New Medicare Foul-up

[Furrball2]

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http://www.nytimes.com/2005/05/22/politics/22medicare.html

 

[retroviridae]

I know this is a highly unpopular view, but I think this is just further proof that we need to nationalize healthcare. Healthcare should be a right for everyone, not just those who can afford this. I mean, is there any other developed country with a system like ours?

 

[Furrball2]

I'm with you.

 

[Mumpu]

I'm all for it but you need to revolutionize medical education at the same time (or basically do global federal loan forgiveness). Physicians in nationalized healthcare systems make less money. A drop in income with unchanged med school tuition would work out to zero new docs.

 

[retroviridae]

I'm all for it but you need to revolutionize medical education at the same time (or basically do global federal loan forgiveness). Physicians in nationalized healthcare systems make less money. A drop in income with unchanged med school tuition would work out to zero new docs.

so I was just looking at Canada med school prices, and UBC says they esitmate first year costs at Canadian $20,240 = US$16,071. UTMB lists first year fees at ~$10,000 (not including housing). So I would say Canadian provincial med school costs are no more than US state med school costs. They have a nationalized medical system ... and their docs do pretty well. Their med schools are not hurting for applicants. I don't know too much about their system, but I think Canada has a pretty good set up.

Anyway, I do agree that US med school costs are really way too high.

 

[Vision]

so I was just looking at Canada med school prices, and UBC says they esitmate first year costs at Canadian $20,240 = US$16,071. UTMB lists first year fees at ~$10,000 (not including housing). So I would say Canadian provincial med school costs are no more than US state med school costs. They have a nationalized medical system ... and their docs do pretty well. Their med schools are not hurting for applicants. I don't know too much about their system, but I think Canada has a pretty good set up.

Anyway, I do agree that US med school costs are really way too high.

Yeah and do you know how long does it take to get a CT scan in Canada? I had a patient how flow down from Canada to get a CT scan because it would take him basically months before he can get it! Just my 2 cent!

 

[UTSouthwestern]

There is no perfect system and nationalized health care systems force rationing of health care resources that many would not find palatable. Altruism and nobility aside, at some point in your medical career you will look for incentives to stay in the medical profession. Nationalized health care reigns in those incentives significantly and can stall the impetus toward improving medical care and delivery of medical care.

 

[retroviridae]

There is no perfect system and nationalized health care systems force rationing of health care resources that many would not find palatable. Altruism and nobility aside, at some point in your medical career you will look for incentives to stay in the medical profession. Nationalized health care reigns in those incentives significantly and can stall the impetus toward improving medical care and delivery of medical care.

Not true. By any objective measure, the US has one of the worse healthcare delivery systems in the developed world. We are always whipped by Scandanavia and other countries (including Canada). This is the old US refrain of how reigning in the free market reduces inovation etc. But, we spend more money on healthcare that any other county in the world, and have little to show for it.

 

[Fantasy Sports]

Not true. By any objective measure, the US has one of the worse healthcare delivery systems in the developed world. We are always whipped by Scandanavia and other countries (including Canada). This is the old US refrain of how reigning in the free market reduces inovation etc. But, we spend more money on healthcare that any other county in the world, and have little to show for it.

So why is it that several prominent Canadian officials, including the director of their socialized health care plan, come to the US for surgery?

 

[retroviridae]

So why is it that several prominent Canadian officials, including the director of their socialized health care plan, come to the US for surgery?

why is it that Americans buy drugs in Canada and Mexico and run off to Thailand/India for surgery?

That is interesting though. Why is the director of the Canadian Health System coming to the US for surgery? That's got to be bad politically.....

 

[Fantasy Sports]

why is it that Americans buy drugs in Canada and Mexico and run off to Thailand/India for surgery?

That is interesting though. Why is the director of the Canadian Health System coming to the US for surgery? That's got to be bad politically.....

The drug point is moot since the drugs are exactly the same, just priced differently (and I would argue, illegally) between countries.

I have heard of some people going to Thailand/India for surgery, but that is not for increased quality, but rather because its cheaper. Can you imagine the Surgeon General of the US going to Canada for surgery? Of course not. Yet the director of Canada's socialized healthcare system came here for surgery.

I think that last fact is the most telling about whose healthcare system is superior. Our problem being, if you can pay, you have the best healthcare in the world by far. But if you can't, you can only get basic care.

 

[Furrball2]

Private insurance spends 15% of budget on paperwork. US Government, e.g. medicare/medicaide and VHA, spend 4%. Paper in Annals of IM last spring had paper on health outcomes for VA patients. VA-Spa had better health outcomes then those in general medicare. This is interesting to me when one considers how much morbidity there is in the VA population.

 

[UTSouthwestern]

Private insurance spends 15% of budget on paperwork. US Government, e.g. medicare/medicaide and VHA, spend 4%. Paper in Annals of IM last spring had paper on health outcomes for VA patients. VA-Spa had better health outcomes then those in general medicare. This is interesting to me when one considers how much morbidity there is in the VA population.

Along those lines, a paper I read one or two years ago noted that if you were to cut physician salaries in half, you would save the US healthcare system 2.7% of expenditures. If you cut healthcare administration costs in half, you would save 25-30% of expenditures. And we wonder why medicare/medicaid wants to cut physician salaries . . .

 

[CircleTheDrain]

So why is it that several prominent Canadian officials, including the director of their socialized health care plan, come to the US for surgery?

