Medicare for all and physician salaries

[jambro]

An insurance company has incentive to cover enough things easily enough that people and companies want buy and incentive to pay well enough easily enough for me to take their insurance.

Govt has none of that due to their power over everyone

I think that the biggest philosophical issue I have with the whole free market thing is that medical insurance just can't be. Most people have it tied to their employer, and thats it. Others buy the cheapest one they can. Others can't afford it so go without. But everyone needs it. Its just not the kind of thing a free market works well for - unlike video games, cars, restaurants, etc.

The outcomes are better... for those who actually survive. The denominator is different.

Second, if you’re willing to trust a plumber with your car go right ahead, but I would prefer the mechanic.

Third, you missed a word in your statement about more people leaving the US to get care. They leave to get WORSE, cheaper care. We just had a young lady who went to Mexico to get treated for the multiple infections she was having. They made a huge incision, nicking a vessel... and removed her spleen. She returned to the US, was hospitalized with massive MRSA sepsis (that kind of happens when you remove the only organ that fights infection), and was dead in 3 days. That’s cheaper care... it’s pretty cheap to have her die at 25 than live out the rest of her life.

Of course the government has an incentive to deny care. How would they support their programs otherwise? The biggest care denier both my father and I deal with is the government, not private insurance. It’s not even close.

Calling physicians in other countries (especially western ones) plumbers vs. mechanics is so condescending and ridiculous. Again if its worse why does the US not have better outcomes then? You keep telling me how great it is. How is that not shown in outcomes? And yet more anecdotal evidence... give me some statistics dude.

It will never pass. This utopia doesn't and won't exist, and it will end up in the crapper like every socialist society ever has. Put some law in to hold insurers and big pharma accountable and that will help. /thread

Scandinavian countries significantly outperform the US in virtually everything... and the US is imploding thanks to a destroyed middle class.

1. Military action is legitimate role of govt and sometimes subcontractors are efficient
2. See #1
3. Govt shouldn’t be using tax funds on health research at all

Govt should not be engaged in general health care provision at all

Why is military action a legitimate role of government and yet providing healthcare is not? What use is freedom (assuming our military action equals freedom) if people die from no healthcare? And subcontractors are the worst example you could've possibly given, they completely gouge the US gov with insane prices and that's a known fact.

Lastly, I can't believe you said you wish the NIH doesn't exist

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[Disciple of Sattar]

How do you figure that the number of patients will decrease? It seems intuitive that extending coverage to the entire population will lead to a higher utilization of healthcare, not lower. Yes, if we invest heavily in preventative med, we might see a decrease (or a decrease in the rate of growth) but that would be many years down the line. I should also note that the reason Canadian physician salaries are higher relative to other single payer systems is that they need to prevent people from hopping the border to practice in the US to make more money.

I also don't fully buy the brain drain argument. Yes, the drop in salaries will deter a few people, but medicine is still an incredibly prestigious career and I don't think admissions standards will start dropping too quickly, especially at the tippy-top of elite schools. There are simply too many applicants for number of seats.

Physicians salaries haven't even kept pace with inflation and they account for ~10% of healthcare spending, I don't think slashing our salaries will be tenable given the massive debt and education burden. Even cutting salaries in half would only decrease spending by 5%. The real sink is administration costs and the massive profits being made by insurance and pharmaceutical companies. If there is a massive impetus to cut salaries, the AMA (or another physicians' union with teeth) needs to start doing its job.

To be clear, I think universal coverage is a moral imperative, but discussions about its implementation should be welcome.

"Losing top minds" has nothing to do with running out of 4.0 528 applicants to top schools.

 

[Chibucks15]

I think that the biggest philosophical issue I have with the whole free market thing is that medical insurance just can't be. Most people have it tied to their employer, and thats it. Others buy the cheapest one they can. Others can't afford it so go without. But everyone needs it. Its just not the kind of thing a free market works well for - unlike video games, cars, restaurants, etc.



Calling physicians in other countries (especially western ones) plumbers vs. mechanics is so condescending and ridiculous. Again if its worse why does the US not have better outcomes then? You keep telling me how great it is. How is that not shown in outcomes? And yet more anecdotal evidence... give me some statistics dude.



