Pay me like a French doctor. You know you want to.

[neusu]

The ACA is far as from socialism as you can get. It's a massive boon to private insurers.

For now, until the government realizes they create waste and creates the single payer system. This is a calculated risk on the par of the government. Make no mistake, medicine as we knew it is over.

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[DermViser]

Like I said, only in America is it considered socialism when the private medical insurance market expanded more than any other point in history save for WWII.

The ACA is far as from socialism as you can get. It's a massive boon to private insurers.

Secondly, without the ACA, the system was going to reach an impassable obstacle where people shut out of the system would have overburdened the entire health infrastructure. Hell, it'll still happen, except it'll be in 2050 instead of 2020.

Obama put the GOP plan into effect. The ACA was exactly the Heritage Foundation's alternative to HillaryCare in the '90s. It's as far free-market as you can get without going back to the days of heroin in children's cough syrups and any idiot with a pen and paper calling himself a doctor.

Sorry, but nice Democratic talking points (esp. the blaming Republicans for a bill passed solely by Democrats).

Democrats have made it clear (some voicing this out loud) that this is definitely one step TOWARDS what they want: a single payer system. Period. Make no mistake, once single payer is achieved, it is game over for all physicians.

 

[KinasePro]

I can hardly wait for a full blown single-payer system to take effect in the civilian market. Have you see how well it's been working for the VA in recent years? Access to care and healthcare outcomes/quality have never been better for our veterans...

http://www.usatoday.com/story/news/...eki-veterans-phoenix-american-legion/8844353/

/sarcasm

 

[PL198]

Which leads us back to the concept that socialism doesn't work at all, therefore no individual components of socialism (moving to single-payer) will be successful. But hey, at least after we do it, we will shed it and then vehemently fight for capitalism for the rest of our lives, like half of the eastern hemisphere. It's pretty lolzy to me that for being the once chief nation of the world, America is going to be the final nation to go through a socialistic phase, have it fail and then people will finally see that the Democratic movement for what it really is. Europe is collapsing, Canada's healthcare is crap, but hey let's mirror them! Imagine all the poor people we could save!!! Oh wait, then everyone else gets screwed. Oh but there are a lot of poor people and other people that vote based on emotion, so we will cater to the poor people anyway.

Good plan ^ Good plan

 

[DermViser]

I can hardly wait for a full blown single-payer system to take effect in the civilian market. Have you see how well it's been working for the VA in recent years? Access to care and healthcare outcomes/quality have never been better for our veterans...

http://www.usatoday.com/story/news/...eki-veterans-phoenix-american-legion/8844353/

/sarcasm

VA healthcare....a race to the bottom. So sad that we allow our veterans to be treated in that way. And now Democrats want to unleash this ****hole on everyone else.

 

[KinasePro]

VA healthcare....a race to the bottom. So sad that we allow our veterans to be treated in that way. And now Democrats want to unleash this ****hole on everyone else.

It's just mind blowing, isn't it? The VA has been publicly criticized for decades and had multiple leadership overhauls, still to no avail.

From what I've read, the current leadership is actually pretty damn good. Shinseki generally kicks ass and takes names, and can usually mobilize bureaucracy fairly well. STILL, even with the best bureaucrat the VA can find, the system is consistently scandal ridden and failing our vets. It's a sad state of affairs, and a grim predictor of what single payer will do to the rest of the country.

 

[PL198]

VA healthcare....a race to the bottom. So sad that we allow our veterans to be treated in that way. And now Democrats want to unleash this ****hole on everyone else.

DONT YOU DARE QUESTION THE COMMON GOOD

 

[DermViser]

It's just mind blowing, isn't it? The VA has been publicly criticized for decades and had multiple leadership overhauls, still to no avail.

From what I've read, the current leadership is actually pretty damn good. Shinseki generally kicks ass and takes names, and can usually mobilize bureaucracy fairly well. STILL, even with the best bureaucrat the VA can find, the system is consistently scandal ridden and failing our vets. It's a sad state of affairs, and a grim predictor of what single payer will do to the rest of the country.

