VA Hopeful Dr

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SSdoc33

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lets call a spade a spade. most docs dont want it b/c they think they will get paid less. the other arguments (rationing, quality, etc) are window dressing.

crappy single payer with supplemental "cadillac" insurance plans are the way to go. sort of like paying extra to skip the line at disney.
 

sb247

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lets call a spade a spade. most docs dont want it b/c they think they will get paid less. the other arguments (rationing, quality, etc) are window dressing.

crappy single payer with supplemental "cadillac" insurance plans are the way to go. sort of like paying extra to skip the line at disney.
Except when you pay to skip line at disney, you didn't have to buy everyone else's tickets first
 

VA Hopeful Dr

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lets call a spade a spade. most docs dont want it b/c they think they will get paid less. the other arguments (rationing, quality, etc) are window dressing.

crappy single payer with supplemental "cadillac" insurance plans are the way to go. sort of like paying extra to skip the line at disney.
I don't think that's true. I mean sure, it absolutely plays a part but there are plenty of universal coverage places that pay fairly well (Canada, NZ, Australia). For a great many of us, quality is a bigger part.
 

willabeast

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lets call a spade a spade. most docs dont want it b/c they think they will get paid less. the other arguments (rationing, quality, etc) are window dressing.

crappy single payer with supplemental "cadillac" insurance plans are the way to go. sort of like paying extra to skip the line at disney.
docs do not want it because of the loss of control over their practices. you might think this is a small thing, but it isn't. it will completely change who applies to medical school and why. docs would mind rationing less if they controlled it, but having a member of the swamp making rationing decisions will make medical school seem like training for a position in the DMV to a lot of people. not everyone, many people will thrive in this new environment. it really is not about the money. my two cents.
 
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SSdoc33

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younger docs dont care about autonomy AS MUCH. there are examples both ways, but millenials seem to care a little bit less then the docs who have been doing it "their way" for years.

i obviously dont want somebody telling me how to practice. medicare, at least where i practice, doesnt do that. the potential for rationing with a single payer is a bit scary, however.

i dont see what canada and NZ have to do with it. you seem to suggest that canada and NZ have poorer quality, and the docs are unhappy there. not really sure thats true
 

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i dont see what canada and NZ have to do with it. you seem to suggest that canada and NZ have poorer quality, and the docs are unhappy there. not really sure thats true
I don't think the doctors in either of those places are unhappy. But Canadians are notorious for coming to America due to waiting lists in their own country. And New Zealand is notorious for not letting anyone immigrate to the country if they have any sort of health condition that's going to cost the government their money. I don't think either of those are things that we really want to emulate, do you?
 

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And New Zealand is notorious for not letting anyone immigrate to the country if they have any sort of health condition that's going to cost the government their money.
Uh...The L.A. County taxpayers have been funding health care for many South Americans since at least 1977. If you can get over the border you can get your cardiac surgery for free (although you might have to pay in the future if you wish to become a USA citizen). Once they get their surgery they go back to their homes in S.A. If the taxpayers knew what was going on they would be pissed off. No need to immigrate.
 
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VA Hopeful Dr

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Uh...The L.A. County taxpayers have been funding health care for many South Americans since at least 1977. If you can get over the border you can get your cardiac surgery for free (although you might have to pay in the future if you wish to become a USA citizen). Once they get their surgery they go back to their homes in S.A. If the taxpayers knew what was going on they would be pissed off. No need to immigrate.
I'm well aware, and that's why I pointed out that many socialized medicine countries restrict immigration (something that our liberal brethren don't care for).
 

Ligament

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I have Canadian patients traveling 3 hours to see me on a weekly basis because they have to wait 6 months for an SIJ injection or 1 year for a Pain Medicine initial consultation in Canada. Every single one of them has paid cash for MRI or CT so they don't have to wait 6 months to get one. Not a single one of them likes socialized medicine. They view it the same way we view our Medicare; broken.

The Canadians have severely restricted IMG physicians to Canada and strictly control physician supply, thus empowering Canadian physicians in a way which allows them to maintain incomes.
 

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I have Canadian patients traveling 3 hours to see me on a weekly basis because they have to wait 6 months for an SIJ injection or 1 year for a Pain Medicine initial consultation in Canada. Every single one of them has paid cash for MRI or CT so they don't have to wait 6 months to get one. Not a single one of them likes socialized medicine. They view it the same way we view our Medicare; broken.

The Canadians have severely restricted IMG physicians to Canada and strictly control physician supply, thus empowering Canadian physicians in a way which allows them to maintain incomes.
Economic Credentialing Reduces Access to Care | The Lund Report
 

BobBarker

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Medicare for all would be better for me both from a practice standpoint and financially. Same day procedures and MRIs. Medicare advantage is easier to work with than commercial even.
 

hyperalgesia

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lets call a spade a spade. most docs dont want it b/c they think they will get paid less. the other arguments (rationing, quality, etc) are window dressing.

crappy single payer with supplemental "cadillac" insurance plans are the way to go. sort of like paying extra to skip the line at disney.
If we're calling a spade a spade, let's also acknowledge that no one will be happy with "crappy single payer".
 