Scandinavian countries significantly outperform the US in virtually everything... and the US is imploding thanks to a destroyed middle class.



Why is military action a legitimate role of government and yet providing healthcare is not? What use is freedom (assuming our military action equals freedom) if people die from no healthcare? And subcontractors are the worst example you could've possibly given, they completely gouge the US gov with insane prices and that's a known fact.

Lastly, I can't believe you said you wish the NIH doesn't exist

That's always the counterpoint...except we are literally nothing like Scandanavia. Population size, density, overall population health, comorbities, age range, etc. We're too big for something like that to ever work, it would simply be too costly. I'd definitely prefer to pay less taxes, especially with 6 figure medical school debt. You're naive and I'm done with this.

 

[jambro]

That’s actually not a totally unreasonable point, but it requires too many “ifs” and I don’t like that. You shouldn’t either.

PMCs are a bad example because they’re allowed to do business with other governments, except in certain cases. For instance, our gun manufacterers supply the whole world’s armies. With some exceptions they can theoretically sell to whomever they want. So the US govt needs to pay market rate.

Private Prisons are a very unique example. They save money by abusing a segment of society that no one cares about. That’s why they can do the job cheaper than the govt. try doing that with sick people and see how far you get.

The thing is I don't think that private prisons do save any money. Private Prisons’ Cost Benefits Debated

That's always the counterpoint...except we are literally nothing like Scandanavia. Population size, density, overall population health, comorbities, age range, etc. We're too big for something like that to ever work, it would simply be too costly. I'm done with this.

Insurance systems work better as you scale them up

 

[nimbus]

If you really want to be depressed, speak to a doctor who works in the UK. Government cuts their salary and increases their hours and patient load on a whim. The public just sees them as greedy and thinks they should work for free, and they can’t strike, so the government and the public craps all over them. It’s a field the smart students avoid. On the plus side, I guess, you can’t really sue them.

Yep, they import healthcare workers like we import farm workers. Brexit is throwing the NHS into chaos.

 

[Chibucks15]

The thing is I don't think that private prisons do save any money. Private Prisons’ Cost Benefits Debated





Insurance systems work better as you scale them up

I'd rather take my chances with private than the government. You can't possibly say they don't mess up most things they touch (at least the first time until they fix it). Your opinions aren't the majority anywhere outside NYC or Cali. Have a nice life

 

[deleted480308]

I think that the biggest philosophical issue I have with the whole free market thing is that medical insurance just can't be. Most people have it tied to their employer, and thats it. Others buy the cheapest one they can. Others can't afford it so go without. But everyone needs it. Its just not the kind of thing a free market works well for - unlike video games, cars, restaurants, etc.



Calling physicians in other countries (especially western ones) plumbers vs. mechanics is so condescending and ridiculous. Again if its worse why does the US not have better outcomes then? You keep telling me how great it is. How is that not shown in outcomes? And yet more anecdotal evidence... give me some statistics dude.



Scandinavian countries significantly outperform the US in virtually everything... and the US is imploding thanks to a destroyed middle class.



Why is military action a legitimate role of government and yet providing healthcare is not? What use is freedom (assuming our military action equals freedom) if people die from no healthcare? And subcontractors are the worst example you could've possibly given, they completely gouge the US gov with insane prices and that's a known fact.

Lastly, I can't believe you said you wish the NIH doesn't exist

Of course insurance can work. It’s only tied to employment because of govt interference and it’s only prohibitively expensive because of all the dumb requirements govt puts in.

The type of insurance that would most appropriate (catastrophic) is not that expensive. And people paying cash for basic maintenance would drive down utilization and prices

Due to not having VA disability forever, it is occasionally cheaper to hire military contractors

And yes, cancel general govt health research

 

[Peach Newport]

1. I’m not a dude, I’m a woman.
2. Your reading comprehension is off. The people I’m calling plumbers are the government, not physicians. When I decide that something is medically necessary, I don’t want the government telling me it isn’t. Which in a socialist nation, it will routinely do.
3. As far as the outcomes you keep harping on, I don’t have to go far from my own field. The Netherlands has a much better hip fracture outcome than the US, and can run trials of the type we cannot. But the Netherlands have a homogeneous population, high compliance rates, low need for narcotics. They don’t have 50% obesity rates. That’s the difference. It is a completely different patient population. You can’t make gold from s**t.

