when young and paid for that sacrifice later. Cut doctor salaries any further and it will become a pure vanity profession for the wealthy.

If an engineer makes $80k out of college at 22 and rises incrementally to $120k by 30, but lives like a medical student and saves/invests that whole time, he/she could easily save up $400-500k. $400k with college debt. $500k without. So that $120k plus the savings is really more like $160-170k because of the extra income from investments. Meanwhile, during that time a physician goes massively in debt and gets paid pennies, basically unable to save up anything at all. If that same engineer lives on ~$50k raw expenses until they are 35 (not counting money paid into a mortgage, because that is investment, not expense, and thus $50k is actually a very generous lifestyle), they have a net worth of $1MM and effectively make an extra $70k-100k from investments alone. So that engineer making ~$150k at 35 is actually bringing in $220k-250k. As they get older, this continues to rise, and by retirement most professionals are making more from interest on their nest eggs as they are from salary (i.e. $2MM in retirement funds makes in the range of $140-200k in returns every year on average).

Physician income reflects the complete inability to participate in capitalism until later in life. However, all people see is outlier cardiologist salaries.

The only reason this isn't blatantly obvious in the real world is because people spend their money, 90% of it on average. The 25 year old engineer is taking nice trips abroad and living in a one bedroom while the medical student is riding a bicycle they bought used on Craigslist and living with 3 roommates who only barely reliably pay rent (true story, welcome to my life). The engineer isn't living like a medical student and becoming a millionaire by 35 because practically no one wants to live like a medical student, but in terms of opportunity to acquire wealth, doctors don't have it better than anyone else, and nearly everyone who becomes a doctor could have earned as much if not more money over a lifetime in another profession. Doctors completely earn their salary and deserve their fair shake when the sacrifice is done. I don't want to see a single person tell me that the valedictorians and overachievers of our society who sacrifice their entire 20s and most of their 30s getting paid pennies and getting worked to the bone while literally taking people's lives into their hands should earn less.

The above needs to be the #1 talking point with physicians any time someone suggests cutting salaries. We don't get the benefits of European physicians, with subsidized education, fewer training years, and early career entry.

That's my rant on salaries. Please understand this and use these arguments effectively when you hear someone lamenting about physician salaries. Basically anyone making six figures could live like a physician if they live like a medical student/resident until they are 35.

Finally, I just want to take a moment to recognize that many of those who are commenting on this thread are not verified and have no status as healthcare providers, medical students, or anything else. It's very common for activists to take to online message boards to push particular narratives, which is why you see sensationalism and oversimplification in a lot of the arguments.

Always remember to think about who you are actually arguing with, and especially on physician/professional boards, ask yourself if it's worth your time to refute a few individuals who clearly have an agenda and won't be convinced otherwise.
 
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dpmd

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I know how the system works, my question to you is why does BCBC or signa have the authority to decide what a physicians time is worth? Insurance companies do not provide healthcare, and do not receive healthcare as the patient. This should be between the physician and the patient, ideally with a single payer ideally the government (who are accountable to the people they represent) cutting the overhead and the profiteering that helps out insurance company CEO’s while hurting both physicians and patients.
They don't decide what a physician's time is worth. They decide what they are willing to pay for it in exchange for steering their patients there. If they pay too low (like the government does with Medicaid) then most physicians will refuse to participate and patients will choose something else or complain to their employer about it to get them to choose something else. It might be that some doctors are willing to take a lower amount if enough patients will be steered their way and others will hold out for more pay. Therefore different companies pay different rates and different plans within each company may pay different rates even and you can choose which plans you will participate in (end therefore have more patient referrals from).
 
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Given this user is not a doctor, this will not be a very convincing argument. The average person sees doctor salaries and equates that to other salaries they know. They think they can compare the salary of a doctor, after 8 years of post-secondary education and 3-10 years working at slave wages for 90+ hours/week, to the salary of someone in sales, computer science, finance, or even law. Doctors miss out on so much investment opportunity early in life due to loans and long training pathways that the $200-400k salaries people see are really equivalent to $100k-200k in lifetime earnings. The reason doctors today are rich is because they are born rich and because they are essentially forced to be financially responsible when young and paid for that sacrifice later. Cut doctor salaries any further and it will become a pure vanity profession for the wealthy.

