Let's Discuss your Ideal Health Care System

[BLADEMDA]

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Now that Obamacare is moving forward with the blessing of the turn coat Roberts we must face the fact of a Single payer system down the road.

What would the ideal system look like? The GOP will eventually be forced to sell its idea of a Universal Coverage system as an alternative to Medicare for all.

Will our health system resemble Canada or Great Briatin?

http://en.wikipedia.org/wiki/Medicare_(Canada)

 

[BLADEMDA]

Of course, the Brits do pay for their health care in another way – with taxes. their sales tax is a whopping 20% and income taxes are as high as 50%.

 

[Idiopathic]

wait, i got this.

as much work as i want, as much money as i want, as much vacation as i want, as many

CRAZY ASS DUCATIS

and LUGERS as i want.

if you cant pay you best move along. oh yeah and no nurses.

do i have my finger on the pulse or what

 

[BLADEMDA]

I would like to see Health Insurance sold across all state lines; allow as much competition as possible.
I would like to see a lot of different policies with different coverages so the patient can choose the coverage he/she needs.

I would like to see the states take charge of govt. run health care like Medicaid and Medicare with a block grant from the Federal govt. Then, the poor of each state is no longer a FEDERAL issue. Canada allows each province to handle care. I support a State sales tax of 1-2% (sales tax increase) to pay for the extra services for the poor. This tax is paid by everyone especially the poor and the drug dealer who are likely to utilize the free care or E.R.

I supprt BASIC health care coverage for every Citizen of my state through my sales tax or state income tax monies. But, I do not support FEDERAL GOVT involvement. The best govt. is local govt and it has the least amount of waste.

We can get UNIVERSAL COVERAGE by returning health care to the individual and to the state level where it belongs.

Clearly, the STATE has the power to empose an Individual mandate TAX so everyone plays by the rules and gets health insurance.

Let's get the Federal govt. out of the health care business entirely and return the power to the states where it belongs.

 

[Idiopathic]

i agree with almost everything you say in principle. but ultimately, i dont trust the states to provide these services, even in the setting of federal grants and sales taxes. cuts will be easy to get on a state level, especially in balanced budget states, and with no central guarantee of services, supported health care may actually be worse off. i realize that this would be a positive in the minds of many people.

health care is broken, no doubt about it. i dont think the current or proposed models are the right fix, but Im also not sure 50/51 separate bundles of legislation, championed and challenged yearly for political gain could ever be the answer either. states will have no incentive to promote quality health care (especially without preexisting condition restrictions), as it will be much easier to move to oregon than pay for your care in california.

but its all conjecture, im sure it could be worked to succeed. hopefully we can get some intelligent structure to such a system.

 

[naus]

What about states like Illinois with one-party rule that are already broke but whose politics would never say no to unlimited Medicaid expansion and increased benefits, etc?

Ultimately we're all paying for them, one way or another. Greece is more than just Greece's problem.

 

[TheSweetness]

Sounds reasonable, since there is less waste at the smaller gov't level. I do believe there is much less waste doing procedures in ambulatory surgery center's than at large hospitals. Especially, doctor owned ambulatory surgery centers but that is a whole other story.

Also, but if there is going to be a single payer there could be an extra tax on gas, say a dollar per gallon, and that'd make it more fair taxes across the board where everybody pays the same tax rate, and the liberals would be happy to tax gas more and push more people into driving a hybrid. Just a thought.. However, politicians should stick to more limited gov't, regulation, taxes, etc. and not a complete overhaul on the practice of medicine


An ideal health care system would be where patient's actually listened to what you said and actually attempted diet and exercise before medication for htn. Preventative medicine is the future as it was a hundred years ago. Human nature does not allow this to work for most people. With the improvement in medicine and our health care system being the best in the world, our population does not take care of themself as seen with the awful trends in obesity epidemic.

How to pay for the ideal healthcare system is anyone's guess. With the technological advancements in all aspects of medicine from pharmacology to minimally invasive surgeries to expensive prolonged life in ICU care, the money is not there to pay for every person coming through the door for the latest most expensive pill or chemotherapy, the liver transplant on the hiv positive patient that continues to drink, etc. Medical advancements are too fast to keep up with the pocketbooks of the average american .....

