Medical School Discrimination

[Med Ed]

Socialized insurance that disallows private insurance and is where 100% of physician wages come from is socialized medicine in all but name.

Case in point. You are essentially saying there is no substantive difference between being in a typical private practice and working in a VA. Most practitioners would find that proposition laughable, and justifiably so.

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[Mad Jack]

Case in point. You are essentially saying there is no substantive difference between being in a typical private practice and working in a VA. Most practitioners would find that proposition laughable, and justifiably so.

It is kind of an apples to oranges comparison, as private practices today are not operating under single payer. Wages would most likely shrink substantially and private practice as we know it would continue to consolidate until it was a distant memory. Sure, you may not be working for the government, but you'll be working for a hospital that wants more and more of those government dollars for themselves- a situation that is arguably worse than a fully socialized system, as you are fighting with two groups that have their own interests (your employer and the government) rather than one.

 

[7331poas]

How is it moral to have a medical school? How is it moral to require licenses to practice medicine? How is it moral to do a lot of things that are forbidden by law. One justification is the rationale that the introduction of these laws is to promote general welfare and thus, they are moral.

If you entertain that explanation, does the distribution of that tax revenue, in part to social programs, promote general welfare? I think it is self evident the answer to that is yes.

I see a lot of arguments here against socialized healthcare ranging from the system somehow has worse outcomes to a moral debate on the "fundamental right" to not be taxed at all.

How do these arguments line up with the clear cut fact that European nations which run these programs have far far better outcomes than any other nation on the globe.

The next question I have is what exactly is the benefit of "physician autonomy" in terms of healthcare outcomes. Does this quality outweigh the public health benefits of allowing everyone, rich or poor to receive healthcare.

Finally, is it moral for us as a society, to rest the welfare of the poor on the "charity" of doctors dedicating a portion of their time pro bono. Will doctors set aside enough time to meet the needs of the underserved population in this capitalist society? (Or even a larger portion of society which may not be able to afford healthcare in a down market)

 

[Mansamusa]

The next question I have is what exactly is the benefit of "physician autonomy" in terms of healthcare outcomes. Does this quality outweigh the public health benefits of allowing everyone, rich or poor to receive healthcare.

Just addressing this part, but autonomy means different things. Much of the concern with physician autonomy has to do with clinical decision-making. So if there are clinical guidelines that say the best course of treament for this cancer is X, all doctors must implement treatment X. Physician autonomy is the ability of physicians to say, "In my experience, treament X works for a lot of patients, but this particular patient would be better suited by treatment Y."

Taking away physician autonomy means a one size fits all clinical treatment, which obviously isn't good for clinical outcomes

Edit: Autonomy can also refer to physicians having control over what patients they see and their work hours, etc, but a major component is about being able to make clinical decisions

 

[Med Ed]

It is kind of an apples to oranges comparison, as private practices today are not operating under single payer.

The fact remains that there is a huge difference between being working in an insurance-based system, regardless of the number of payers, and being employed within a public bureaucracy.

One might as well say there is no difference between fee-for-service, value-based, and capitated payment models, since the money is all coming from the same place.

 

[Mad Jack]

The fact remains that there is a huge difference between being working in an insurance-based system, regardless of the number of payers, and being employed within a public bureaucracy.

One might as well say there is no difference between fee-for-service, value-based, and capitated payment models, since the money is all coming from the same place.

Neither is good, and both suffer from largely the same problems- healthcare becomes an expense to be cut by Republicans looking to save on the budget, physician incomes become a line-item on the budget to be slashed, patient choice and options are limited, and production is put ahead of most other concerns. Certainly, there will be differences between the two systems, but both will be substantially worse for physicians.

 

[Instatewaiter]

Ummm, not exactly. I was trying to be polite and mature by not replying. I've heard more rational rants from adults talking to themselves on the side of the street.

I think you have a bizarre understanding of both morality and what single payer would look like. We would still live in th USA, where all of the legislative branches would remain intact, where you could protest and tweak via your professional bodies, the media, etc. You wouldn't wake up in the morning and see Stalin on state TV for heavens sakes. And there is nothing to say that physicans couldn't play a major and even guiding role in how single payer would work and how their interests would be protected. There's nothing to prevent an implementation being reversed or substantially revised if all or certain aspects don't end up working. I don't think the citizens of Canada and the European countries believe they are living in gulags or in societies that are immoral by virtue of socialized medicine. I've heard that a group of Harvard MDs and med students have taken a stand in favor of single payer. Do you know anything about that?