If an engineer makes $80k out of college at 22 and rises incrementally to $120k by 30, but lives like a medical student and saves/invests that whole time, he/she could easily save up $400-500k. $400k with college debt. $500k without. So that $120k plus the savings is really more like $160-170k because of the extra income from investments. Meanwhile, during that time a physician goes massively in debt and gets paid pennies, basically unable to save up anything at all. If that same engineer lives on ~$50k raw expenses until they are 35 (not counting money paid into a mortgage, because that is investment, not expense, and thus $50k is actually a very generous lifestyle), they have a net worth of $1MM and effectively make an extra $70k-100k from investments alone. So that engineer making ~$150k at 35 is actually bringing in $220k-250k. As they get older, this continues to rise, and by retirement most professionals are making more from interest on their nest eggs as they are from salary (i.e. $2MM in retirement funds makes in the range of $140-200k in returns every year on average).

Physician income reflects the complete inability to participate in capitalism until later in life. However, all people see is outlier cardiologist salaries.

The only reason this isn't blatantly obvious in the real world is because people spend their money, 90% of it on average. The 25 year old engineer is taking nice trips abroad and living in a one bedroom while the medical student is riding a bicycle they bought used on Craigslist and living with 3 roommates who only barely reliably pay rent (true story, welcome to my life). The engineer isn't living like a medical student and becoming a millionaire by 35 because practically no one wants to live like a medical student, but in terms of opportunity to acquire wealth, doctors don't have it better than anyone else, and nearly everyone who becomes a doctor could have earned as much if not more money over a lifetime in another profession. Doctors completely earn their salary and deserve their fair shake when the sacrifice is done. I don't want to see a single person tell me that the valedictorians and overachievers of our society who sacrifice their entire 20s and most of their 30s getting paid pennies and getting worked to the bone while literally taking people's lives into their hands should earn less.

The above needs to be the #1 talking point with physicians any time someone suggests cutting salaries. We don't get the benefits of European physicians, with subsidized education, fewer training years, and early career entry.

That's my rant on salaries. Please understand this and use these arguments effectively when you hear someone lamenting about physician salaries. Basically anyone making six figures could live like a physician if they live like a medical student/resident until they are 35.

Finally, I just want to take a moment to recognize that many of those who are commenting on this thread are not verified and have no status as healthcare providers, medical students, or anything else. It's very common for activists to take to online message boards to push particular narratives, which is why you see sensationalism and oversimplification in a lot of the arguments.

Always remember to think about who you are actually arguing with, and especially on physician/professional boards, ask yourself if it's worth your time to refute a few individuals who clearly have an agenda and won't be convinced otherwise.

I’m not an activist, but that’s a convenient character assassination that will give you peace of mind when disregarding my opinion.

“Single payer healthcare can’t be done!” Scream the capitalists of the ONLY developed country that doesn’t have single payer healthcare. Simplistic argument... sure, but accurate.

Yes, you’re sacrificing your 20’s in school for a noble goal; but you aren’t martyrs. I park in the physician lot too, I’m the only one without a BMW/Lexus/Mercedes. Let’s stick with reality; most physicians are paid well and are well off, and they should be.
 
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They don't decide what a physician's time is worth. They decide what they are willing to pay for it in exchange for steering their patients there. If they pay too low (like the government does with Medicaid) then most physicians will refuse to participate and patients will choose something else or complain to their employer about it to get them to choose something else. It might be that some doctors are willing to take a lower amount if enough patients will be steered their way and others will hold out for more pay. Therefore different companies pay different rates and different plans within each company may pay different rates even and you can choose which plans you will participate in (end therefore have more patient referrals from).

I see your position but it’s coming across as a distinction without a difference; if they lower reimbursement to the point that you will no longer see T19, then they have in effect just dictated your compensation, since you will be seeing less patients overall. I know T19 folks are often very sick and require a lot of management, but there’s enough metformin and ARB refills mixed in there that you will still make money by seeing them, just not as much as you’re worth.
 