I don’t get why no one gets this. If we really wanted great healthcare outcomes, we would actually legislate primary prevention.

If we really wanted to compete with Norway, banning 60oz soft drinks and funding our public schools would do 50x more than overhauling our healthcare system to single payer.

 

[doc05]

Maybe all of the docs in support of MFA can just offer free or vastly reduced prices for their services to those that need them. That way they can feel charitable and give up most of their salary without advocating for the destruction of the profession for everyone else.

Actually, most of us already do that.

 

[VA Hopeful Dr]

1. I’m not a dude, I’m a woman.
2. Your reading comprehension is off. The people I’m calling plumbers are the government, not physicians. When I decide that something is medically necessary, I don’t want the government telling me it isn’t. Which in a socialist nation, it will routinely do.
3. As far as the outcomes you keep harping on, I don’t have to go far from my own field. The Netherlands has a much better hip fracture outcome than the US, and can run trials of the type we cannot. But the Netherlands have a homogeneous population, high compliance rates, low need for narcotics. They don’t have 50% obesity rates. That’s the difference. It is a completely different patient population. You can’t make gold from s**t.

So there's a few articles worth noting.

The first is my all time favorite: The Myth of Americans' Poor Life Expectancy

Turns out if you take out deaths from violence and car wrecks, our life expectancy is pretty damned good. Oh and our cancer patients do much better than anywhere else.

Second is this one: Global Obesity Levels - Obesity - ProCon.org

Turns out you have bad outcomes if you have the highest obesity rate in the developed world. Like diabetes maybe: https://endocrinenews.endocrine.org/u-s-leads-developed-nations-in-diabetes-prevalence/


But nah, its clearly our lack of single payer that's the problem.

 

[VA Hopeful Dr]

Actually, most of us already do that.

Yep. I'm hospital employed so I can't not charge people, but I will aggressively downcode uninsured patients (when they aren't jerks).

 

[doc05]

So there's a few articles worth noting.

The first is my all time favorite: The Myth of Americans' Poor Life Expectancy

Turns out if you take out deaths from violence and car wrecks, our life expectancy is pretty damned good. Oh and our cancer patients do much better than anywhere else.

Second is this one: Global Obesity Levels - Obesity - ProCon.org

Turns out you have bad outcomes if you have the highest obesity rate in the developed world. Like diabetes maybe: https://endocrinenews.endocrine.org/u-s-leads-developed-nations-in-diabetes-prevalence/


But nah, its clearly our lack of single payer that's the problem.

Your source is terribly inaccurate. It says 36% obesity in the U.S. That’s a gross underestimate.

 

[VA Hopeful Dr]

Your source is terribly inaccurate. It says 36% obesity in the U.S. That’s a gross underestimate.

It is 3 years old

 

[atomi]

Why is military action a legitimate role of government and yet providing healthcare is not? What use is freedom (assuming our military action equals freedom) if people die from no healthcare?

Article I, Section 8, Clause 12 of the constitution.

https://www.usconstitution.net/xconst_A1Sec8.html

People die anyway. Forcing the general population to pay for your preventative healthcare, elective procedures, emergent care, and end of life care trying to squeeze every last second out of life so that you don't have to bear the burden of having to provide for your own physical well-being is unconstitutional as it deprives others of liberty.

You have a right to life as in no one can take it away from you. But the natural history of life always ends in death regardless who pays for your healthcare and what services you receive. You do not have a right to force others to provide you with maximized longevity. If you want longevity and health, you should bear the burden to provide it for yourself if you are able. If you are not able (e.g., if you are a child, if you are mentally or physically disabled, if you are elderly), then it is reasonable to expect a reasonable amount of societal-provided care as a compassionate societal responsibility for these people to prevent suffering.

 

[atomi]

This thread has turned into a political discussion but to the original point: physician incomes are unlikely to increase above inflation as it is and it doesn’t do you any good to stress about *possible* legislation and drastic changes that may result. In any case students/residents should minimize their debt the best they can, live below their means, and make hay while the sun shines.

It was a political topic to start with. Young people choosing their paths in life would be wise to consider how proposed legislation may impact their employment situation and compensation model going forward with a 30-40 year career.