Part of the problem is that govt. is so big, it doesn't matter where you are in the system, it's hard for anyone to be accountable. The VA is one of the worst when it comes to anyone being accountable for anything. There are just way too many bureaucrats and middlemen in the system. If this had happened in a private hospital, heads would be rolling. Even the person who actually wants to make things better is slowly weared down by the ridiculous level of bureaucracy, and esp. in these type of systems, the doctor is left holding the bag.

 

[PL198]

Can't wait until licensing boards start threatening physicians to revoke their licenses if they speak their minds about the healthcare system... It's going to happen eventually. I mean most medical schools teach that healthcare is a human right, so it eventually it'll be warped into the duty of the profession, and detractors will be punished. The state board of my state threatened physicians with removing their licenses if they assisted in death penalty proceedings.

 

[DermViser]

Can't wait until licensing boards start threatening physicians to revoke their licenses if they speak their minds about the healthcare system... It's going to happen eventually. I mean most medical schools teach that healthcare is a human right, so it eventually it'll be warped into the duty of the profession, and detractors will be punished. The state board of my state threatened physicians with removing their licenses if they assisted in death penalty proceedings.

Yup, as "unprofessional" behavior or as a "disruptive" physician. Someone was saying that the ASA banned anesthesiologists from taking part in death penalty punishments, hence not surprising on the death penalty gone awry in Oklahoma.

 

[Mad Jack]

I feel like the massive student loans are a part of the plan to shackle physicians to government jobs once things go single payer. Pay your loans down as fast as you can, and get added non-healthcare qualifications and experience if possible (MBA or whatever) so that if single payer happens, you can bail out. Hope for the best, but have an out in case things go worse than we can imagine.

 

[solitarius]

Wait, you don't want to be a GS-15 who doesn't work and doesn't care about being sued?

 

[PL198]

Yup, as "unprofessional" behavior or as a "disruptive" physician. Someone was saying that the ASA banned anesthesiologists from taking part in death penalty punishments, hence not surprising on the death penalty gone awry in Oklahoma.

nah bro don't you dare question your supervisors. living in a dream world of not doing crap and trying to impose their will on others, you should have A LOT of respect for them.

 

[KinasePro]

Which leads us back to the concept that socialism doesn't work at all, therefore no individual components of socialism (moving to single-payer) will be successful. But hey, at least after we do it, we will shed it and then vehemently fight for capitalism for the rest of our lives, like half of the eastern hemisphere. It's pretty lolzy to me that for being the once chief nation of the world, America is going to be the final nation to go through a socialistic phase, have it fail and then people will finally see that the Democratic movement for what it really is. Europe is collapsing, Canada's healthcare is crap, but hey let's mirror them! Imagine all the poor people we could save!!! Oh wait, then everyone else gets screwed. Oh but there are a lot of poor people and other people that vote based on emotion, so we will cater to the poor people anyway.

Good plan ^ Good plan

The problem with bleeding-heart progressive policies, especially in today's political environment, is that the trade-off is almost never clearly articulated.

It's easy for progressive politicians to garner support for generous government assistance programs like universal healthcare, immigration reform, increased minimum wage, etc b/c there's a crystal clear upside to the uneducated voter. Who doesn't want free healthcare, better wages, and citizenship for well-meaning illegal aliens?

The problem is that there's a trade-off for everything, and progressives like Pelosi, Reid, Obama, and Zeke Emanuel almost NEVER paint the trade-off in an accurate light. Just look at the "if you like your plan, you can keep it" fiasco. A clear trade-off for the ACA that was swept under the rug because it was unsavory and could have halted public approval of the ACA.

Unfortunately for conservatives and libertarians, they are rightly concerned with the trade-offs and are easily villianized in the media as being anti-middle class and pro-1%. Being level headed and concerned with negative consequences doesn't buy you any favor in the public eye in today's political environment.

 

[circulus vitios]

You know that hospitals are swallowing up private practices of PCPs and consolidating, left and right, right?

I wonder how many of the buyouts are because the practice has become unsustainable, and how many are because the managing physicians just want to cash out.

 

[PL198]

The problem with bleeding-heart progressive policies, especially in today's political environment, is that the trade-off is almost never clearly articulated.

It's easy for progressive politicians to garner support for generous government assistance programs like universal healthcare, immigration reform, increased minimum wage, etc b/c there's a crystal clear upside to the uneducated voter. Who doesn't want free healthcare, better wages, and citizenship for well-meaning illegal aliens?