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Middle class Americans can’t afford to go in the exchanges without the employer sponsored subsidies that most people rely on for their insurance. They have to take the insurance their company offers and they can’t afford to do anything else. Nor do most people have the ability to change jobs for healthcare benefits, that’s an unrealistic expectation. There’s nothing free market in our healthcare system.
So which is more likely to result in changes:

You work for a company with 500 employees and you complain to HR about the bad coverage for certain medical expenses or

You complain to your state representative (who represents 400k people and is one of 215-ish people who also represent that many people who all must agree for any changes to be made).

Companies change insurance providers all the time. Medicare changes significantly very very rarely.
 
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So which is more likely to result in changes:

You work for a company with 500 employees and you complain to HR about the bad coverage for certain medical expenses or

You complain to your state representative (who represents 400k people and is one of 215-ish people who also represent that many people who all must agree for any changes to be made).

Companies change insurance providers all the time. Medicare changes significantly very very rarely.

You wouldn’t be the only one complaining, it would be many thousands of you.

Here’s an article that may be of interest.

 
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dpmd

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I see your position but it’s coming across as a distinction without a difference; if they lower reimbursement to the point that you will no longer see T19, then they have in effect just dictated your compensation, since you will be seeing less patients overall. I know T19 folks are often very sick and require a lot of management, but there’s enough metformin and ARB refills mixed in there that you will still make money by seeing them, just not as much as you’re worth.
Not necessarily. Some people do quite well only accepting the highest reimbursing insurance plans (or not being in network at all). Your plan would change that and we would all be stuck with something closer to Medicaid than Medicare (which pays lower than many private insurers). So while you think it is a distinction without a difference it is in fact the major difference between what goes on with private insurance versus what goes on with government run single payer health care.
 
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dpmd

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You wouldn’t be the only one complaining, it would be many thousands of you.

Here’s an article that may be of interest.

"Private insurers make their money by paying out less in claims than they collect in premiums, and make us jump through bureaucratic hoops to secure payment. Basic tests and treatments must be cleared in advance with insurers or they won’t be covered. Claims are routinely denied. If you’ve ever spent hours on the phone haggling with your insurance company, then you’ve had a small taste of what it’s like to practice medicine today."
In what fantasy land does the author live that they don't spend more time dealing with the prior authorizations and denials that come from Medicaid and Medicare than they do with private insurance?
 
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You wouldn’t be the only one complaining, it would be many thousands of you.

Here’s an article that may be of interest.

Only if many many thousands actually wanted the exact same change. Tell me, what major medicare changes have we seen in the last 30 years and how did they come about?

That article is an opinion fluff piece by a group whose sole purpose to get a single payer program.
 

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"Private insurers make their money by paying out less in claims than they collect in premiums, and make us jump through bureaucratic hoops to secure payment. Basic tests and treatments must be cleared in advance with insurers or they won’t be covered. Claims are routinely denied. If you’ve ever spent hours on the phone haggling with your insurance company, then you’ve had a small taste of what it’s like to practice medicine today."
In what fantasy land does the author live that they don't spend more time dealing with the prior authorizations and denials that come from Medicaid and Medicare than they do with private insurance?
Medicare is actually worse about that where I am. Plus if something isn't covered they don't really have the option of paying cash-pay rates to most places.
 

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I’m not an activist, but that’s a convenient character assassination that will give you peace of mind when disregarding my opinion.

“Single payer healthcare can’t be done!” Scream the capitalists of the ONLY developed country that doesn’t have single payer healthcare. Simplistic argument... sure, but accurate.

Yes, you’re sacrificing your 20’s in school for a noble goal; but you aren’t martyrs. I park in the physician lot too, I’m the only one without a BMW/Lexus/Mercedes. Let’s stick with reality; most physicians are paid well and are well off, and they should be.
1) Most developed countries don't have single payer.