 

[Boola Boy]

Medicare for all won’t work.

Definitely agree with incentivizing preventive care and reducing obesity rates, but people don’t want long-term solutions.

I hope I get a scholarship lol otherwise my financial future is looking real grim. Might even sign up to go rural...

 

[doc05]

Medicare for all won’t work.

Definitely agree with incentivizing preventive care and reducing obesity rates, but people don’t want long-term solutions.

I hope I get a scholarship lol otherwise my financial future is looking real grim. Might even sign up to go rural...

Yes, it will work. Not this year, but defintely during your working years. So be prepared

 

[Psai]

It will cut physician pay by HALF.

Docs will make less than what CRNAs/PAs/NPs currently make.

Source: look at Canada or England

Do they even have midlevels in canada? Their family docs and anesthesiologists make more than we do here.

 

[TheRealCookieMonster]

my financial future is looking real grim.

You must have some special circumstances? Because anyone going into medicine knows it's one of the most lucrative and least risky educational investments available. Do the work = Make bank.

1. Military action is legitimate role of govt and sometimes subcontractors are efficient
2. See #1
3. Govt shouldn’t be using tax funds on health research at all
Govt should not be engaged in general health care provision at all

Inspiring Liberals around the world.

 

[Kuratz]

It was a political topic to start with. Young people choosing their paths in life would be wise to consider how proposed legislation may impact their employment situation and compensation model going forward with a 30-40 year career.

Absolutely they would be wise to be aware of the practice landscape. This thread is in the context of people who are already medical students or beyond. If you already have racked up a quarter-mil in medical education costs, as I have, then making a career switch saddled with debt when residency is just around the corner would be premature. For a pre-med the financial decision to attend medical school isn't as clear cut as it may have been previously, but for those of us in M3/M4 I'd still argue the best thing is to understand the potential changes facing medicine and continue through residency. As it stands now medicine is still a pretty damn good profession. That may change but until it does then it isn't worth getting worked up about. And regardless of if **** hits the fan or not my point was that one of the wisest things to do financially is to live within your means because of the flexibility it affords.

 

[wontonsoup]

I'm curious what the physicians in this thread think of a capitation payment scheme instead of fee-for-service. To my knowledge, Kaiser uses capitation in California and their system is reporting lower overall costs, higher physician/patient satisfaction, and wages are market-based supplemented by incentive-based bonuses. Is there any reason we couldn't use this as a model for the rest of the US?

It seems to me from this thread that a lot of the frustration around M4A is possibility of claims being denied outright or the bureaucratic red tape which ties physicians' hands in terms of decision-making and that a capitation system would remove a lot of those problems.

 

[alprazoslam]

It will never pass. This utopia doesn't and won't exist, and it will end up in the crapper like every socialist society ever has. Put some law in to hold insurers and big pharma accountable and that will help. I'm usually right in the middle on things, and I'm all for moving forward to a better system, but dumb stuff that will obviously fail isn't the way to go./thread

EDIT: Also, for all the hype this gets out on the coasts, I think NY and Cali severely overestimate how much the middle of the country agrees with most of their extremely progressive ideals.

But that’s to reasonable. It’s either total free market with everyone running around with ak 47s or government supreme socialism like USSR.

Just working to cut down on current corruption on lobbying doesn’t get people’s feel good emotions rolling.

 

[Med Ed]

Thoughts on a two tiered system?

A very reasonable option given America's idiosyncrasies. If something that could be deemed "Medicare for all" is enacted I imagine it would push us further toward a two tiered model.

It is rather ironic that the only reason we are having this discussion is because republicans got so close to repealing the ACA. If they just left it alone they might still have the House.

 

[deleted480308]

A very reasonable option given America's idiosyncrasies. If something that could be deemed "Medicare for all" is enacted I imagine it would push us further toward a two tiered model.

It is rather ironic that the only reason we are having this discussion is because republicans got so close to repealing the ACA. If they just left it alone they might still have the House.

Trump is why they lost the house (energized dems) along with a disillusioned base precisely because they didn’t repeal ACA.

They should have repealed it outright

 

[alprazoslam]

mindless liberal arts college kids and people wanting free stuff and voting for the likesof occasional cortex and her minions are the reason we lost the house

Fixt it lol

 

[Med Ed]

Trump is why they lost the house (energized dems) along with a disillusioned base precisely because they didn’t repeal ACA.