What makes you think physicians would be involved? It is not as if ACA involved physician input- it was pushed politically. Similarly 44% of physicians were outright opposed to the law even before its roll out (and since up to 66% are). Doesn't exactly sound like physicians were involved if half were outright opposed to it...

You talk of repealing or revising something we don't like... Well ACA is largely unpopular with physicians (66% oppose it) and nothing is being done. Also, remind me again what social welfare program has ever been reversed in the history of the US?

 

[ridethecliche]

And after 75% taxes and a reduced income because you're no longer having to pay for your own education, you will be making $75,000.

Hahahahahahhahahhahahhaha.

Well I guess you realize the immorality of your ways. Perhaps a more apt analogy would really hit home:

Your insistance on your (and others') right to my labors is no different than some republican's insistance he can legislate away a woman's right to make decisions about her own body

You still missed the point broseph.

Most people don't understand the distinction between socialized medicine and socialized insurance.

*slow clap*

 

[Mad Jack]

Ummm, not exactly. I was trying to be polite and mature by not replying. I've heard more rational rants from adults talking to themselves on the side of the street.

I think you have a bizarre understanding of both morality and what single payer would look like. We would still live in th USA, where all of the legislative branches would remain intact, where you could protest and tweak via your professional bodies, the media, etc. You wouldn't wake up in the morning and see Stalin on state TV for heavens sakes. And there is nothing to say that physicans couldn't play a major and even guiding role in how single payer would work and how their interests would be protected. There's nothing to prevent an implementation being reversed or substantially revised if all or certain aspects don't end up working. I don't think the citizens of Canada and the European countries believe they are living in gulags or in societies that are immoral by virtue of socialized medicine. I've heard that a group of Harvard MDs and med students have taken a stand in favor of single payer. Do you know anything about that?

First off, no one cares what a bunch of medical students (who usually change substantially in their views by the end of residency care of the things they see) and academic physicians (who are shielded from what current and future practice would be like by their positions in the white tower of academia) take a stand about. They're the least realistic and most sheltered groups in regard to what actual medical practice, wages, and conditions are like.

Second, physicians don't have a whole hell of a lot of say in much- our own AMA threw us under the bus for Obamacare because the government gives them more money than physicians do (not even ****ing joking), and there's a whole lot more people that would like to see us hurt financially than would like to see us well off, because there is, as they say, only so much of the pie to go around.

I view socialism as unethical myself, as it arbitrarily takes from the productive and gives to the unproductive, often for things that serve no benefit to the productive person. If a wealthy person wants to help others, that should be their prerogative, not the government's. Again, this goes down to morality being taken away from individuals and given to a system that is inherently amoral at best and immoral at worst- you cannot force people to do good and still have it be "good." Practical, yes. Ethical, not so much.

 

[Med Ed]

Neither is good, and both suffer from largely the same problems- healthcare becomes an expense to be cut by Republicans looking to save on the budget, physician incomes become a line-item on the budget to be slashed, patient choice and options are limited, and production is put ahead of most other concerns. Certainly, there will be differences between the two systems, but both will be substantially worse for physicians.

Ah, I see. You just need to rant for awhile. Carry on.

 

[NeuResurgens]

How do these arguments line up with the clear cut fact that European nations which run these programs have far far better outcomes than any other nation on the globe.

I understand your point, but this is incredibly debatable and far from a clear cut fact.For example, one analysis found that life expectancies were higher in Europe than in the U.S., but when you control for the amount of people dying young from gun violence, car crashes and the like, our life expectancy shot up to par with the Europeans and even surpassed some.

My point is, there are valid arguments in favor of universal healthcare, but "far far better clinical outcomes" is not one of those.

 

[Nietzschelover]

I view socialism as unethical myself, as it arbitrarily takes from the productive and gives to the unproductive, often for things that serve no benefit to the productive person. If a wealthy person wants to help others, that should be their prerogative, not the government's. Again, this goes down to morality being taken away from individuals and given to a system that is inherently amoral at best and immoral at worst- you cannot force people to do good and still have it be "good." Practical, yes. Ethical, not so much.

You mean like unproductive children who can't pay?

 

[Nietzschelover]

What makes you think physicians would be involved? It is not as if ACA involved physician input- it was pushed politically. Similarly 44% of physicians were outright opposed to the law even before its roll out (and since up to 66% are). Doesn't exactly sound like physicians were involved if half were outright opposed to it...

You talk of repealing or revising something we don't like... Well ACA is largely unpopular with physicians (66% oppose it) and nothing is being done. Also, remind me again what social welfare program has ever been reversed in the history of the US?

Every Republican Prez in the last 50 years has slashed social programs.