2) No one here is arguing against universal healthcare. We're arguing about the feasibility of enacting single payer in a country where literal conspiracy theorists are elected to our congress and at least half the government wants to cut every social benefit available to its citizens. We need a major cultural shift before single payer will work. Until then, expanding medicare/medicaid eligibility and increasing subsidies can do a mountain of good without putting the whole system in jeopardy.

3) Doctors aren't capitalists. Doctors work for their money. Doctors are literally the least capitalist professionals in US society, because we make the smallest percentage of our overall wealth from investment and capital gains. We make basically nothing until our mid-30s and miss out on a decade or more of compounded interest on investments (e.g. retirement accounts, mortgages). This means most of our money, especially compared to other professions, comes from labor, not capital. Again, by 35, an engineer/manager/software developer/etc who lives like a medical student/resident will be making approximately 1/3 of their yearly income from capital gains/investments (e.g. $130k/year salary and $60-70k from investment/ownership), and by 65 capitalist gains will be the majority of their take home (which is how most people retire, by being capitalists). Whatever your occupation, you are probably more of a capitalist than I.

4) We're not martyrs, but many would like to make us martyrs by both stealing our 20s/30s and paying us as if we hadn't just worked for pennies for 90+ hours/week for years in enormous amounts of debt to keep this dysfunctional system running. It seems like you either didn't understand or didn't read my argument. If normal people making decent salaries lived like physicians do up to age 35, all of those people would be driving luxury cars, too, and they'd have an extra $100k/year pouring into their accounts from all the extra money they saved that is now going to work for them in a brokerage account. They chose to spend their time and money on other things, like not living with roommates into their 30s, having a car, taking vacations, etc... all things doctors in training can't have unless they come from rich households. That's not a judgement. Most people would rather live comfortably in their 20s and 30s in exchange for a smaller take home later. Thinking of the physician income as a privilege is just a failure to understand the effects of saving and compounded interest.

Being a physician is not independently lucrative. It's obligatory fiscal responsibility, and the majority of those in the profession start with a massive leg up because many physicians come from wealthy families, meaning they don't have the loans. As we (rightly) transition to a more socioeconomically diverse physician workforce, arguing for single payer while claiming that doctors make too much money (based on what the parking lot looks like) is both naïve and dangerous to those potential doctors who don't come from money. Anyone arguing for single payer should be simultaneously arguing for increased medicare reimbursement rates, loan forgiveness for physicians, and accelerated pathways to being a physician.
In what fantasy land does the author live that they don't spend more time dealing with the prior authorizations and denials that come from Medicaid and Medicare than they do with private insurance?
Amen. At the homeless shelter we had a few people who came back to the clinic to see the attending we had on staff there, despite no longer being homeless. They were the only ones not on Medicaid (thankfully I live in a state not completely overrun by Republican goons and the homeless can qualify), and 90% of the time getting them care was significantly easier than those on Medicaid.
 
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1) Most developed countries don't have single payer.

2) No one here is arguing against universal healthcare. We're arguing about the feasibility of enacting single payer in a country where literal conspiracy theorists are elected to our congress and at least half the government wants to cut every social benefit available to its citizens. We need a major cultural shift before single payer will work. Until then, expanding medicare/medicaid eligibility and increasing subsidies can do a mountain of good without putting the whole system in jeopardy.

3) Doctors aren't capitalists. Doctors work for their money. Doctors are literally the least capitalist professionals in US society, because we make the smallest percentage of our overall wealth from investment and capital gains. We make basically nothing until our mid-30s and miss out on a decade or more of compounded interest on investments (e.g. retirement accounts, mortgages). This means most of our money, especially compared to other professions, comes from labor, not capital. Again, by 35, an engineer/manager/software developer/etc who lives like a medical student/resident will be making approximately 1/3 of their yearly income from capital gains/investments (e.g. $130k/year salary and $60-70k from investment/ownership), and by 65 capitalist gains will be the majority of their take home (which is how most people retire, by being capitalists). Whatever your occupation, you are probably more of a capitalist than I.