This might be logical if the ACA were unpopular, but it isn't (at least not anymore). Even red states like Nebraska, Idaho, and Utah have seen ballot measures pass to expand Medicaid. Preexisting condition coverage has become a new political third rail.

The One Issue That's Really Driving the Midterm Elections
The Fate of Obamacare's Most Popular Provision

 

[whoknows2012]

It was a political topic to start with. Young people choosing their paths in life would be wise to consider how proposed legislation may impact their employment situation and compensation model going forward with a 30-40 year career.

Instead of this devolving into right vs left we should try to understand the sentiment behind wanting a single payer system;
More people insured
Protections for vulnerable patients
Better preventative care
Possibility of Improved health care outcomes

Legislators on the progressive left in my opinion are just looking for a system that insures the most people and hoping that outcomes will improve following that. Obviously we know they don’t necessarily go hand in hand which is why we are going to continue to need healthy debate to find a system that works better than what we currently have. This also involves drug pricing which is ballooning out of control. Having 10% of our population uninsured doesn’t work. Having people kicked off insurance plans or paying through the roof for premiums doesn’t work.

I went back and reviewed some old posts I made on sdn back when I started med school a decade ago. The same type of health care debate was going on with much of the same sentiment. I was posting in a thread which is eerily similar to this.

Point is this type of discussion always spooks med students residents/fellows and physicians in practice for a variety of reasons. Facts are facts though. There is literally no possible way as I’ve said and many others have said, that legislation for a single payer only plan could pass at any point in the near future. Best case for supporters of a Medicare for all and abolishing private health insurance is a compromise with expanded Medicare with more regulations on private health insurers. Kind of like ACA but with some fixes.

I suspect 10 yrs from now the same discussion will be going on while private health insurance companies still exist.

 

[studentdoct4281]

Lmao “Medicare for all”: where doctors will literally be supplying the funds for their own personal salary and even counterparts/competitor’s salary with their OWN taxes paid.

Lollllll. How are people so dumb...

 

[studentdoct4281]

“Medicare for all”: where doctors literally pay their own patients to treat them

 

[RNthenDoc]

Do they even have midlevels in canada? Their family docs and anesthesiologists make more than we do here.

Yes they do have midlevels.

Google tells me Canadians make 204k for family practice (have to convert to USD, the dollar is stronger) and have a Canadian-level tax and COL.

Here we have 227k average for family practice, with American taxes and COL.

Definitely a wider gulf in Europe as far as compensation, but there’s a pretty stark difference between the above anyway!

 

[atomi]

This might be logical if the ACA were unpopular, but it isn't (at least not anymore). Even red states like Nebraska, Idaho, and Utah have seen ballot measures pass to expand Medicaid. Preexisting condition coverage has become a new political third rail.

The One Issue That's Really Driving the Midterm Elections
The Fate of Obamacare's Most Popular Provision

Making healthcare affordable is of course popular. The problem is that the ACA artificially redistributed the true actuarial cost of "insurance" and thereby actually made healthcare more expensive and less accessible. This should surprise no one.

Healthcare service is a commodity, and when the government pre-determines what it is wiling to pay for this commodity without regard to the free market, providers (not just solo practioners, but including for-profit and non for-profit hospitals) lose the profit incentive to provide better care. Nobody wants to fill their schedule primarily with patients who have pre-set low reimbursement rates who take up spots from private insurers and cash payers that pay much better. As a result, the best providers refuse to see these patients and the providers who do are the ones who for whatever reason have no other choice. Demand goes up when there is no longer a requirement for cash to change hands at the time of service, the system becomes overburdened, wait times increase, provider quality of care goes down, and the cost for everybody else paying their own way goes way up. Government intervention in healthcare is a total fail situation from every angle and for every participant.

Once again, socialist policies harm the poorest and most vulnerable citizens, as they always do. They cannot afford more expensive insurance and have to fight for their place in line for the handout scraps, under the farce that they are getting a good deal because no cash leaves their wallet. With ACA, they still had to pay for (more expensive) "insurance," and guess what? The number of uninsured went up even though that was supposed to be against the rules.

The solution is, and always has been, open markets and transparent pricing.