 

[pgg]

i dont trust the states to provide these services, even in the setting of federal grants and sales taxes.

Yeah, there's a recipe for success: the states run by sensible people will craft health care plans designed to persuade poor people with chronic medical problems to relocate to other states ...


Blade, I know you're a state rights uber alles on all things kind of guy, but universal healthcare, if it's going to be done, ought to be done at the federal level.

The whole staterights / "let the states do it" argument rests on the notion that meaningful competition will take place between states that have an incentive to do something well. And if they do it poorly, the people can vote with their feet and easily move to another state.

But state-run healthcare would be like state-run welfare. We've seen what happens there; California leans generous and it's no coincidence that we've got 1/3 of the country's welfare recipients. The state that provides the best health benefits would suddenly find a horde of benefit-seekers moving in, or settling permanently.

It's totally predictable what will happen if healthcare is kicked to the states. Except for the perennial heart-bleeding "we'll never say no" states like California, Illinois, etc ... the states would have an incentive to do it poorly, and they would. Meanwhile, the states that offered the "best" plans would be overrun.

 

[cincincyreds]

I would like to see Health Insurance sold across all state lines; allow as much competition as possible.
I would like to see a lot of different policies with different coverages so the patient can choose the coverage he/she needs.

I would like to see the states take charge of govt. run health care like Medicaid and Medicare with a block grant from the Federal govt. Then, the poor of each state is no longer a FEDERAL issue. Canada allows each province to handle care. I support a State sales tax of 1-2% (sales tax increase) to pay for the extra services for the poor. This tax is paid by everyone especially the poor and the drug dealer who are likely to utilize the free care or E.R.

I supprt BASIC health care coverage for every Citizen of my state through my sales tax or state income tax monies. But, I do not support FEDERAL GOVT involvement. The best govt. is local govt and it has the least amount of waste.

We can get UNIVERSAL COVERAGE by returning health care to the individual and to the state level where it belongs.

Clearly, the STATE has the power to empose an Individual mandate TAX so everyone plays by the rules and gets health insurance.

Let's get the Federal govt. out of the health care business entirely and return the power to the states where it belongs.

I'm more a believer in free market capitolism. But I do believe we do need a certain amount of government for the public good. Economics is about supply and demand. Also, there needs to be some degree of moral hazard, so if you don't want to buy the health insurance good look in getting cared for when you need it. My big issue with healthcare before Obabmny Care is the fact that the issue that has never been addressed is THE INSURANCE COMPANIES take TOO MUCH MONEY out of the pot, and then they get the public to believe it is the doctors who take too much from the pot. I think physician salaries account for 10% of healthcare spending.

Healthcare insurance should only be for catastrophies, like if you need surgery for a heart transplant for example. Everything else you pay out of pocket. Kind of like a car. You do get insurance when you initally buy the car, but have to pay for maintence things like oil changes. If you don't work and contribute to society, so be it. You just won't get healthcare when you need it. The goal of the government will be to keep the insurance companies from colluding on price. The way to do this is to offer the option of the government offering healthcare insurance that people have the choice to buy, or they can go with the private guys. The goal of all of this is for the least amount of profit being generated by the healthcare companies and thus more money for healthcare for the people actually buying health insurance.

The other caveat is the only tax that will be needed is for the disease treatment for the diseases that could hurt the general population like tuberculosis. This is more of a public good type of government policy that I alluded to before.

I personally could care less about someone elses situation and feel someone elses problem is not mine, so I shouldn't have to pay for them. I know this isn't Christian, but I am not Christian.

As long as your decision not to participate in healthcare doesn't hurt society, I believe it is okay not to participate because people should have the right to make their own choices.

 

[yappy]

I agree with what Blade has suggested as far as the changes that could be made to make insurance more affordable. I would also like to add that there will always be a population that cannot afford health care due to sickness, pre-existing conditions, drug addictions, etc. etc.

I think these people should be taken care of by physicians and other health care professions for a tax credit. The value of the services they provide will be documented and then work against their tax liability. Therefore, hospitals and physician offices can work in as much free work as they deem beneficial into their business model. It's win - win. The huge plus to the tax payer? Fewer expensive Washington employees / time is needed to work out how to run things like medicaid and the like.

