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Moving to Topics in Healthcare.
Doesn't the army have a very specific word for avoiding work - gold brick?
No you would not. As a former federal employee I can assure you, you would not.
The VA is a great example of what happens when you remove productivity incentives.Possibly. I did not enjoy my VA rotations as a resident. Neither are good options. Nothing beats working for yourself.
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.
The VA is a great example of what happens when you remove productivity incentives.
I remember being shocked in residency when the private surgeons didn't stop operating at noon...
And its entirely a systems issue. I worked with some great doctors there but just having good doctors isn't enough.Yeah the care at the VA where I rotated was atrocious.
Supposedly the VA where ETSU is (JC, Tennessee) has pretty good care. I know someone who gets their care there, and he is quite happy with it. Some of them are awful though.And its entirely a systems issue. I worked with some great doctors there but just having good doctors isn't enough.
Lots a vets at the place I rotated through were happy with their care, but I can tell you from my perspective the care wasn't good. Just because someone is happy with the care doesn't mean its any good. See: every urgent care everSupposedly the VA where ETSU is (JC, Tennessee) has pretty good care. I know someone who gets their care there, and he is quite happy with it. Some of them are awful though.
Lots a vets at the place I rotated through were happy with their care, but I can tell you from my perspective the care wasn't good. Just because someone is happy with the care doesn't mean its any good. See: every urgent care ever
Lots a vets at the place I rotated through were happy with their care, but I can tell you from my perspective the care wasn't good. Just because someone is happy with the care doesn't mean its any good. See: every urgent care ever
Doesn't even have to be that extreme. If something is free to you, you're much less likely to complain about quality.I imagine it’s easier to be satisfied with your care if it’s not making you broke. A large proportion of patient complaints are about the bills they receive.
Sigh.
Health Insurance in 2018 Finds ACA Gains Reversing
Definitely holding steady!
Of course it’s all trump’s fault and nothing to do with inherent flaws in the underlying theory of redistributing healthcare costs playing out over time revealing the true steady state of such policies and not the transient initial response. But look at 2015 - Victory!
Doesn't even have to be that extreme. If something is free to you, you're much less likely to complain about quality.
Take the NHS. Family doctors there average sub-8 minute visits. Lots of Americans get mad if they get sub 15-minute visits.
And MFA saves trillions compared to our current system.
I mean, if you get rid of the individual mandate, it's going to plummet.
As it shouldI mean, if you get rid of the individual mandate, it's going to plummet.
Except the individual mandate was in effect for all of 2018 and the repeal of the penalty doesn’t go into effect until 2019.
Nice try.
Like I said, it’s gotta be Trump’s fault - can’t be a flaw with Obama’s policy!
Did I say its the ultimate representation of health care? No.That's a little cherry-picking, no? The NHS (which is reported to have around 9 minute visits) is not the ultimate representative of universal healthcare. From the Independent, "Patients in France already have 16-minute appointments while those in the US have 21.07 minutes of face-to-face time with their GP and Swiss patients are seen for an average of 17 minutes. Those in Lithuania, Belgium, Portugal, Luxembourg, Iceland, Cyprus and Peru currently have 15-minute consultations. ... They found that the average appointment varied from just 48 seconds in Bangladesh to 22.5 minutes in Sweden. There were 15 countries with appointment times of less than five minutes, 25 countries with a consultation length of five to 9.9 minutes, 11 countries with 10 to 14.9 minutes, 13 countries with a consultation length of 15 to 19.9 minutes and three countries with a consultation length of more than 20 minutes."
It seems the length of visits correlates more with density of physicians than with style of healthcare. Everyone in this thread seems to be harping on how awful the NHS is but nobody is discussing countries with perfectly good universal healthcare where both patients and physicians seem, dare I say, happy with how the system works.
Doesn't even have to be that extreme. If something is free to you, you're much less likely to complain about quality.
Take the NHS. Family doctors there average sub-8 minute visits. Lots of Americans get mad if they get sub 15-minute visits.
This line of thinking is so silly and superficial, as it always is with socialists, I’m forced to respond with a silly example:
I can save thousands on car repairs by using the cheapest possible parts, waiting an extra 6 months between oil changes, having the service done by high school drop outs at jiffy lube instead of factory trained and certified technicians, only focusing on major repairs, ignoring cosmetic problems (you don’t really need paint, bare metal with rust protection works just as well), etc. Tires are worn out. Why buy new ones when you can get a mixed set of used ones much cheaper? The heat’s broken, but it’s February already so I’m just going to wait until next December to fix it. What’s causing the heat to be broken? Maybe the coolant is low and will seize up the engine in the meantime. Nah, don’t worry about it, look at all the money I’m saving.