The problem is that there's a trade-off for everything, and progressives like Pelosi, Reid, Obama, and Zeke Emanuel almost NEVER paint the trade-off in an accurate light. Just look at the "if you like your plan, you can keep it" fiasco. A clear trade-off for the ACA that was swept under the rug because it was unsavory and could have halted public approval of the ACA.

Unfortunately for conservatives and libertarians, they are rightly concerned with the trade-offs and are easily villianized in the media as being anti-middle class and pro-1%. Being level headed and concerned with negative consequences doesn't buy you any favor in the public eye in today's political environment.

Yes. I love how the whole "if you like your plan, you can keep it," thing turned out. So first, that was a lie and like 5 million people had their coverage dropped. Next, those 5 million people were rolled into the new ACA plans, and that boosted the numbers significantly for them, and that somehow reflected positively on the efficacy of the plan. So first, we were lied to, then the people who suffered due to the lie were forced to pick up a new type of coverage, and that somehow supports the whole idea that the liars were pushing for in the first place. Brilliant.

 

[PL198]

I wonder how many of the buyouts are because the practice has become unsustainable, and how many are because the managing physicians just want to cash out.

If they were sustainable under their current model, then another physician(not a corp) would buy them out and take it over for themselves and continue to run it. So I'd say the answer to your question is 100/0. Physicians practice well into the 70s/80s relatively frequently. If they are making adequate money in their opinion, they will keep it going, or bring in a partner to take the brunt of the work and simply assist.

 

[circulus vitios]

If they were sustainable under their current model, then another physician(not a corp) would buy them out and take it over for themselves and continue to run it. So I'd say the answer to your question is 100/0. Physicians practice well into the 70s/80s relatively frequently. If they are making adequate money in their opinion, they will keep it going, or bring in a partner to take the brunt of the work and simply assist.

The analysis isn't that cut and dry. A hospital could pay far above market value for a practice for the purpose of decreasing competition in a given area. This isn't viable for physicians because the average hospital has access to a much larger line of credit than a typical private practice, and the debt burden incurred by the purchase over-expenditure is much greater on a practice with a net operating income of a couple million versus a hospital with a net operating income of tens of millions or more.

If they want to cash out, why would they "keep doing it?" Bringing a partner on-board requires interviewing, a typical multi-year partner vetting process, and then you're still left involved with the operations of the practice because you presumably share voting rights with this new partner. A hospital comes to you with an above market offer -- a check with no strings attached. Which is more attractive?

 

[DermViser]

I wonder how many of the buyouts are because the practice has become unsustainable, and how many are because the managing physicians just want to cash out.

The practice has become unsustainable bc of every increasing govt. regulations and ever decreasing reimbursement from third party payers esp. the govt. If I was in that scenario, I would want to cash out before **** hits the fan.

 

[PL198]

The analysis isn't that cut and dry. A hospital could pay far above market value for a practice for the purpose of decreasing competition in a given area. This isn't viable for physicians because the average hospital has access to a much larger line of credit than a typical private practice, and the debt burden incurred by the purchase over-expenditure is much greater on a practice with a net operating income of a couple million versus a hospital with a net operating income of tens of millions or more.

If they want to cash out, why would they "keep doing it?" Bringing a partner on-board requires interviewing, a typical multi-year partner vetting process, and then you're still left involved with the operations of the practice because you presumably share voting rights with this new partner. A hospital comes to you with an above market offer -- a check with no strings attached. Which is more attractive?

That's not what happens in a free market, or else all you would see is larger companies abusing economies of scale and small companies being unable to flourish. The gov't is forcing what you said to happen, and I'd still call that unsustainable.

 

[circulus vitios]

That's not what happens in a free market, or else all you would see is larger companies abusing economies of scale and small companies being unable to flourish. The gov't is forcing what you said to happen, and I'd still call that unsustainable.

Are you serious or are you ****ing with me right now?

Have you ever heard of a company called Walmart?

 

[notbobtrustme]

Sorry, but nice Democratic talking points (esp. the blaming Republicans for a bill passed solely by Democrats).

Democrats have made it clear (some voicing this out loud) that this is definitely one step TOWARDS what they want: a single payer system. Period. Make no mistake, once single payer is achieved, it is game over for all physicians.

good. We should have a single payer system.