 

[Med Ed]

Making healthcare affordable is of course popular. The problem is that the ACA artificially redistributed the true actuarial cost of "insurance" and thereby actually made healthcare more expensive and less accessible. This should surprise no one.

Thanks, Obamacare: America's Uninsured Rate is Now Lowest Ever (2015)

 

[Giovanotto]

I will work exactly as hard as you pay me to work. Currently I'm paid based on billing so I work my tail off. If you salary me at half what I make now I will absolutely work half as hard.

except you won't because you won't have any bargaining power at that point.

 

[atomi]

Thanks, Obamacare: America's Uninsured Rate is Now Lowest Ever (2015)

Right. In the parentheses. 2015. That was right after the ACA went into effect. Due in part to the subsequent price increases and lack of insurers in the marketplace the uninsured rate is now rising steadily and pushing past where it started.

 

[Med Ed]

Right. In the parentheses. 2015. That was right after the ACA went into effect. Due in part to the subsequent price increases and lack of insurers in the marketplace the uninsured rate is now rising steadily and pushing past where it started.

Two New Federal Surveys Show Stable Uninsured Rate (2018)

 

[jambro]

I'd rather take my chances with private than the government. You can't possibly say they don't mess up most things they touch (at least the first time until they fix it). Your opinions aren't the majority anywhere outside NYC or Cali. Have a nice life

Don't freak out, but more republicans support medicare for all than do not.

When I decide that something is medically necessary, I don’t want the government telling me it isn’t. Which in a socialist nation, it will routinely do.
3. As far as the outcomes you keep harping on, I don’t have to go far from my own field. The Netherlands has a much better hip fracture outcome than the US, and can run trials of the type we cannot. But the Netherlands have a homogeneous population, high compliance rates, low need for narcotics. They don’t have 50% obesity rates. That’s the difference. It is a completely different patient population. You can’t make gold from s**t.

I’m also done with the thread. Please go move to whatever socialist sh**hole you want to, and have a struggling immigrant take your place who actually appreciates what this country can provide, and doesn’t expect their hand to be held for the rest of their lives.

Again, to pretend that only the government has an incentive to deny care from physicians is just ridiculous. I tis literally the obligation of an insurance company to do that, however. In fact there are testimonials that, the more rejections, the higher the salaries of some insurance bureaucrats. That's horrible.

Lastly, I'm not sure why you're so triggered by the idea of covering everyone. I'm also not sure what "****hole" socialist country you would be talking and in what way they are "****holes" compared to the US. Paid time off, healthcare, tuition costs, how are they ****holes? And, my mom was a struggling immigrant, so I definitely appreciate the opportunities here. Just looking to make it better for everyone.

Actually, most of us already do that.

I think it'd be better to get paid for your work, so that's why I support MFA.

Article I, Section 8, Clause 12 of the constitution.

https://www.usconstitution.net/xconst_A1Sec8.html

. Forcing the general population to pay for your preventative healthcare, elective procedures, emergent care, and end of life care trying to squeeze every last second out of life so that you don't have to bear the burden of having to provide for your own physical well-being is unconstitutional as it deprives others of liberty.

You have a right to life as in no one can take it away from you. But the natural history of life always ends in death regardless who pays for your healthcare and what services you receive. You do not have a right to force others to provide you with maximized longevity. If you want longevity and health, you should bear the burden to provide it for yourself if you are able. If you are not able (e.g., if you are a child, if you are mentally or physically disabled, if you are elderly), then it is reasonable to expect a reasonable amount of societal-provided care as a compassionate societal responsibility for these people to prevent suffering.

I'm not sure how providing things through taxation takes away people's liberty. Also, why would anyone under MFA not be providing for themselves? Everyone is chipping in and paying taxes for healthcare.

Lmao “Medicare for all”: where doctors will literally be supplying the funds for their own personal salary and even counterparts/competitor’s salary with their OWN taxes paid.

Lollllll. How are people so dumb...

Hmm, I didn't realize that medicare taxes on physician salaries could literally pay for the healthcare of the entire country. Man physicians must be rich!