Yes but.They can both be wrong. The problem, in my view, is the corporatization of healthcare, including and especially the profit-skimming by insurance companies. At the minimum, you have to admit that the money padding the wallets of insurance execs is "wasted" money in terms of providing care and that the magnitude of this money is absolutely massive.
Yep, because it shows how inexpensive lots of things really are. Its the whole idea behind Direct Primary Care.I'm sticking my hand in fire here but...
Does anyone think more diversified models of healthcare delivery would be viable? Thinks like the Surgery Center of Oklahoma seem promising for at least a share of procedures. At this point, it looks like a personal loan for a surgery would be a better deal than going with insurance. It's not applicable to everything, but for a share of the market I think cutting out the middle man makes sense and might drive competition to lower prices.
I also think the concierge service model holds a lot of promise.
Except the individual mandate was in effect for all of 2018 and the repeal of the penalty doesn’t go into effect until 2019.
Nice try.
Like I said, it’s gotta be Trump’s fault - can’t be a flaw with Obama’s policy!
As it should
What do people think of this study:
Full Report
It looked at what physician salaries would be if everyone was paid by medicare rates, broken down by specialty. The effect was very different depending on specialty (some saw salaries cut by over a third and others made modest gains). Thought it was interesting
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.
This line of thinking is so silly and superficial, as it always is with socialists, I’m forced to respond with a silly example:
I can save thousands on car repairs by using the cheapest possible parts, waiting an extra 6 months between oil changes, having the service done by high school drop outs at jiffy lube instead of factory trained and certified technicians, only focusing on major repairs, ignoring cosmetic problems (you don’t really need paint, bare metal with rust protection works just as well), etc. Tires are worn out. Why buy new ones when you can get a mixed set of used ones much cheaper? The heat’s broken, but it’s February already so I’m just going to wait until next December to fix it. What’s causing the heat to be broken? Maybe the coolant is low and will seize up the engine in the meantime. Nah, don’t worry about it, look at all the money I’m saving.
This seems to really affect surgical/competitive specialties by far the worst according to that report. I can’t imagine many people wanting to go into a grueling residency like that for a lot less pay
There are *so* many reasons that you cannot implement Swedish or Canadian policies in America and expect the same results that is it laughable.
The state of California has more citizens than the ENTIRETY of Canada by 3 Million people. That's one state of 50.
Let that sink in.
America is geographically and culturally diverse in such a way that you cannot compare it to tiny nations like Sweden. That doesn't mean we can't learn from the successes and failures of other nations, but I'd posit that we aren't going to find a federal-level, one-size-fits-all healthcare paradigm that works across our vast union and commonwealths.
Except the individual mandate was in effect for all of 2018 and the repeal of the penalty doesn’t go into effect until 2019.
Nice try.
Like I said, it’s gotta be Trump’s fault - can’t be a flaw with Obama’s policy!
The same thing could have been said when we proposed: social security, police force, army, public schooling, etc. and would you look at that, we have all those things just like the tiny socialized nations do and they work fine.
Furthermore, in this particular example, it’s even worse because insurance systems work better and depend on a large number of people paying in. Explain to me how anything that I said is incorrect.
Exactly. In the hospital and ambulance example… There won’t be any ambulances. My father returned to our home country recently. The same dilapidated building he grew up in looks exactly the same nearly 50 years later. The elevator has not run for 20 years, the front hall is partially collapsed… And people still live there. And scavenge trash from the nearby landfill. Yay socialism!
I know its difficult, but reading the thread you post in can actually be useful as this point has already been addressed... by me.You keep implying that care in these countries is worse. If the United States is so great, why don’t we have the best healthcare outcomes? These countries, whose physicians you’re comparing to high school dropouts, have healthcare systems that are better ranked than ours.
The truly silly thing is your opinion which isn’t based in facts at all, but feelings.
Equally funny is OrthoMds anecdotes about growing up in Yugoslavia or something and implying it’s the same as literally every other country with universal healthcare, and the US if we joined them.
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.
I can’t stand your use of “your home country” for every response you make. Fact of the matter is the US is unique for many reasons that have been outlined well already in this thread, but involve diversity of population, income and SES gap, and large size of population compared to the “socialist” European countries to which we’re being compared. There is no comparison. Whatever healthcare coverage experiment we move to next is unlikely to resemble anything they have in “your home country,” to which you continue to state but fail to say which country it is. In any event I don’t agree with a single payer system only, but even if something like that came to fruition, it is unlikely, given the stark differences in our populations and politics, to resemble how it has unfolded in European countries.
I’m not sure if you’re aware, but just so you know the whole “small, geographically homogenous” argument is usually used as a dog whistle to imply that if we were nice and white like everyone in those other countries we could have nice things, but because of those darn immigrants and brown people (lazy) we can’t. Furthermore, just saying that we can’t have the same system because we’re bigger and less homogeneous isn’t actually an argument.