I ran this idea by a dentist I know and he loved it. He said it would work for him and instead of losing money on medicaid patients he could determine how many charity cases he could take on to limit his taxes at the end of the year. Again, this is 100% efficiency in terms of percentage of dollars that are actually spent on health services.

The general goal, at least in my mind, is to keep as much government out of health care as possible. Keep it between the patient and doctor where it belongs.

 

[narcusprince]

Now that Obamacare is moving forward with the blessing of the turn coat Roberts we must face the fact of a Single payer system down the road.

What would the ideal system look like? The GOP will eventually be forced to sell its idea of a Universal Coverage system as an alternative to Medicare for all.

Will our health system resemble Canada or Great Briatin?

http://en.wikipedia.org/wiki/Medicare_(Canada)

Blade
I feel like we as anesthesiologist have fought against CRNA independent practice fought against healthcare reform (obamacare). I feel like the greater fight(independent CRNA practice) is the worse of the two evils. With a government system one payer system their is greater flexibility in mandating Anesthesiologist coverage for all cases in an ACT model. If more people are insured does that not mean more surgeries? More job opportunities? sure the days of making 400-500+ may be limited but I would be happy with everyone making 250+ a year and more jobs. We cannot fight everything, but lets make sure we come out ahead in this issue.

 

[BLADEMDA]

I'm more a believer in free market capitolism. But I do believe we do need a certain amount of government for the public good. Economics is about supply and demand. Also, there needs to be some degree of moral hazard, so if you don't want to buy the health insurance good look in getting cared for when you need it. My big issue with healthcare before Obabmny Care is the fact that the issue that has never been addressed is THE INSURANCE COMPANIES take TOO MUCH MONEY out of the pot, and then they get the public to believe it is the doctors who take too much from the pot. I think physician salaries account for 10% of healthcare spending.

Healthcare insurance should only be for catastrophies, like if you need surgery for a heart transplant for example. Everything else you pay out of pocket. Kind of like a car. You do get insurance when you initally buy the car, but have to pay for maintence things like oil changes. If you don't work and contribute to society, so be it. You just won't get healthcare when you need it. The goal of the government will be to keep the insurance companies from colluding on price. The way to do this is to offer the option of the government offering healthcare insurance that people have the choice to buy, or they can go with the private guys. The goal of all of this is for the least amount of profit being generated by the healthcare companies and thus more money for healthcare for the people actually buying health insurance.

The other caveat is the only tax that will be needed is for the disease treatment for the diseases that could hurt the general population like tuberculosis. This is more of a public good type of government policy that I alluded to before.

I personally could care less about someone elses situation and feel someone elses problem is not mine, so I shouldn't have to pay for them. I know this isn't Christian, but I am not Christian.

As long as your decision not to participate in healthcare doesn't hurt society, I believe it is okay not to participate because people should have the right to make their own choices.

Canadians pay 6 cents out of every dollar for management/oversight while Insurance companies take about 25 cents (soon to be 20 cents per Obamacare this year )

 

[BLADEMDA]

Blade
I feel like we as anesthesiologist have fought against CRNA independent practice fought against healthcare reform (obamacare). I feel like the greater fight(independent CRNA practice) is the worse of the two evils. With a government system one payer system their is greater flexibility in mandating Anesthesiologist coverage for all cases in an ACT model. If more people are insured does that not mean more surgeries? More job opportunities? sure the days of making 400-500+ may be limited but I would be happy with everyone making 250+ a year and more jobs. We cannot fight everything, but lets make sure we come out ahead in this issue.

I fully understand our days of earning $500K are numbered. I accept the ACT Model as something worth fighting for; but, Canadian Anesthesiologists easily earn $350-$400K working 45 hours a week so why shouldn't we? After all, they only do ONE room while I have to cover 4 or maybe even 5!😱

 

[BLADEMDA]

Let's read your Solution so the GOP can counter ObamaCare in the Senate. The status Quo is broken.
Should we be advocating for a SWITZERLAND SOLUTION or A CANADIAN SYSTEM.