Blitz2006

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To bust some myths:

1) "Canadian doctors are poorly paid"

Doctors in Canada get paid very well. There are even ophthalmologists earning >2 million/year in rural parts:

Eye doctors dominate list of top billers in Manitoba

Impressive list, no, for "socialized health care". BTW, I know pain doctors in Toronto/Vancouver (Desirable cities) that crank 600-700k. Maybe not 2 million, but comfortable living.


2) "Canadians come to the U.S for healthcare"

"The Fraser Institute report estimates that about one per cent of Canadian patients who received treatment from a specialist in 2015 got that treatment outside of Canada."

1% of Canadian patients receiving specialist treatment went abroad

Check out the chart

Here's a study that backs it up: Phantoms In The Snow: Canadians’ Use Of Health Care Services In The United States

or a nice summary here: No, Canadians do not flee en masse for US health care

"They also tracked Canadians' behaviors by examining data from the National Population Health Survey, where 18,000 Canadians were asked if they sought medical treatment in the US. "Only 90 of those 18,000 Canadians had received care in the United States; only 20 of them had done so electively."


Anecdotally, I have tons of Canadian friend who's parents have winter homes in Florida. If you spend more than 180 days in the U.S, Canadians lose their free healthcare. So none of them spend more than 6 months down south because most Canadians FEAR the American healthcare system. None of them will ever cross the border to get healthcare here.

I have a cousin who is dual citizen, Canadian-American, lives in Boston area, and takes his parents to Toronto for healthcare, despite living 5 miles from MGH/BID/BWH...his reasoning? Why deal with all the hassle and potential for having a huge $100k bill when you can get just as good, world-class care at hospitals like Princess Margaret Hospital, Toronto Sick Kids, Toronto General Hospital, etc.?
 
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Blitz2006

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I don't think the doctors in either of those places are unhappy. But Canadians are notorious for coming to America due to waiting lists in their own country. And New Zealand is notorious for not letting anyone immigrate to the country if they have any sort of health condition that's going to cost the government their money. I don't think either of those are things that we really want to emulate, do you?
Please refer to:

No, Canadians do not flee en masse for US health care
Phantoms In The Snow: Canadians’ Use Of Health Care Services In The United States
1% of Canadian patients receiving specialist treatment went abroad
 
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Blitz2006

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I have Canadian patients traveling 3 hours to see me on a weekly basis because they have to wait 6 months for an SIJ injection or 1 year for a Pain Medicine initial consultation in Canada. Every single one of them has paid cash for MRI or CT so they don't have to wait 6 months to get one. Not a single one of them likes socialized medicine. They view it the same way we view our Medicare; broken.

The Canadians have severely restricted IMG physicians to Canada and strictly control physician supply, thus empowering Canadian physicians in a way which allows them to maintain incomes.
"As the lead author on the paper, University of Michigan's Steven Katz, told Vox, "A hip replacement [in the US] would cost nearly $100,000 out of pocket plus travel and living expenses." Waiting get one for free in Canada is easy compared to that, he added. "Canadians are happier with their system than we are and life expectancy and other health indicators are higher."

No, Canadians do not flee en masse for US health care
 
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PharmD500

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I love that you posted this. I'm sure you already know this, but most people are only looking for evidence and statistics to confirm their current beliefs. Unfortunately, I don't think any evidence you present will change most people's mind.
 
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Blitz2006

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I love that you posted this. I'm sure you already know this, but most people are only looking for evidence and statistics to confirm their current beliefs. Unfortunately, I don't think any evidence you present will change most people's mind.
Don't get me wrong, Canada ain't perfect. There are some downsides. But its still better healthcare than U.S.

The U.S healthcare system is only better than Canada for doctors for the 1% (the guys making $10-20 million/year, like these guys:

7 doctors got more than $10M from Medicare in 2012

But if you're the other 99%, Canada is >> U.S for $$. And remember, less stress/less litigation/less paperwork in Canada.

However, I firmly still believe that Australia has the best healthcare in the world (its two tiered, unlike Canada which is only universal health care), but thats another discussion.
 
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PharmD500

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Don't get me wrong, Canada ain't perfect. There are some downsides. But its still better healthcare than U.S.

The U.S healthcare system is only better than Canada for doctors for the 1% (the guys making $10-20 million/year, like these guys:

7 doctors got more than $10M from Medicare in 2012

But if you're the other 99%, Canada is >> U.S for $$. And remember, less stress/less litigation/less paperwork in Canada.

However, I firmly still believe that Australia has the best healthcare in the world (its two tiered, unlike Canada which is only universal health care), but thats another discussion.
What do you think about Sweden or Germany's healthcare compared to ours?

All the other developed countries are ranked higher than us in healthcare, with better outcomes for lower cost.
 

Blitz2006

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What do you think about Sweden or Germany's healthcare compared to ours?
For the patient Scandinavia and Europe is fine, but obviously for the physician the pay is crap. Thats why Canada/Oz are role models, since it offers good pay and good healthcare.

