Medicare for all and physician salaries

[Matthew9Thirtyfive]

Moving to Topics in Healthcare.

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[Matthew9Thirtyfive]

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

In the Navy, we call it skating.

 

[puahate]

Well this thread is dead now lol

 

[nimbus]

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

Possibly. I did not enjoy my VA rotations as a resident. Neither are good options. Nothing beats working for yourself.

 

[OrthoTraumaMD]

I just read about this this morning. Socialism in its final form. Not only does the government not care about its starving citizens, they refuse aid because they are more interested in keeping a grip on power.
Bloomberg - Are you a robot?

 

[VA Hopeful Dr]

Possibly. I did not enjoy my VA rotations as a resident. Neither are good options. Nothing beats working for yourself.

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...

 

[Boola Boy]

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.

Hi TheRealCookieMonster!

I grew up the suburbs, and I’m tired of the car-centric, secluded lifestyle, so I want to live in a city where I don’t need a car.

Basically I want to live in an urban core similar to NYC, but NYC and the north in general is too cold, so that leaves me with a few options. NYC and other coastal urban cores are overpriced as a whole.

The only med school that I have gotten into that will let me live the way I want is also one of the most expensive, but this lifestyle is something I refuse to compromise on.

So I just have to be okay with living in debt for the rest of my life. That’s why I say the future is grim!

But at least I won’t have to worry about car note/repairs/insurance/maintenance anymore!

 

[OrthoTraumaMD]

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...

Yeah the care at the VA where I rotated was atrocious.

 

[VA Hopeful Dr]

Yeah the care at the VA where I rotated was atrocious.

And its entirely a systems issue. I worked with some great doctors there but just having good doctors isn't enough.

 

[Matthew9Thirtyfive]

And its entirely a systems issue. I worked with some great doctors there but just having good doctors isn't enough.

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.

 

[VA Hopeful Dr]

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.

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

 

[Matthew9Thirtyfive]

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

True. I mean this guy is a med student, so I think he has a slightly better perspective, but you could be totally right.

 

[nimbus]

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

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.

 

[VA Hopeful Dr]

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.

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.

 

[atomi]

Two New Federal Surveys Show Stable Uninsured Rate (2018)

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!

 

[Matthew9Thirtyfive]

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!

I mean, if you get rid of the individual mandate, it's going to plummet.

 

[wontonsoup]

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.

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.

 

[atomi]

And MFA saves trillions compared to our current system.

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.

 

[atomi]

I 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!

 

[deleted480308]

I mean, if you get rid of the individual mandate, it's going to plummet.

As it should

 

[wontonsoup]

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!

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.

 

[VA Hopeful Dr]

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.

Did I say its the ultimate representation of health care? No.

I was using an example of a place with known short visit times where the patients didn't get mad about it (with my hypothesis being that you get less angry at something if you don't pay for it directly). That is literally all. I wasn't making a larger point about socialized medicine in any way shape or form. It was purely a "if something is free you're less likely to complain about it" point, which I thought was pretty clear from my post:

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.

 

[OrthoTraumaMD]

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.

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!

 

[Cryc_to_the_point]

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.

 

[VA Hopeful Dr]

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.

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.

 

[VA Hopeful Dr]

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.

Yep, because it shows how inexpensive lots of things really are. Its the whole idea behind Direct Primary Care.

 

[RNthenDoc]

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.

It's easy to point at the failures of American healthcare (and socialized state's healthcare), but much more challenging to propose a solution.

This is an entire message board full of people who are supposed to be entirely devoted to solving problems, so I'd love to hear suggestions about what we actually *should* do. If Physicians and other healthcare professionals in an anonymous, low-risk, digital format cannot come up with anything, I'll feel pretty bad for condemning politicians who door a poor job of it. If you aren't comfortable posting your thoughts/linking me to sites where your opinion is enumerated, I'd be happy to get some PMs with intelligent ideas.

I'll hold off on spewing my own opinions for now. Nobody likes an uppity nurse.

 

[Matthew9Thirtyfive]

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!