You'll never convince me that the current system or the past system was any good because I experienced first hand what happened in our old system. My Dad was a self-employed engineer who had no insurance because of his pre-existing conditions back in the 90s and early 2000s. My mom lost her job in the recession of 2001 and we couldn't afford the nearly 2000/month insurance premium, so we went without insurance. During that time, my dad showed all the signs and symptoms of lung cancer. By the time my mom found another job in early 2002 and waited out the obligatory 6 month waiting period (otherwise the insurance carrier wouldn't cover what was found), the cancer metasized everywhere in his body. He was dead in 2003.

You can never convince me that healthcare isn't a basic human right. Sure, we can debate about how to implement care, but there's no way I'll back down from the position that everyone deserves access to healthcare.

 

[KinasePro]

Yes. I love how the whole "if you like your plan, you can keep it," thing turned out. So first, that was a lie and like 5 million people had their coverage dropped. Next, those 5 million people were rolled into the new ACA plans, and that boosted the numbers significantly for them, and that somehow reflected positively on the efficacy of the plan. So first, we were lied to, then the people who suffered due to the lie were forced to pick up a new type of coverage, and that somehow supports the whole idea that the liars were pushing for in the first place. Brilliant.

Exactly. And while we're at it, why don't we change the census questionnaire so that it UNDERestimates the # of uninsured citizens moving forward, thus inflating the perceived effect of the ACA? http://www.nytimes.com/2014/04/16/us/politics/census-survey-revisions-mask-health-law-effects.html

I don't recall any pundits like Jon Stewart lampooning that uber-political move.

If it's any consolation, I think the mid-terms will stir the political pot a good bit this year. Nate Silver's crew is predicting the pendulum to swing in favor of republicans, with even the senate being up for grabs this year. Will be interesting to see what republicans do with a senate that has a severely weakened filibuster courtesy of Reid's brilliant "nuclear option" which will almost certainly backfire on the democrats in the long run.

 

[PL198]

Are you serious or are you ******* with me right now?

Have you ever heard of a company called Walmart?

Have you ever heard of regulations? Because unless Walmart existed in the 1700s, then I'm not sure what you are saying.

 

[PL198]

good. We should have a single payer system.

You'll never convince me that the current system or the past system was any good because I experienced first hand what happened in our old system. My Dad was a self-employed engineer who had no insurance because of his pre-existing conditions back in the 90s and early 2000s. My mom lost her job in the recession of 2001 and we couldn't afford the nearly 2000/month insurance premium, so we went without insurance. During that time, my dad showed all the signs and symptoms of lung cancer. By the time my mom found another job in early 2002 and waited out the obligatory 6 month waiting period (otherwise the insurance carrier wouldn't cover what was found), the cancer metasized everywhere in his body. He was dead in 2003.

You can never convince me that healthcare isn't a basic human right. Sure, we can debate about how to implement care, but there's no way I'll back down from the position that everyone deserves access to healthcare.

Why should a company be forced to insure your father if it was fiscally irresponsible to do so? I'm sorry for your loss and can't imagine what that would be like, but I don't understand what you are saying in regards to the nation's healthcare. If you force companies to undergo decisions that aren't profitable, then they will fail as companies.

 

[KinasePro]

good. We should have a single payer system.

You'll never convince me that the current system or the past system was any good because I experienced first hand what happened in our old system. My Dad was a self-employed engineer who had no insurance because of his pre-existing conditions back in the 90s and early 2000s. My mom lost her job in the recession of 2001 and we couldn't afford the nearly 2000/month insurance premium, so we went without insurance. During that time, my dad showed all the signs and symptoms of lung cancer. By the time my mom found another job in early 2002 and waited out the obligatory 6 month waiting period (otherwise the insurance carrier wouldn't cover what was found), the cancer metasized everywhere in his body. He was dead in 2003.

You can never convince me that healthcare isn't a basic human right. Sure, we can debate about how to implement care, but there's no way I'll back down from the position that everyone deserves access to healthcare.

What happened to your father is tragic, and I'm sorry for your loss. I've seen this play out many times in the urban hospital I trained at.