.
Its not a dog whistle for racism, at least not for most of us. People often point to Japan or Singapore as well when talking single payer/socialized medicine. The truth is there are almost no countries on earth with the level of diversity we have which makes comparisons difficult.I’m not sure if you’re aware, but just so you know the whole “small, geographically homogenous” argument is usually used as a dog whistle to imply that if we were nice and white like everyone in those other countries we could have nice things, but because of those darn immigrants and brown people (lazy) we can’t. Furthermore, just saying that we can’t have the same system because we’re bigger and less homogeneous isn’t actually an argument.
The same thing could have been said when we proposed: social security, police force, army, public schooling, etc. and would you look at that, we have all those things just like the tiny socialized nations do and they work fine.
Furthermore, in this particular example, it’s even worse because insurance systems work better and depend on a large number of people paying in. Explain to me how anything that I said is incorrect.
Yes but.
The amount that insurance companies spend on executive compensation in the grand scheme of things isn't all that much.
For example Aetna covers 39 million people. Their CEO made 59 million. So if had made 0 dollars, that's less than $2/person/year. Let's even say that we take the top $400 million in salaries from the highest levels of Aetna. That means each Aetna covered person gets a little over $10/year less in premiums per person.
The primary issue is the complexity of the system which necessitates more and more employees to deal with it. My medical group has a whole team of people whose only job is to make sure we stay compliant with Medicare. That doesn't count the similar but larger team at the hospital doing the same thing. Look up how big your local hospitals "Compliance Department" is. Its pretty shocking.
Got you covered:What *DO* you agree with?
What do you think would work?
I'm really here looking for potential answers.
We can all argue here about who is what political affiliation or who is more right about minor things, but what are the solutions?
The "they work fine" part is absolutely incorrect.
Social security is bankrupt
The police force has been literally protested for years. Just turn on CNN.
The "army" (I assume you mean all armed forces) is huge and does a good job because it takes an insane amount of money. Still wildly inefficient. Do you have any family who serve? Ask them.
I've worked in the public school system, and if you think it works well you need a stat psych consult
So yeah. I believe you are incontrovertibly incorrect.
The RVU-based system (or any other productivity based system, in truth) isn't itself the problem. The problem is the incredible complexity of the system in general - which means Medicare as everyone else follows their lead.I agree wholeheartedly. Hospitals should be run by the people who provide healthcare, period. It seems to me that implementing M4A as it stands would simply transfer a lot of the bureaucracy from the insurance companies to the government. This makes me think that one of the issues underlying frustration for physicians (or even patients) on both ends of the political spectrum lies in how payments are calculated and disbursed. I don't see an easy way to eliminate the bureaucratic nightmare as long as the current RVU-based system persists. I am very curious to hear your thoughts on a capitation based system (or any viable alternative to the current fee-for-service scheme), a la Kaiser in California.
Social security is not bankrupt. It can pay out benefits until 2034 at which point it can pay 75% of benefits. And regardless, it is very easy to make completely solvent, but you have one party whose goal is to cut it to the bone.
Issue with the police force is violence against some groups of people, but overall we are protected.
Army is inefficient, but we are still protected.
Public school system has given hundreds of millions a fair shot at the American dream. You think a fully private system is better?
Overall, there are issues with publicly funded things of course, but they are much better than the alternatives. Yet again, you provide no one provides any statistics or data to back up their arguments.
I know its difficult, but reading the thread you post in can actually be useful as this point has already been addressed... by me.
Got you covered:
Its not a dog whistle for racism, at least not for most of us. People often point to Japan or Singapore as well when talking single payer/socialized medicine. The truth is there are almost no countries on earth with the level of diversity we have which makes comparisons difficult.
Umm, our public school system absolutely doesn't work fine. U.S. academic achievement lags that of many other countries
Social Security is in trouble. Social Security Is Still in Trouble -- Here's How We Can Fix It -- The Motley Fool
Not every issue with our outcomes can be attributed to higher obesity, higher car wrecks, and higher diabetes. To extrapolate that those things explain it all is ridiculous.
Depending on your metric, it can explain a lot of them. And I'd wager I could find data that would explain almost any metric you care to bring up.Not every issue with our outcomes can be attributed to higher obesity, higher car wrecks, and higher diabetes. To extrapolate that those things explain it all is ridiculous.
Yes, hence why I said SS is in trouble. I never said bankrupt, unfixable, or anything like that. Read better.U.S. achievement is indeed lagging. One country it is lagging, Finland, has completely banned private schools and ranks 5, 11, and 4 compared to our 24, 39, and 24. How does that prove your point?
Also, your SS article stated what I already said. It is an easy fix.