4) We're not martyrs, but many would like to make us martyrs by both stealing our 20s/30s and paying us as if we hadn't just worked for pennies for 90+ hours/week for years in enormous amounts of debt to keep this dysfunctional system running. It seems like you either didn't understand or didn't read my argument. If normal people making decent salaries lived like physicians do up to age 35, all of those people would be driving luxury cars, too, and they'd have an extra $100k/year pouring into their accounts from all the extra money they saved that is now going to work for them in a brokerage account. They chose to spend their time and money on other things, like not living with roommates into their 30s, having a car, taking vacations, etc... all things doctors in training can't have unless they come from rich households. That's not a judgement. Most people would rather live comfortably in their 20s and 30s in exchange for a smaller take home later. Thinking of the physician income as a privilege is just a failure to understand the effects of saving and compounded interest.

Being a physician is not independently lucrative. It's obligatory fiscal responsibility, and the majority of those in the profession start with a massive leg up because many physicians come from wealthy families, meaning they don't have the loans. As we (rightly) transition to a more socioeconomically diverse physician workforce, arguing for single payer while claiming that doctors make too much money (based on what the parking lot looks like) is both naïve and dangerous to those potential doctors who don't come from money. Anyone arguing for single payer should be simultaneously arguing for increased medicare reimbursement rates, loan forgiveness for physicians, and accelerated pathways to being a physician.

Amen. At the homeless shelter we had a few people who came back to the clinic to see the attending we had on staff there, despite no longer being homeless. They were the only ones not on Medicaid (thankfully I live in a state not completely overrun by Republican goons and the homeless can qualify), and 90% of the time getting them care was significantly easier than those on Medicaid.

Did I ever once say physicians don’t deserve their salary? In fact I said the opposite at least twice in this thread alone, once clearly stating PCP income should increase drastically. On top of being incorrect as a whole on this post, you’re purposefully misconstruing my position to make it fit in with your viewpoint. You’re replying to what you wish I had said instead of what I’ve said.
 

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Did I ever once say physicians don’t deserve their salary? In fact I said the opposite at least twice in this thread alone, once clearly stating PCP income should increase drastically. On top of being incorrect as a whole on this post, you’re purposefully misconstruing my position to make it fit in with your viewpoint. You’re replying to what you wish I had said instead of what I’ve said.
Where am I incorrect as a whole? Everything I said regarding healthcare/physician salaries was correct, at least to the degree of rigor expected on a forum.

I'll give you that you didn't outright say doctors shouldn't be paid well, but words are meaningless when your definitive stance is one supporting single payer blindly. You can't advocate for single payer in the US without making it contingent on the benefits other countries get (e.g. subsidized tuition, earlier career entry, better working hours), and then say, "oh but I support maintaining physician salaries." It's like being anti-gun regulation but then topping it off with, "oh but I don't support murder or school shootings." The stance matters. The sentiment doesn't. If I responded to a fake version of you, then that's my mistake, but you can see where I'd make that mistake, especially given the comments about the luxury cars. The point of my comment was that basically any other professional who spent the first 15 years of their career living on peanuts would easily be able to afford a Lexus/BMW with their investment portfolio pumping on all cylinders. Doctors are getting that wealth building opportunity, but without the option to live a nicer life in their 30s and give up the long-term investment advantage.

We all want the same things. We want good healthcare for every American. We want physicians to be among the most qualified workers in society, and we want them to be able to make financial parity with similarly competitive positions. What it comes down to is execution and delivery. Which approach will provide a better healthcare system? IMO, without any drastic governmental changes, very obviously it is expansion of the ACA. Others think single payer, even without the necessary changes, is the best way to go. At the end of the day, most people arguing about healthcare on the internet have made up their mind.
 
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Gyuji

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No worry, guys. Most Americans have $90, 000 saved up somewhere just for medical emergency.

Plus universal healthcare has never worked or executed well. Look at Norway and those other countries. Even Honduras has it and it doesn't work.

Don't understand why some Americans think we need more socialism when it doesn't work. Look at other countries like Venezuela, Denmark, Finland, etc. It's all bad. We have neoliberal policies since Jimmy Carter and it's still working fine.