But can't we make the same argument for every other disadvantage in society? I come from a blue collar family and am the only educated person in an extended family of ~40 people. Because of the many ills associated with our "class"of society, the average lifespan in my family will be undoubtedly shorter than the national average. Everyone above age 50 in my family is obese, has DMII, HTN, and poor social mobility. Using you're same logic, didn't they deserve better jobs, a better neighborhood, better education, better preventative health counseling, a better social network, etc?

In a vacuum, I'd say they (...and I) "deserve" all those things as basic human rights. But the devil is in the details, and I don't think the trade-off would be acceptable to society at large.

 

[DermViser]

good. We should have a single payer system.

You'll never convince me that the current system or the past system was any good because I experienced first hand what happened in our old system. My Dad was a self-employed engineer who had no insurance because of his pre-existing conditions back in the 90s and early 2000s. My mom lost her job in the recession of 2001 and we couldn't afford the nearly 2000/month insurance premium, so we went without insurance. During that time, my dad showed all the signs and symptoms of lung cancer. By the time my mom found another job in early 2002 and waited out the obligatory 6 month waiting period (otherwise the insurance carrier wouldn't cover what was found), the cancer metasized everywhere in his body. He was dead in 2003.

You can never convince me that healthcare isn't a basic human right. Sure, we can debate about how to implement care, but there's no way I'll back down from the position that everyone deserves access to healthcare.

Ah, now we're getting to the heart of the story. You personally were affected, hence your "healthcare is a human right" meme. Thank you for acknowledging this and I truly am sincerely sorry for your loss. However, this doesn't change the facts on the groud.

Obamacare is not just "no pre-existing conditions", "stay on your parents' insurance till age 26", etc. All of these things, including "free" birth control, "free" preventative checkups, etc. are not "free". They cost SOMEONE in the system money, which is then reflected in your premium. Anyone prior to Obamacare was free to buy an individual plan or get a COBRA plan if they lost their job. Everyone now is required to buy health insurance, regardless of whether they can afford it or not, or risk having to pay a fine.

What you don't get is that health insurance does not equal healthcare. Hospitals are not required to take your healthcare plan, as demonstrated by the Obamacare healthcare exchange plans which have very narrow networks. So much for "if you like your doctor, you can keep your doctor", which was found to be a lie. You do not have a "right" to something, when it costs SOMEONE ELSE their money and time. You do not have a "right" to medical healthcare services (which are never free) given by doctors and nurses.

Those who had plans were kicked out by their insurance companies and have now had to buy plans with higher premiums, higher deductibles, higher copays for nearly the same benefits. So now, people are forced to buy plans that are more expensive, and which include benefits that many of them will not use. What has happened is that Obamacare has disrupted the market for the 85% of people who were perfectly happy with their plans, instead of just targeting the 15%.

I truly hope you enjoy this system in place, in which you will now as a healthcare provider be evaluated on govt. metrics (which if you do not follow, you will not receive reimbursement for your services), and your every move will be scrutinized. The next step in Obamacare is racheting down reimbursements even further to hospitals and providers, and healthcare services for "cost savings", which will be effectively rationed (i.e. no chemotherapy if you're elderly, etc.) by a govt. body, the Independent Payment Advisory Board (IPAB), when they deem certain services as costing too much to the system. But please don't let this ruin your utopia.

 

[VA Hopeful Dr]

You know that hospitals are swallowing up private practices of PCPs and consolidating, left and right, right?

Yep, but that doesn't change the point I was trying to make nor does it mean that, outside of NYC, PCPs are making less than 100k, and even there most of the jobs are more like 120k.

 

[PL198]

Yep, but that doesn't change the point I was trying to make nor does it mean that, outside of NYC, PCPs are making less than 100k, and even there most of the jobs are more like 120k.

Ok so why is that? Can you possibly think of any other STEM profession with such a poor ROI? You see to think this is acceptable. It's not. Show me another profession comparable.

 

[circulus vitios]

Ok so why is that? Can you possibly think of any other STEM profession with such a poor ROI? You see to think this is acceptable. It's not. Show me another profession comparable.

Uh, are you serious? Do a lifetime earnings analysis on medicine and it's still miles ahead unless you decide on primary care in a ****hole like NYC.