Please note the Canadians allow the provinces to handle health care reimbursement and set rates NOT the National Government.

 

[BLADEMDA]

 

[powermd]

I believe Taiwan looked at this issue in 1995 when overhauling their own health system. They looked at every major democratic health model and came up with what they thought combined the best aspects of each. It's a system of national health insurance like Canada, however there is no rationing of services. From what I saw in a documentary (forgot which) heavy utilizers get repeated calls from case managers to straighten them out.

http://www.dissentmagazine.org/article/?article=985

Here's the part most people around here will care about:

"The NHI does not seem to have abused its monopoly power to drive down doctors’ earnings, as there is vigorous competition among practitioners and institutions for patient patronage, even at the fees collectively agreed upon. The ease of payment, with the government writing the checks, seems to have been a good enough trade-off for the doctors. There is nothing to stop a doctor setting up private practice—except a shortage of clients. The system was originally based on fee for service but then transitioned to a “case-payment” system based on fifty-three items. The program’s chief financial officer, Michael Chen, says that the idea is that the NHI is purchasing “not just medical care, but health, as evidenced by initiatives aiming at encouraging ‘pay for performance.’” The 95 percent inoculation rate against measles suggests the success of the program.

The NHI Committee for the Arbitration of Medical Costs considers not only the overall figures but also individual providers’ performance based on support for patients’ rights, accessibility and satisfaction, efficiency of service, and similar criteria. The committee rewards providers if scored for “excellence” through the “quality assurance funds.”

 

[hoyden]

hm... by your graph the US is doing the best...

this was BEFORE obamacare, though

 

[periopdoc]

Whatever system we end up with, physicians must be allowed to negotiate as a group with our payer(s) with no concern for anti-trust prosecution. As long as this anti-trust bull$hit is allowed to continue, we negotiate from a huge disadvantage. Our payers are allowed to know and share exactly what each of us is being paid, we should (legally) be allowed to have the same information and use it in negotiation.

- pod

 

[naus]

I believe Taiwan looked at this issue in 1995 when overhauling their own health system. They looked at every major democratic health model and came up with what they thought combined the best aspects of each. It's a system of national health insurance like Canada, however there is no rationing of services. From what I saw in a documentary (forgot which) heavy utilizers get repeated calls from case managers to straighten them out.

I'm very familiar with the Taiwan reform. Before reform doctors worked their butts off at 60+ hrs a week. After reform, doctors worked 40 hrs a week as there was little incentive to work more.

 

[DrRobert]

For anesthesia I would like to see cash only, fee for service.

I would have to give some serious thought to the pricing structure but preliminarily:

Elective cases:
Labor epidural - $500
C-Section - $1,000
Peripheral nerve block for post-op pain control - $250
Uncomplicated MAC - $250
Complicated MAC - $500
Uncomplicated General Anesthesia - $500 per hour
Complicated General Anesthesia (ASA 3-4, A-line/CVC/TEE required) - $750 per hour

Emergent cases:
- Fee based on patient's annual income
- Minimum fee for the "unemployed"
- Garnishment of welfare benefits and/or hospital/government subsidies to cover these patients who refuse to pay minimum fee
- Patients who refuse to pay cannot file a malpractice claim under any circumstances

 

[AlmostJesus]

Let's read your Solution so the GOP can counter ObamaCare in the Senate. The status Quo is broken.
Should we be advocating for a SWITZERLAND SOLUTION or A CANADIAN SYSTEM.

Please note the Canadians allow the provinces to handle health care reimbursement and set rates NOT the National Government.

The Swiss solution.
Get the government out of the payor business, axe Medicare and Medicaid. Everyone has to have basic health insurance coverage that the insurance companies cannot profit off of. Government would provide a subsidy for those who's insurance is over a determined percentage of their annual income.
Dont want to enroll? You will either be enrolled or if you decide you dont need insurance, the hospital can decide that they don't need to care for you.
Make it a constitutional amendment instead of dancing around the commerce clause.