 

[Instatewaiter]

Unfortunately that is not true

 

[Mansamusa]

And after 75% taxes and a reduced income because you're no longer having to pay for your own education, you will be making $75,000.

$75K will likely (hopefully at least) be my take home pay after I make my yearly loan payments. My payments will be $50K/yr for 20 yrs (unless I go into a specialty that pays over $300K and I can pay down faster)

 

[Mad Jack]

You mean like unproductive children who can't pay?

Children are the responsibility of their adult parents, a responsibility they willingly enter when they choose to follow through with a pregnancy. Comparing full-grown adults to children is degrading to them and a wholly disingenuous comparison.

Ah, I see. You just need to rant for awhile. Carry on.

A system in which the government pays other people to pay physicians is arguably worse than a system in which they pay physicians directly, and effectively makes the system the same as the military contract system for providing military equipment and services. Yeah, you're not technically employed by the government, but you still need to jump through all of their pre-ordained hoops while also having the guy running the operation skimming some cream off the top. The government, meanwhile, takes no responsibility for facilities, maintenance, or anything else- it's basically the worst of both worlds, and gives the government the ability to both depress wages while having plausible deniability for any of the public's complaints. Yeah, truly, an ideal system

 

[Nietzschelover]

Children are the responsibility of their adult parents, a responsibility they willingly enter when they choose to follow through with a pregnancy. Comparing full-grown adults to children is degrading to them and a wholly disingenuous comparison.

The point is.....do you believe children do NOT have a "right" to healthcare?

 

[Nietzschelover]

I have a feeling that if some of you were guaranteed more money than you expect, much greater autonomy about clinical decision making, more reasonable hours, better benefits, etc, etc you still would object solely because you believe people shouldn't be guaranteed health care.

 

[Mad Jack]

The point is.....do you believe children do NOT have a "right" to healthcare?

I believe it is within the right of states to establish programs for children if they feel that that is in-line with the values of their citizens. While I do not believe a child would have the "right" to my services, if I were in peds or FP, I'd take a good number of kids whose parents couldn't pay on my panel. Not because they have a right to my practice, but because sometimes the right thing to do doesn't have to do with rights. Now, I don't think society should force anyone to care for a population that they do not want to, regardless of whether caring for said individual is the right thing to do or not.

 

[Mad Jack]

I have a feeling that if some of you were guaranteed more money than you expect, much greater autonomy about clinical decision making, more reasonable hours, better benefits, etc, etc you still would object solely because you believe people shouldn't be guaranteed health care.

I generally object to anything that's going to make the deficit explode or put me under the thumb of Congress. Would you trust Congress to manage your child's high school? How about your grocery store? If you wouldn't want Congress managing these things, why in the **** would you want them managing every day of your very livelihood?

 

[Nietzschelover]

I generally object to anything that's going to make the deficit explode or put me under the thumb of Congress. Would you trust Congress to manage your child's high school? How about your grocery store? If you wouldn't want Congress managing these things, why in the **** would you want them managing every day of your very livelihood?

I think you are describing a very distorted picture of how things would work.

 

[Mad Jack]

I think you are describing a very distorted picture of how things would work.

Hardly. Appropriations for such a system would fall under, you guessed it, the Congressional Budget Office. You honestly think the Republicans wouldn't threaten to shut down funding every year or so, fight to make cuts, etc on the system?

 

[Nietzschelover]

Hardly. Appropriations for such a system would fall under, you guessed it, the Congressional Budget Office. You honestly think the Republicans wouldn't threaten to shut down funding every year or so, fight to make cuts, etc on the system?

For starters, ANY plan would have to get through Congress. Have you noticed that every Repub candidate has vowed to get rid of Obamacare on Day 1? There is no reason why physicians can't heavily influence ANY plan that goes through, and there's no reason in theory why physicians couldn't be front and center in determining how single payer would work. Listen, if it's truly unattractive to physicians across the board I wouldn't expect you or anyone else to support it.

 

[qwert876]

$75K will likely (hopefully at least) be my take home pay after I make my yearly loan payments. My payments will be $50K/yr for 20 yrs (unless I go into a specialty that pays over $300K and I can pay down faster)

Do you have $600,000 in loans?

 

[Instatewaiter]

Hardly. Appropriations for such a system would fall under, you guessed it, the Congressional Budget Office. You honestly think the Republicans wouldn't threaten to shut down funding every year or so, fight to make cuts, etc on the system?

And it's not just republicans. It's independents. It's democrats. It is any politician who has to pay for a program on a budget without having to raise taxes significantly.

 

[Mansamusa]

Do you have $600,000 in loans?