The UK is not too bad either, pay is not great, but remember, you can work private on the side in England and make decent money. But yes, pay in England is much <<< less than Canada/Oz.
 

PharmD500

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For the patient Scandinavia and Europe is fine, but obviously for the physician the pay is crap. Thats why Canada/Oz are role models, since it offers good pay and good healthcare.

The UK is not too bad either, pay is not great, but remember, you can work private on the side in England and make decent money. But yes, pay in England is much <<< less than Canada/Oz.
England scares me because I've heard of doctors and other healthcare professionals being held criminally liable for errors, and being sent to prison. Is that exaggerated?

I know it happens here, too, but it's rare.
 

Blitz2006

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I'm well aware, and that's why I pointed out that many socialized medicine countries restrict immigration (something that our liberal brethren don't care for).
? The UK (Until Brexit) and Oz are probably some of the easiest countries to immigrate to. Thats why Brexit happened, because of the huge influx of immigrants over the past few decades and people are getting fed up.

And now with Trudeau, immigrating to Canada is also relatively straightforward. But yes, very difficult for immigrant doctors to migrate to Canada (almost next to impossible). So a big downside for Canada.
 
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Blitz2006

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England scares me because I've heard of doctors and other healthcare professionals being held criminally liable for errors, and being sent to prison. Is that exaggerated?

I know it happens here, too, but it's rare.
It definitly happens, but the British media/tabloids are infamous for making mountain out of moles. Physicians in the UK are highly regulated by the "General Medical Council"/GMC.

GMC | Home

The good thing about the UK is that everything is highly regulated. There are very few "private practices" and "private hospitals". So I actually trust British docs more than some PP/community docs here in the U.S.
 
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PharmD500

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It definitly happens, but the British media/tabloids are infamous for making mountain out of moles. Physicians in the UK are highly regulated by the "General Medical Council"/GMC.

GMC | Home

The good thing about the UK is that everything is highly regulated. There are very few "private practices" and "private hospitals". So I actually trust British docs more than some PP/community docs here in the U.S.
Regulation can be good or bad, depending on the government doing the regulating. However, most doctors I've met don't want to be regulated any more than they already are. What is an example of a good regulation in the U.K. That you wish we had here?

Our government comes up with craziness, like reimbursement being tied to patient satisfaction surveys instead of objective outcomes!
 

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I don't think that's true. I mean sure, it absolutely plays a part but there are plenty of universal coverage places that pay fairly well (Canada, NZ, Australia).
Overall, at approximately 9% physician compensation is only a small portion of overall healthcare expenditures in the US.



In regard to compensation, US remuneration is significantly higher than other countries. I don't think many GPs would or should accept a 50% reduction in their salary to be remunerated like Canadian physicians.



Cheers




Charts of the Day: Doctor Pay in America and Other Countries
https://www.jacksonhealthcare.com/media-room/news/us-physician-compensation-among-lowest-of-western-nations/
 
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NOSfan

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....as long as pharma, device manufacturers, and commercial insurance continue to drive up the costs, single payer is where we will be forced to end up -- for better or worse.....
A significant cost of our healthcare costs are attributed to administrative costs:



Here is a very poignant graph:

 

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for some reason, I still have trouble getting it through my thick skull that getting over some illness is not a right, but owning a glock is.
 

hyperalgesia

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I still want to see a serious universal health care attempt in a state. Not so I can say "Haha I told you it wouldn't work" but I really want to see if it can be done in this country. I would love to see it.

But I am skeptical enough of failure that I wouldn't want to do this experiment on the whole country. It just seems irresponsible to me.
 

lobelsteve

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for some reason, I still have trouble getting it through my thick skull that getting over some illness is not a right, but owning a glock is.
Life, liberty, pursuit of happiness.
Constitution?
 

Ligament

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for some reason, I still have trouble getting it through my thick skull that getting over some illness is not a right, but owning a glock is.
Health and healthcare is not a "right". Nowhere is this recognized as a right in the constitution.
Bearing and owning firearms is a right, see the second amendment of the constitution.
 
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Ducttape

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Health and healthcare is not a "right". Nowhere is this recognized as a right in the constitution.
Bearing and owning firearms is a right, see the second amendment of the constitution.
If you ignore the broad implications of the 9th amendment....


Sent from my iPhone using SDN mobile
 

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Do we have to rehash this tired argument, nobody is going to change their minds.

Some believe that the richest country in world can and morally should provide basic care for all citizens like many poorer and less developed countries around the world.

The rest are heartless bastards who say "Qu'ils mangent de la brioche"
 
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lobelsteve

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Do we have to rehash this tired argument, nobody is going to change their minds.

Some believe that the richest country in world can and morally should provide basic care for all citizens like many poorer and less developed countries around the world.

The rest are heartless bastards who say "Qu'ils mangent de la brioche"
l'enfer est pavé de bonnes intentions
 
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SSdoc33

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The gun crowd isn't demanding for their neighbors to buy them guns
if we dont make billy bob buy his own insurance, you are sure as sh$t going to pay when he gets lung cancer. somebody has to, and it might as be his medical insurance.
 
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