 

[BLADEMDA]

The Swiss solution.
Get the government out of the payor business, axe Medicare and Medicaid. Everyone has to have basic health insurance coverage that the insurance companies cannot profit off of. Government would provide a subsidy for those who's insurance is over a determined percentage of their annual income.
Dont want to enroll? You will either be enrolled or if you decide you dont need insurance, the hospital can decide that they don't need to care for you.
Make it a constitutional amendment instead of dancing around the commerce clause.

I agre with you. Let the Insurance companies handle health insurance and get the govt. out of this business entirely.

The Paul Ryan Voucher system is the way to go for the elderly and the poor. Then, you can buy the type of policy you want or can afford. But, there must be a basic policy avail even with only the voucher/coupon from the govt. THis basic policy should be a loss leader for the industry. I would still cap their profits at 15-20% because Insurance companies should act like utility companies.

Policies should be sold across state lines and the govt. is OUT OF THE HEALTH CARE BUSINESS.

 

[Perrotfish]

A modified singapore solution. Everyone gets a healtcare savings account (unter their own control) and everyone has mone taken directly out o their paycheck for the account, which they can only use for healthcare. The poorest quartile get an extra donation towards their account. Medicare goes away. Medicaid is only for kids and those with serious congenital conditions. Catastrophic insurance is 100% private and capped. Hospitals HAVE to advertise their prices, and to recieve the consent of their customers before billing them for anything. Free market competition drives down prices and weeds out expensive modalities with marginal utility.

Licensure no longer tied to completing medical school: anyone who passes federally regulated standardized tests can get a training license. Residencies should be replaced with a jouneyman system when you can work for any other licensed professional: you get your unrestricted license when you pass several standardized tests and complete a certain amount of work under a licensed professional.

Its worked in Singapore. They have some of the least educated sets of health care professionals in the world, they spend an order of magnitude less on health care than we do, and they're as healthy as Europeans.

 

[BLADEMDA]

A modified singapore solution. Everyone gets a healtcare savings account (unter their own control) and everyone has mone taken directly out o their paycheck for the account, which they can only use for healthcare. The poorest quartile get an extra donation towards their account. Medicare goes away. Medicaid is only for kids and those with serious congenital conditions. Catastrophic insurance is 100% private and capped. Hospitals HAVE to advertise their prices, and to recieve the consent of their customers before billing them for anything. Free market competition drives down prices and weeds out expensive modalities with marginal utility.

Licensure no longer tied to completing medical school: anyone who passes federally regulated standardized tests can get a training license. Residencies should be replaced with a jouneyman system when you can work for any other licensed professional: you get your unrestricted license when you pass several standardized tests and complete a certain amount of work under a licensed professional.

Its worked in Singapore. They have some of the least educated sets of health care professionals in the world, they spend an order of magnitude less on health care than we do, and they're as healthy as Europeans.

Very Interesting post. ZERO PERCENT chance that it will happen in the USA but a thoughtful post nonetheless.

 

[hoyden]

Licensure no longer tied to completing medical school: anyone who passes federally regulated standardized tests can get a training license. Residencies should be replaced with a jouneyman system when you can work for any other licensed professional: you get your unrestricted license when you pass several standardized tests and complete a certain amount of work under a licensed professional.

Its worked in Singapore. They have some of the least educated sets of health care professionals in the world, they spend an order of magnitude less on health care than we do, and they're as healthy as Europeans.

This is the worst possible system for training imaginable.

Actually in some variations it does exist in a lot of countries - and this is the pavement for Corruption, it's majesty.

God forbid anything even in resemblance EVER is implemented in this country - it will be the end of qualified medicine overall

 

[BLADEMDA]

This is the worst possible system for training imaginable.

Actually in some variations it does exist in a lot of countries - and this is the pavement for Corruption, it's majesty.

God forbid anything even in resemblance EVER is implemented in this country - it will be the end of qualified medicine overall

I enjoyed reading his post; I like Sci Fi and Fantasy movies as well.😉

We have excellent quality in the USA but COST is another matter and PROVIDERS are not the main reason for escalating costs.

 

[Impromptu]

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/

If you've ever wondered how other countries do it, watch this documentary. It is actually quite eye opening.

Great Britain, Japan, Germany, Tawain, Switzerland.

If I remember correctly, one nice thing about the Taiwanese program is the nearly instant payments to the providers from the government. You provide a service, then get paid within a couple of days. Very nice.