We weakened labor unions and shipped decent paying jobs overseas with NAFTA and other free trade deals, passed free market policies like the Telecommunications Act of 1996, deregulated banks in the late-1990's like dismantling of Glass-Steagall and no economic crash since and giving a nice steady austerity diet to the general public while giving tax cuts for corporations and the economic elites.

What I think, we need more liberal economic policies to expand privatization become like Guatemala, El Salvador and Honduras. Look at them, they got it right and working fine, right?
 
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FutureInternist

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No worry, guys. Most Americans have $90, 000 saved up somewhere just for medical emergency.

Plus universal healthcare has never worked or executed well. Look at Norway and those other countries. Even Honduras has it and it doesn't work.

Don't understand why some Americans think we need more socialism when it doesn't work. Look at other countries like Venezuela, Denmark, Finland, etc. It's all bad. We have neoliberal policies since Jimmy Carter and it's still working fine.

We weakened labor unions and shipped decent paying jobs overseas with NAFTA and other free trade deals, passed free market policies like the Telecommunications Act of 1996, deregulated banks in the late-1990's like dismantling of Glass-Steagall and no economic crash since and giving a nice steady austerity diet to the general public while giving tax cuts for corporations and the economic elites.

What I think, we need more liberal economic policies to expand privatization become like Guatemala, El Salvador and Honduras. Look at them, they got it right and working fine, right?

Is it “Socialist” to use the police or fire dept?
If yes, then why not add HelathCare to it to?
If no, then what would you call it?

There is a difference b/w making everyone equal (which I don’t think many are advocating for), and having a lower threshold below which we should try our best to not let anyone fall.

When a majority of families cannot pay for an emergency $500 expense, let alone the astronomical healthcare prices, then they system is broken.

Meanwhile Republicans keep giving tax breaks to those who don’t even pay what they owe (although it helps that they buy politicians that then write the laws), and keep blaming poor people on welfare for deficits
 

VA Hopeful Dr

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That requires changing your job, which is why it shouldn’t be tied to employment.

Keeps workers complacent, and if they strike, you just pull their insurance.
Or complaining to HR.

Had an HR director patient in just yesterday. Her company switched from Cigna to United Healthcare in January after their workers complained about Cigna being difficult to work with.
 

ChordaEpiphany

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That requires changing your job, which is why it shouldn’t be tied to employment.

Keeps workers complacent, and if they strike, you just pull their insurance.
Yup, it definitely should not be tied to employment. As much as we're all going to disagree about the payment system (e.g. single payer vs. public option vs. privatized vs. hybrid public/private), I think we can all agree that tying health insurance to employment is a pretty dumb idea. The thing I always go back to is that there are plenty of options that can work, but which ones will work? Theoretically COBRA should work wonderfully, but obviously it sucks because in practice it just shifts 100% of the costs onto someone who just lost their job.

There are so many "tiny" changes we could make that are so bleedingly obvious. The OOP maximum needs to be universal and enforced. If you pay more than the OOP max, it should just go immediately into your tax refund, and the primary path should be that all costs above the OOP max are covered by the insurance company. Things like COBRA need to be paid by the employer (big companies) for at least 6 months or by the government (small companies) for at least a year. Unemployed people don't need a kick in the shin when they are down, and losing your health coverage is exactly how people go from "between jobs" to homeless. Premiums need to make up a larger percentage of insurance costs, which would decrease volatility. We need an "80/20" rule to cap administrative spending in hospital groups like exists in insurance. There's no reason private equity and administrative empires should be taking over medicine and sucking up massive profits like this without providing any actual value in most cases. Insurance companies need to be regulated much more carefully, much like how they are in Switzerland.
Is it “Socialist” to use the police or fire dept?
If yes, then why not add HelathCare to it to?
If no, then what would you call it?

There is a difference b/w making everyone equal (which I don’t think many are advocating for), and having a lower threshold below which we should try our best to not let anyone fall.

When a majority of families cannot pay for an emergency $500 expense, let alone the astronomical healthcare prices, then they system is broken.