I mean, there are other issues with how it has been handled since he took office, and there were a lot of issues with how it was implemented. It was behind the 8-ball from the start, but this administration hasn't helped.

As it should

I'm not really in the mood to debate libertarian philosophy. I find it immature and selfish, and a lot of the arguments for it that I see on here are extremely obtuse. So agree to disagree.

 

[medschoolzombie]

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 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

 

[jambro]

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.

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.

 

[jambro]

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

Then maybe the match process wouldn’t be so nightmarish...

 

[jambro]

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.

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.

 

[whoknows2012]

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!

You are extremely narrow minded in your responses. The trump administration has done a TON to weaken the aca even though yes the individual mandate was still in place. If you think that the reason insured rates have ticked up slightly is because of an inherent flaw in the aca then you’re living in the same fantasy land inhabited by democratic socialists who believe this is all fixed with single payer

Also @atomi literally within the document you sent in one of the first paragraphs it outlines two of the reasons they believe the insured rate has fallen
1) lack of federal legislative actions to improve specific weaknesses in the aca (part trump part Congress (Dems and Republicans) part Obama
2) actions by CURRENT administration that have exacerbated those weaknesses

Also you stated the insured rates reversed and are nearing pre ACA levels. Really? It’s super easy to find that data. It’s closer to the nadir than the peak uninsured levels. Slightly disengious if you. Would say a more factual statement would be that they’ve ticked up since legislation revealed individual mandate AND specific actions have been taken to weaken the aca as above

 

[RNthenDoc]

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.

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.

 

[whoknows2012]

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 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.

 

[VA Hopeful Dr]

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.

I know its difficult, but reading the thread you post in can actually be useful as this point has already been addressed... by me.

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.

 

[RNthenDoc]

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.

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?

 

[medschoolzombie]

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.
.

This is usually used as part of the argument because different races can be prone to different illnesses/necessities of care which can increase the cost.This also ties into SES among other issues

 

[VA Hopeful Dr]

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.

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

 

[wontonsoup]

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.

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.

 

[VA Hopeful Dr]

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?

Got you covered:

 

[jambro]

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.

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.

 

[VA Hopeful Dr]

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.

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.

We'd all like to be paid more, but that's not the problem. The basics of the billing system, while sometimes irritating, aren't the problem. Its the constantly changing rules, with no options to appeal.

 

[RNthenDoc]

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.

...And any American can waltz into an ER and get medical care.
Having a system doesn't mean it's a good system, or a solvent system.

I don't provide data because your argument is fallacious in its inception at a philosophical level.

You're saying that having any system is good enough... we have a system.

I disagree that it's good enough.

 

[jambro]

I know its difficult, but reading the thread you post in can actually be useful as this point has already been addressed... by me.

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.

 

[RNthenDoc]

Got you covered:

I listened to this guy on a certain Podcast. He seems to have put more thought into his position than most! (I actually downloaded the full text of his proposal months ago, but haven't read it in its entirety yet, because.... MS1)

need moar like dis

 

[jambro]

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

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.

 

[medschoolzombie]

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.

I’d argue a lot of people’s problems could be attributed to things like obesity and diabetes. Historically, Governmental interference in areas like nutrition (corn subsidies, pot sugar stances etc) were a big part of the reason these rates went up

 

[VA Hopeful Dr]

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.

Let's look at basic facts. If you exclude violent deaths we have about the highest life expectancy in the world (or did 8 years ago).

We have the best cancer survival rates in the world.

When people talk about health care metrics its generally things like cardiac disease (directly related to both obesity and diabetes), surgical complications (directly related to both obesity and diabetes), maternity care (directly related to obesity and diabetes) and neonatal (that one is more related to pre-maturity which again is related to obesity and diabetes).

 

[VA Hopeful Dr]

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.

Yes, hence why I said SS is in trouble. I never said bankrupt, unfixable, or anything like that. Read better.

Finland is an interesting place, education wise. What Americans Keep Ignoring About Finland's School Success - The Atlantic

Interestingly the approach that Finland takes is much more aligned with what many of our private schools do, most notably the Montessori schools, but what our public schools are doing less and less of.