 

[hoyden]

I enjoyed reading his post; I like Sci Fi and Fantasy movies as well.😉

We have excellent quality in the USA but COST is another matter and PROVIDERS are not the main reason for escalating costs.

I did not touch the part of the post which was related to healthcare, only that which was realted to medical training.

Though in the country I am from one has to finish medical school and goes through residency ( which is 2 years for the most specialties) but the training itself is more or less as described - you learn on your own under some supervision of somebody.
It is common practice in a lot of European countries - and it is extremely corrupted system, which depends solely on who knows whom.
And money. Yes. Money. Not as a salary, but as a bribe.
For training.

 

[Perrotfish]

This is the worst possible system for training imaginable.

Actually in some variations it does exist in a lot of countries - and this is the pavement for Corruption, it's majesty.

God forbid anything even in resemblance EVER is implemented in this country - it will be the end of qualified medicine overall

This is how engineers, pilots, and Paramedics are already trainined in this country. Life and death professions, I'm sure you'll age, and yet they manage to get by with nothing more than the journeyman system I mentioned above, coupled with a few federal tests. The circling lawyers keep people from hiring incompetents from being hired to practice (because they're not practicing under their own license), and in fact make sure almost everyone goes to some kind of formal school to make sure they can pass the tests. However the addition of the free market to the training process lowers the cost to the customers (by reducing the cost of training) and the misery of providers (because, without different companies colluding to keep prices down and hours high, they can live a decent life and get paid what they're worth)

Very Interesting post. ZERO PERCENT chance that it will happen in the USA
but a thoughtful post nonetheless.

I disagree. What makes the US such a good country for political/regulatory experimentation is that the states are relatively autonomous. That's why some states can license neuropaths, others can let NPs function independently, and others won't even let a physician take step 3 until they've almost finished residency. You wouldn't need to implement this system nation wide, all you need is one state with strong enough tea party leanings to stop accepting Medicaid and try something like this. If it works other states will pick up on the idea when they're threatened with bankruptcy from their own failed regulations.

 

[hoyden]

This is how engineers, pilots, and Paramedics are already trainined in this country. Life and death professions, I'm sure you'll age, and yet they manage to get by with nothing more than the journeyman system I mentioned above, coupled with a few federal tests. The circling lawyers keep people from hiring incompetents to practice (because they're not practicing under their own license), and in fact make sure almost everyone goes to some kind of formal school to make sure they can pass the tests. However the addition of the free market to the training process lowers the cost to the customers (by reducing the cost of training) and the misery of providers (because, without different companies colluding to keep prices down and hours high, they can live a decent life and get paid what they're worth).

we are talking about medicine not about pilots or engineers.
Training in medicine differs a lot from that of training in other specialties

I disagree. What makes the US such a good country for political/regulatory experimentation is that the states are relatively autonomous. That's why some states can license neuropaths, others can let NPs function independently, and others won't even let a physician take step 3 until they've almost finished residency. You wouldn't need to implement this system nation wide, all you need is one state with strong enough tea party leanings to stop accepting Medicaid and try something like this. If it works other states will pick up on the idea when they're threatened with bankruptcy from their own failed regulations.

It is your inborn right 🙂

But I have lived through the system you have described and this is a nightmare - not only it is corrupted, it is usually not well operating.

It has absolutely nothing to do with states rights and so on. you are mixing our existing political and economical problems with the fundamental principla of how the physician is trained in the US.

I have done it twice - by your model and by American one ( excluding medical school in the US) - and I can compare.
Not only by my own experience in training but by my own experience as a physician

 

[Perrotfish]

But I have lived through the system you have described and this is a nightmare - not only it is corrupted, it is usually not well operating.

I don't know where you're from, but engineering trainng in many non-American countries is also often corrupt, resulting in incompetent engineers. Some nations tolerate a culture of corruption where there are few consequences for bad behavior. I think you might be confusing a national problem with a proessional one.

we are talking about medicine not about pilots or engineers.
Training in
medicine differs a lot from that of training in other specialties

Having trained as both, I honestly believe that there is no profesion as similar to medicine as engineering. The long hours and technical nature of the education, the way the training narrows from a general overview to a specific subsecialty, the life and death nature of the work that gets masked by extreme boredom, and even the kind of personalities that the fields attract. They feel very similar to me.