Meanwhile Republicans keep giving tax breaks to those who don’t even pay what they owe (although it helps that they buy politicians that then write the laws), and keep blaming poor people on welfare for deficits
You pretty much spelled out the only reason I'm not a gungho socialist in this post. Yup, the top of the post all checks out. Why shouldn't healthcare be a public service available to all? In a way, I find it almost insulting that I'm spending this much time learning to be a physician and someone is sitting around telling me who I can and can't help based on their specific insurance qualifications. However, then I remember why it won't be any better in America under single payer or a government-run system. The American government frankly sucks. The Republican party should be a fringe, far right group, but instead they represent the views of about 45-50% of America, and they have ~50% of the power. As long as that dynamic exists, we can't really have these nice things. It's like trying to build a deck of cards with a wild 3 year old running around the room hyped up on sugar sticks. You can imagine how wonderful it would be, but it'll never come to fruition in these conditions.

My barber summed it up pretty nicely today. We were discussing reopening schools. I made a comment along the lines of, "seriously, raise my taxes and throw it towards getting these kids caught up with everything they missed." His response, "Yeah except they'll raise your taxes and then everyone will pocket their share of the spoils and the kids will get pennies." Ain't it the truth though? The money's there. The concepts are there. The problem isn't capitalism or socialism, it's just people.

At least for now, having something of a market means that every entity that provides coverage is held to some standard. That market can be improved with the addition of a public option or with stricter regulation of insurance companies. However, what you don't want is a monopsony from a party that doesn't actually care about outcomes, which could be either the government (i.e. if Republicans are in power, which they will be plenty in our lifetimes and beyond) or insurance companies.
 
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FutureInternist

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Didn’t want to quote your whole reply.

Agree with almost all of what you said (although had to google 80/20 rule).

Republicans have a stranglehold on rural, religious and less educated communities (the very same people that Dem policies seek to help), yet the fear of “Socialism” (and ofcourse the idiotic stand on abortion) is what keeps people voting against their own interest.

Republicans are OK with “Socialism” as long as it covers what they themselves cannot provide for (roads, schools, police, bailouts due to idiotic Republican policies), and the ~ 2500 counties Trump won contribute only ~ 30% to GDP while the ~ 600 won by Biden make up the other 70%.
Additionally, more Republican states are on the top of the list for getting federal aid, and putting less into the federal gov coffers than they take out.

I wish we could do a “pseudo-secession” for all the Republican states (although Texas may have changed its tune for a week before blaming fed gov for all of its own idiocy), just to show them how they could hardly keep their lights on were it not for the snowflake, democrats’ tax dollars.

The voter suppression that Republicans do (they are passing a law in GA that says people cannot do early voting on Sundays amongst many other racists tactics) does ensure that they continue to get elected despite representing a smaller % of the populations’ views.

People may be a problem, but Republican people are worse.
 
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ChordaEpiphany

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People may be a problem, but Republican people are worse.
Agreed, but I'm still going to try to hold people's feet to the fire when they want to jump the gun on democratic socialist policies without first securing the sentiment to support it, especially when there are sensible reforms on the table that will get people relief soon.

Democratic socialism is wonderful, but it requires a buy in from the population. We just don't have that. I think we will in our lifetime, but not if we jump the gun and enact awful policy before it's time. As much as I want these things for all of us, I want them to work. More to the point, I definitely don't want to be a worker in another underfunded and poorly managed American public service.
 

FutureInternist

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Agreed, but I'm still going to try to hold people's feet to the fire when they want to jump the gun on democratic socialist policies without first securing the sentiment to support it, especially when there are sensible reforms on the table that will get people relief soon.

Democratic socialism is wonderful, but it requires a buy in from the population. We just don't have that. I think we will in our lifetime, but not if we jump the gun and enact awful policy before it's time. As much as I want these things for all of us, I want them to work. More to the point, I definitely don't want to be a worker in another underfunded and poorly managed American public service.

Which is why we need more Dems in House and Senate so we can start collecting taxes from free-loading corporations.

Not sure if waiting for buy-in is the right way to go.
Racial issues, gay issues, MJ issues... some states just said “F it” and did it, and when the world didn’t end the racists, homophobes and anti-drug folks had less to bitch about.
 
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