Once again, socialist policies harm the poorest and most vulnerable citizens, as they always do. They cannot afford more expensive insurance and have to fight for their place in line for the handout scraps, under the farce that they are getting a good deal because no cash leaves their wallet. With ACA, they still had to pay for (more expensive) "insurance," and guess what? The number of uninsured went up even though that was supposed to be against the rules.

The solution is, and always has been, open markets and transparent pricing.

You're arguing that socialist systems treat poorer and more vulnerable citizens worse than, for example, the one in the United States? Are we ignoring the ones who die from not having healthcare or no? Then again, you're right. If someone was bleeding out, but knew that the hospital 2 hours away charged less, they could just go there instead and force the hospital 5 minutes away to lower their prices. Oh wait, I forgot, they were unconscious and bleeding out and an ambulance took them to the nearest hospital. Period.

 

[nimbus]

Hey I completely agree, twin that much money with 1/3rd the income would be crazy. The thing is I think you're just throwing those numbers around (1/3rd) without any logic or reason because you're uncomfortable with change, and you want to portray any change as being obviously catastrophic for physicians so that we keep the status quo which is good in some ways for some people.

In anesthesia those are real numbers and current reality. Medicare pays 1/3 of what the crappiest private insurers pay. In addition they institute ridiculous surrogate quality measures that have nothing to do with quality but it’s easy enough to click the boxes on EMR.

 

[jambro]

I think that different specialties would be hit harder than others according to current medicare rates, but I'm not suggesting that I think medicare rates are inherently reasonable right now. After all, many times there are discounts for the elderly, and medicare is a program for the elderly. It could be thought of as discounted rates. So, if medicare for all was instituted and everyone had the program, those low rates might not be sustainable. I just think that the single payer system is a good idea.

 

[dohopeful13]

Hmm, I didn't realize that medicare taxes on physician salaries could literally pay for the healthcare of the entire country. Man physicians must be rich!

That's not what he's saying. He's saying physicians will be taxed heavily to fund the program that has already resulted in taking half or more of their salary.

Don't freak out, but more republicans support medicare for all than do not.
.

Public support for MFA drops to the mid 30% range for all Americans when it A) involves removing private insurance or B)involves raising taxes on most Americans. Both of those qualifiers would happen in the current Bernie Sanders bill. People always support ideas that sound great on the surface until they have to think about actually paying for it

 

[wimby2016]

A couple of things.

1. The term "Medicare for all" is getting thrown around a lot lately, but without a specific policy proposal it is rather futile to read the tea leaves. It could mean making Medicare available to everyone regardless of age (i.e. a public option), or it could mean destroying the private health insurance industry. It could mean Medicare as it is now (premiums, copays, etc.), or it could mean a 100% tax-funded system without premiums or copays. So if you want to have a discussion about this I think you need to pick one model and be clear about your question.

2. Physician salaries in Canada are an interesting study. On average generalists make more than their US counterparts and specialists make less. Overall physician satisfaction actually tends to be higher, because they spend more of their time practicing and less of their time navigating insurance. Coding and billing is essentially uniform within each province. IMHO their systems for handling malpractice are superior to ours, and lead to fewer concerns about defensive medicine. All that said, I strongly doubt that a sudden shift to a Canadian model would be politically feasible in this country.

I think (not totally sure) the idea of medicare for all most people have in their head isn't really "medicare," but a single payer system without any premiums or copays. So that's the version I'm asking about...

 

[jambro]

That's not what he's saying. He's saying physicians will be taxed heavily to fund the program that has already resulted in taking half or more of their salary.




Public support for MFA drops to the mid 30% range for all Americans when it A) involves removing private insurance or B)involves raising taxes on most Americans. Both of those qualifiers would happen in the current Bernie Sanders bill. People always support ideas that sound great on the surface until they have to think about actually paying for it

He’s implying that physician taxes will be a large source of revenue the for the plan which they will not be. Everyone will be paying into it and yes higher earners will be paying relatively more. But to imply it’s literally physician salaries paying for patients to get healthcare is ridiculous.


Public support would increase when they realize how great an insurance system Medicare’s is, the most popular insurance in America. And a vast majority of people will pay significantly less in extra taxes than they do now in healthcare spending. And MFA saves trillions compared to our current system.

 

[deleted480308]

He’s implying that physician taxes will be a large source of revenue the for the plan which they will not be. Everyone will be paying into it and yes higher earners will be paying relatively more. But to imply it’s literally physician salaries paying for patients to get healthcare is ridiculous.