When people tell me 'that works in engineering, but it couldn't work in medicine' I get pretty much the same feeling as I do when the NCAA says 'a tournament works in basketball, but it couldn't work in football'.

 

[pgg]

This is how engineers, pilots, and Paramedics are already trainined in this country. Life and death professions,

There's another life & death profession trained in this manner (more or less) ... CRNAs.

 

[Perrotfish]

There's another life & death profession trained in this manner (more or less) ... CRNAs.

No they train like we do, they just train less. There's no real period of supervision or testing after they finish their formal training, they just start working with a full license (whatever a full license means in that state).

 

[hoyden]

I don't know where you're from, but engineering trainng in many non-American countries is also often corrupt, resulting in incompetent engineers. Some nations tolerate a culture of corruption where there are few consequences for bad behavior. I think you might be confusing a national problem with a proessional one..

It has nothing to do with the culture of corruption in a nation. Our nation is as corrupted as others are - in the areas where it is allowed by the system ( as is on many levels at local governing - look what is going on with school board system - I would say it is an example of THE Corruption, ahead of many other nations ))) and I do not even start on how corrupt is our system of welfare - many will envy

Do not jump into eugenics - humankind is extremely flexible and if there is a possibility - it will be taken advantage of to the extreme extent, no matter what race, religion or sexual preference one has 😉

Having trained as both, I honestly believe that there is no profesion as similar to medicine as engineering. The long hours and technical nature of the education, the way the training narrows from a general overview to a specific subsecialty, the life and death nature of the work that gets masked by extreme boredom, and even the kind of personalities that the fields attract. They feel very similar to me.

When people tell me 'that works in engineering, but it couldn't work in medicine' I get pretty much the same feeling as I do when the NCAA says 'a tournament works in basketball, but it couldn't work in football'.

You still do not have experience not only in training but in LIVING under the system you've described and I have trained and lived through it
American training system in medicine( except it's costs) is almost perfect - do not improve something if it works.
How is the training in engineering I will find out soon - my son is starting this fall 😀

 

[Perrotfish]

Our training system in medicine( except it's costs) is almost perfect - do not make something better if it works.

Saying our healthcare works 'except for its costs' is like saying that a car is almost perfect 'except that it tends to explode'. The financial weight of our entitlements is the central problem that's threatening the integrity of not just our healthcare system, but of our entire nation. They're going up at 20%/year when they need to go DOWN by an order of magnitude. When Singapore has a working system that has kept health care costing a fraction of what it does here, with better results, I think that's worth trying

How the training in engineering works I will find out soon - my son is starting
this fall

Congrats. What kind of engineer?

 

[hoyden]

Saying our healthcare works 'except for its costs' is like saying that a car is almost perfect 'except that it tends to explode'. The financial weight of our entitlements is the central problem that's threatening the integrity of not just our healthcare system, but of our entire nation. They're going up at 20%/year when they need to go DOWN by an order of magnitude. When Singapore has a working system that has kept health care costing a fraction of what it does here, with better results, I think that's worth trying

Are post-ICU call? 😉 Just kidding

Training in medicine is NOT equivalent to healthcare and entitlements costs.


Training in medicine is a humongous cost to the trainee, not to the training system - the system is making money on you, cheap labor and very well qualified.

I was referring only to the residency/fellowship system - it is grueling but effective in producing a physician. If one adds the cost for medical school ( for the trainee, obviously), it is blowing your mind off completely.

Singapore is a small country with totally different political system. And their organization of the healthcare system might be worth looking into. My objection is only the system of training medical doctors - do not improve something working, and American system of training physicians IS working.

Congrats. What kind of engineer?

Thank you
Electrical for the start with interest in nukes

 

[partydoc]

A lot of the countries brought up have significantly less populations than the US. Can and the UK have populations just above 30 million. We are around 300 million. Any thoughts about the practicalities of implementing such a large health care system? Would it run more "efficiently" if state controlled?