I'm going to call you on this! Canada doesn't have a director of healthcare! It has seperate systems for each province and territory. These are run by the Ministries of Health under a Cabinet Minister.
FYI Canadas system isn't socialist. Its a single payer system and the doctors and hospitals are paid fee for service. Ontarios system OHIP (Ontario Health Insurance Plan) just reduces it to one insurance provider with universal coverage. 😉

 

[Fantasy Sports]

I'm going to call you on this! Canada doesn't have a director of healthcare! It has seperate systems for each province and territory. These are run by the Ministries of Health under a Cabinet Minister.
FYI Canadas system isn't socialist. Its a single payer system and the doctors and hospitals are paid fee for service. Ontarios system OHIP (Ontario Health Insurance Plan) just reduces it to one insurance provider with universal coverage. 😉

Or a director of provincial healthcare, it doesnt really matter (I dont pretend to know the different cabinet members of Canadian ministries)

And a single payer system is by definition socialist-- as there is no competition and that lack of competition is mandated by law.

 

[Pterion]

so I was just looking at Canada med school prices, and UBC says they esitmate first year costs at Canadian $20,240 = US$16,071. UTMB lists first year fees at ~$10,000 (not including housing). So I would say Canadian provincial med school costs are no more than US state med school costs. They have a nationalized medical system ... and their docs do pretty well.

Baloney. In Ottawa, the capital city BTW, many MD's only practice 6 mos out of a year. Their capitated system pays what amounts to a lump sum for their work. The more patients seen = less reimbursement per patient. As for their second jobs; some farm, one I met sells cars. They're starving compared the their US counterparts.

Yes, everyone in Canada has healthcare. Not good healthcare, not thorough healthcare (by comparison), but healthcare. Of course our system isn't perfect. But I doubt individual citizens would be happy about the changes in their plans should they be subject to the Canadian system.

 

[Mumpu]

As I was saying... US physicians by and large make significantly more than their counterparts worldwide.

 

[awdc]

US physicians also incur more educational debt than their counterparts worldwide.

 

[Sinnman]

I'm always amazed with some of the viewpoints on this board. Statements like "we need to nationalize healthcare" and “their (Canadian) docs do pretty well." That's why 55% of Canadians are now dissatisfied by their healthcare system. And the Canadian doctors are making so much money that's why so many of them leave their home country and come to the US.

I can't help but believe that anyone who thinks that making the government in charge will make things better is completely insane. The government is the problem not the solution.

Do you know of anything that the government does that is efficient? Sorry, but .gov is not exactly known for its efficiency (remember the $1000 toilet seats?) Have you every actually been to a VA hospital? Have you been in healthcare long enough to even hear about the VA? They're awful!!! I can guarantee you that anybody who has the choice between going to a VA hospital or going to a private hospital will pick the private hospital every single time.

There is a money issue to this also. I left a job where I was making a good living to go to medical school. I'm not in this for the money but I've lived in the real world long enough to know that don’t want to be at least 8 years older than most people starting a career with $200,000 of debt accruing interest with many years of lost retirement income, soaring malpractice costs and make 1 dollar less than the doctors are making today. Anybody with any financial sense will tell you that.

 

[Furrball2]

I'm always amazed with some of the viewpoints on this board. Statements like "we need to nationalize healthcare" and “their (Canadian) docs do pretty well." That's why 55% of Canadians are now dissatisfied by their healthcare system. And the Canadian doctors are making so much money that's why so many of them leave their home country and come to the US.

I can't help but believe that anyone who thinks that making the government in charge will make things better is completely insane. The government is the problem not the solution.

Do you know of anything that the government does that is efficient? Sorry, but .gov is not exactly known for its efficiency (remember the $1000 toilet seats?) Have you every actually been to a VA hospital? Have you been in healthcare long enough to even hear about the VA? They're awful!!! I can guarantee you that anybody who has the choice between going to a VA hospital or going to a private hospital will pick the private hospital every single time.

There is a money issue to this also. I left a job where I was making a good living to go to medical school. I'm not in this for the money but I've lived in the real world long enough to know that don’t want to be at least 8 years older than most people starting a career with $200,000 of debt accruing interest with many years of lost retirement income, soaring malpractice costs and make 1 dollar less than the doctors are making today. Anybody with any financial sense will tell you that.

Yes half of my med school rotations were at the VA, half of my IM residency will be at the VA. There are definately some things about the VA that drive me up teh wall but I can say that about the university and community hospitals I've worked at too. VA patients in their 60's actaully have better health outcomes than non-Vets with medicare. There are 30 million or so Americans who would love to have the care and benefits that Vets got through the VA. Have you ever tried to get dental care for a indigent patient in a University ED? They let the MS3 drain the oral abscess -- it was fun -- at the VA they see a dentist. Med student satisfaction aside which would you prefer if you were the patient with the abscess? I still remember the OMF residents instructions,"just stick the needle in until you hit the bone."

So 55% of Canadians are dissatisfied, well 30 million out of 275 million Americans don't even have coverage or access and then there are the several more million Americans with "coverage" but inadequate access... I wonder what percentage of Americans are dissatisfied? Remember all of those Americans who go north just to fill their perscriptions. Of course Vets don't have to do this since the VHA is allowed to negotiate drug prices, unlike Medicare/Medicaid.

Let's not forget that the VHA spends around 4 % of its budget on admininstative overhead unlike private insurance which spends around 15%.