Public support would increase when they realize how great an insurance system Medicare’s is, the most popular insurance in America. And a vast majority of people will pay significantly less in extra taxes than they do now in healthcare spending. And MFA saves trillions compared to our current system.

No. “Everyone” would not at all be paying into it, certainly not paying their actual cost. That will just create more burden for those of us making money who will now make less

It’s one of the reasons for so many people to like the plan, free stuff is popular

 

[VA Hopeful Dr]

except you won't because you won't have any bargaining power at that point.

This is easily one of the most worthless posts I've seen in some time.

It's not about bargaining power, its about not working as hard. Instead of busting my ass to see every patient I can including same days and walk ins, I will see scheduled patients only, no double booking, no walk ins. You get the idea.

 

[TheHikingDoctor]

Corporate for-profit medicine is the one thing that is more evil than single payer. I’d rather work for the government than for “investors”.

No you would not. As a former federal employee I can assure you, you would not.

 

[TheHikingDoctor]

This is easily one of the most worthless posts I've seen in some time.

It's not about bargaining power, its about not working as hard. Instead of busting my ass to see every patient I can including same days and walk inside, I will see scheduled patients only, no double booking, no walk inside. You get the idea.

Once the government gets involved you may not have a choice.

 

[deleted480308]

This is easily one of the most worthless posts I've seen in some time.

It's not about bargaining power, its about not working as hard. Instead of busting my ass to see every patient I can including same days and walk inside, I will see scheduled patients only, no double booking, no walk inside. You get the idea.

it's like people have never been to the DMV or the building dept...

Once the government gets involved you may not have a choice.

see above

 

[TheHikingDoctor]

No, it would just become even more a profession only for rich kids as it traditionally was before the loan servicing industry saw an opportunity to profit. Right now poor and middle class kids can become doctors if they are willing to become an indentured servant at a criminal 7% interest rate that will take them 15 years to pay back while their rich colleagues instead enjoy 15 years of maxing out retirement accounts that grow tax free through recent tax loopholes.

Medicine is basically one step above cash advance stores at this point in terms of exploiting people trying to work and advance in life.

Life isn't fair. Sometimes you start out ahead, sometimes behind but at least in America you can do and be what you want. It's not criminal because they are taking the risk at not being paid back and often they're not.

 

[TheHikingDoctor]

it's like people have never been to the DMV or the building dept...


see above

I agree. My perspective is as a former Infantry Officer so my outlook on the matter and working for the government could be a bit more dire.

 

[VA Hopeful Dr]

I agree. My perspective is as a former Infantry Officer so my outlook on the matter and working for the government could be a bit more dire.

Doesn't the army have a very specific word for avoiding work - gold brick?

 

[Dr G Oogle]

How do you figure that the number of patients will decrease? It seems intuitive that extending coverage to the entire population will lead to a higher utilization of healthcare, not lower. Yes, if we invest heavily in preventative med, we might see a decrease (or a decrease in the rate of growth) but that would be many years down the line. I should also note that the reason Canadian physician salaries are higher relative to other single payer systems is that they need to prevent people from hopping the border to practice in the US to make more money.

I also don't fully buy the brain drain argument. Yes, the drop in salaries will deter a few people, but medicine is still an incredibly prestigious career and I don't think admissions standards will start dropping too quickly, especially at the tippy-top of elite schools. There are simply too many applicants for number of seats.

Physicians salaries haven't even kept pace with inflation and they account for ~10% of healthcare spending, I don't think slashing our salaries will be tenable given the massive debt and education burden. Even cutting salaries in half would only decrease spending by 5%. The real sink is administration costs and the massive profits being made by insurance and pharmaceutical companies. If there is a massive impetus to cut salaries, the AMA (or another physicians' union with teeth) needs to start doing its job.

To be clear, I think universal coverage is a moral imperative, but discussions about its implementation should be welcome.

The number of patients needing to be seen wouldn’t decrease but the number of patients who are seen would decrease because there would be no incentive to see more if everyone is paid at a similar rate and there is no incentive to see more patients. I also think everyone should get coverage and have access to care but I don’t believe a single payer system will result in anything but a bottle neck in patient care.