 

[AlmostJesus]

A modified singapore solution. Everyone gets a healtcare savings account (unter their own control) and everyone has mone taken directly out o their paycheck for the account, which they can only use for healthcare. The poorest quartile get an extra donation towards their account. Medicare goes away. Medicaid is only for kids and those with serious congenital conditions. Catastrophic insurance is 100% private and capped. Hospitals HAVE to advertise their prices, and to recieve the consent of their customers before billing them for anything. Free market competition drives down prices and weeds out expensive modalities with marginal utility.

Licensure no longer tied to completing medical school: anyone who passes federally regulated standardized tests can get a training license. Residencies should be replaced with a jouneyman system when you can work for any other licensed professional: you get your unrestricted license when you pass several standardized tests and complete a certain amount of work under a licensed professional.

Its worked in Singapore. They have some of the least educated sets of health care professionals in the world, they spend an order of magnitude less on health care than we do, and they're as healthy as Europeans.

The idea of the healthcare savings account automatic deduction is a good idea, there would be no excuse for not having money to spend on your health insurance. I dont know how easy it would be to pitch that to the populous though.

A lot of the countries brought up have significantly less populations than the US. Can and the UK have populations just above 30 million. We are around 300 million. Any thoughts about the practicalities of implementing such a large health care system? Would it run more "efficiently" if state controlled?

We know well that the government sucks at running things, especially health care. Look at the Indian Health Service if you are looking for a good example. Chronically underfunded, poor quality, poorly staffed.
If we went to a government run system, we would be looking at a health care system like the VA, sure they will get you taken care of, but you dont have the advantage of competition which drives improving quality, innovation, and customer satisfaction.

I agre with you. Let the Insurance companies handle health insurance and get the govt. out of this business entirely.

The Paul Ryan Voucher system is the way to go for the elderly and the poor. Then, you can buy the type of policy you want or can afford. But, there must be a basic policy avail even with only the voucher/coupon from the govt. THis basic policy should be a loss leader for the industry. I would still cap their profits at 15-20% because Insurance companies should act like utility companies.

Policies should be sold across state lines and the govt. is OUT OF THE HEALTH CARE BUSINESS.

That is the best post Ive seen out of you.
Id preferably see the insurance companies not making a profit off of the base health care plan, but allowing them to make a profit off of supplemental policies that cover the non-basic things such as labor epidurals, etc.

The government should only be functioning in healthcare to the extent of ensuring that everyone has adequate health insurance coverage. They do that through their power to tax. Their place is not in being the payor or the health care provider. A regulated free market system will take care of that.

 

[vector2]

I agre with you. Let the Insurance companies handle health insurance and get the govt. out of this business entirely.

The Paul Ryan Voucher system is the way to go for the elderly and the poor. Then, you can buy the type of policy you want or can afford. But, there must be a basic policy avail even with only the voucher/coupon from the govt. THis basic policy should be a loss leader for the industry. I would still cap their profits at 15-20% because Insurance companies should act like utility companies.

Policies should be sold across state lines and the govt. is OUT OF THE HEALTH CARE BUSINESS.

Comrade Blade wants to cap profits at a measly 15-20%??? Maybe in Soviet Russia...


But seriously, you want insurance companies to regulate themselves while simultaneously having the government regulate them too...gotta make up your mind dude...


Personally I like the Australian system. Everyone has single-payer tax-funded 'Medicare' there and can go to public hospitals, but in addition you can buy private cadillac insurance if you want a private doc/private hospital.

 

[BLADEMDA]

Comrade Blade wants to cap profits at a measly 15-20%??? Maybe in Soviet Russia...


But seriously, you want insurance companies to regulate themselves while simultaneously having the government regulate them too...gotta make up your mind dude...


Personally I like the Australian system. Everyone has single-payer tax-funded 'Medicare' there and can go to public hospitals, but in addition you can buy private cadillac insurance if you want a private doc/private hospital.

We are broke. That is the fact. The Meducare system can't handle the citizens it currently insures. Yet, you want it to take on a new burden?

Just voucher everyone who needs help or was promised Medicare but make sure a basic policy exists by law at no additional cost. This means on demand medical care wth all the bells and whistles won't be free