It'll be about $320-330K, which will be close to $600K once residency is finished

(AAMC First loan calculator projects the total pay out to be $1 million if I take 20yrs after residency to pay. If I do a 6yr residency the monthly payment to pay off in 10yrs will be $12.5K/month so I likely won't be doing that)

 

[ridethecliche]

First off, no one cares what a bunch of medical students (who usually change substantially in their views by the end of residency care of the things they see) and academic physicians (who are shielded from what current and future practice would be like by their positions in the white tower of academia) take a stand about. They're the least realistic and most sheltered groups in regard to what actual medical practice, wages, and conditions are like.

Second, physicians don't have a whole hell of a lot of say in much- our own AMA threw us under the bus for Obamacare because the government gives them more money than physicians do (not even ****ing joking), and there's a whole lot more people that would like to see us hurt financially than would like to see us well off, because there is, as they say, only so much of the pie to go around.

I view socialism as unethical myself, as it arbitrarily takes from the productive and gives to the unproductive, often for things that serve no benefit to the productive person. If a wealthy person wants to help others, that should be their prerogative, not the government's. Again, this goes down to morality being taken away from individuals and given to a system that is inherently amoral at best and immoral at worst- you cannot force people to do good and still have it be "good." Practical, yes. Ethical, not so much.

I believe we have incommensurable definitions for what constitutes morality. Our government also gives tons of money to corps and has a tax code that allows them to escape paying much if anything in many circumstances. I'd consider that at best immoral and at most unethical.

 

[Mad Jack]

I believe we have incommensurable definitions for what constitutes morality. Our government also gives tons of money to corps and has a tax code that allows them to escape paying much if anything in many circumstances. I'd consider that at best immoral and at most unethical.

I also consider those practices to be immoral and unethical. We have no disagreement in that regard.

 

[Instatewaiter]

I believe we have incommensurable definitions for what constitutes morality. Our government also gives tons of money to corps and has a tax code that allows them to escape paying much if anything in many circumstances. I'd consider that at best immoral and at most unethical.

Giving tons of money to corporations I view as immoral. Paying less tax which is allowed by law- not immoral. Quite frankly it is their money. They shouldn't pay a dime above what they need to by law.

 

[ridethecliche]

Giving tons of money to corporations I view as immoral. Paying less tax which is allowed by law- not immoral. Quite frankly it is their money. They shouldn't pay a dime above what they need to by law.

So can I incorporate myself, declare bankruptcy after med school, and profit?

I mean, if they have people rights and all.

I'm basically saying that an update to the tax code can probably generate all this money that everyone has been freaking out about. Sure a few players might leave, but this market is pretty gigantic. It's not like they'll stop doing business here. China is too unpredictable for the likes of many western companies as a place to set up shop. but i digress...

 

[AirplaneFruit]

White males are the most sensitive, easily-offended people in history. "But muh RIGHTS to call people N-words!!!"

 

[ZedsDed]

White males are the most sensitive, easily-offended people in history. "But muh RIGHTS to call people N-words!!!"

Thanks for your contribution...

 

[Montisumo]

It's probably no secret on SDN that I'm a libertarian-conservative: I don't believe healthcare should be a right. I don't believe government has any role in dictating what women should do with their bodies. And I certainly don't believe that the government should be spending itself into a fiscal cliff.

But since I'm starting med school in the Fall, there's one thing I'm concerned about, and that's whether I will be discriminated against in med school for not being a liberal (especially in this PC and microaggression climate).

Should I be concerned?

i think you are an amazing person first and foremost. your political views make up just a small portion of who you are. you'll be fine making friends. Besides, there's plenty of conservatives in texas right?

 

[bumblebee611]

I thought they were useless because they didn't take into account the possibility that disparities between the sexes may be due to biological differences. Such a blank-slate, pseudo-Marxist "analysis" is incomplete and disingenuous at best. There are issues, obviously. But not all inequality is evidence of oppression.

So is an African-American history course useless if it doesn't take into account the "possibility" (ahem, I think you mean racist canard) that disparities between the races "may be due to biological differences"? Better yet, how about some kind of comparative literature course that doesn't take into account the "possibility" that different forms of literature "may be due to biological differences"?

 

[ZedsDed]

So is an African-American history course useless if it doesn't take into account the "possibility" (ahem, I think you mean racist canard) that disparities between the races "may be due to biological differences"? Better yet, how about some kind of comparative literature course that doesn't take into account the "possibility" that different forms of literature "may be due to biological differences"?

Great. More straw man arguments. I don't have time to get into another "debate" with a walking satire of Tumblr. Try reading the thread next time before throwing out ignorant and puerile comments.