 

[PL198]

Uh, are you serious? Do a lifetime earnings analysis on medicine and it's still miles ahead unless you decide on primary care in a ****hole like NYC.

Well that was exactly what we were talking about, wasn't it? Miles ahead in relation to what? Are you talking gross values? Why wouldn't it be? I'm talking relative compensation to training.

 

[notbobtrustme]

Ah, now we're getting to the heart of the story. You personally were affected, hence your "healthcare is a human right" meme. Thank you for acknowledging this and I truly am sincerely sorry for your loss. However, this doesn't change the facts on the groud.

Obamacare is not just "no pre-existing conditions", "stay on your parents' insurance till age 26", etc. All of these things, including "free" birth control, "free" preventative checkups, etc. are not "free". They cost SOMEONE in the system money, which is then reflected in your premium. Anyone prior to Obamacare was free to buy an individual plan or get a COBRA plan if they lost their job. Everyone now is required to buy health insurance, regardless of whether they can afford it or not, or risk having to pay a fine.

What you don't get is that health insurance does not equal healthcare. Hospitals are not required to take your healthcare plan, as demonstrated by the Obamacare healthcare exchange plans which have very narrow networks. So much for "if you like your doctor, you can keep your doctor", which was found to be a lie. You do not have a "right" to something, when it costs SOMEONE ELSE their money and time. You do not have a "right" to medical healthcare services (which are never free) given by doctors and nurses.

Those who had plans were kicked out by their insurance companies and have now had to buy plans with higher premiums, higher deductibles, higher copays for nearly the same benefits. So now, people are forced to buy plans that are more expensive, and which include benefits that many of them will not use. What has happened is that Obamacare has disrupted the market for the 85% of people who were perfectly happy with their plans, instead of just targeting the 15%.

I truly hope you enjoy this system in place, in which you will now as a healthcare provider be evaluated on govt. metrics (which if you do not follow, you will not receive reimbursement for your services), and your every move will be scrutinized. The next step in Obamacare is racheting down reimbursements even further to hospitals and providers, and healthcare services for "cost savings", which will be effectively rationed (i.e. no chemotherapy if you're elderly, etc.) by a govt. body, the Independent Payment Advisory Board (IPAB), when they deem certain services as costing too much to the system. But please don't let this ruin your utopia.

No I agree with you. Obamacare is just a symptom of the problem. The real problem is a for-profit medical industry that places managers/MBAs/CEOs ahead of patients and providers.

I don't like the ACA because it doesn't go far enough. A single-payer system will never work in this country, however, that doesn't mean we can't have universal access and coverage. Look at Sweden or Germany, they have a mix of private and public health insurance, pay less in taxes and health costs and still manage to pay their doctors 4-5x the median wage, while ensuring reasonable debt levels and working conditions.

Or Canada, where they enjoy all the perks of a socialized healthcare system and their doctors earn as much or more than US doctors and work less to boot.

Personally, I'm about to give up on this country anyways. The way it's looking, the middle class is going to be decimated anyways. My kids will not have the opportunities that I have and I don't have the opportunities that my parents' generation had. The US squandered 50 years of prosperity since the '80s by worshiping ideology instead of pragmitism.

 

[PL198]

No I agree with you. Obamacare is just a symptom of the problem. The real problem is a for-profit medical industry that places managers/MBAs/CEOs ahead of patients and providers.

I don't like the ACA because it doesn't go far enough. A single-payer system will never work in this country, however, that doesn't mean we can't have universal access and coverage. Look at Sweden or Germany, they have a mix of private and public health insurance, pay less in taxes and health costs and still manage to pay their doctors 4-5x the median wage, while ensuring reasonable debt levels and working conditions.

Or Canada, where they enjoy all the perks of a socialized healthcare system and their doctors earn as much or more than US doctors and work less to boot.

Personally, I'm about to give up on this country anyways. The way it's looking, the middle class is going to be decimated anyways. My kids will not have the opportunities that I have and I don't have the opportunities that my parents' generation had. The US squandered 50 years of prosperity since the '80s by worshiping ideology instead of pragmitism.

So you believe that making a profit is wrong? Why in the world would anyone be motivated to do medicine? Are we really going to the whole " it's a calling", "do it for the people" things?

 

[DermViser]

No I agree with you. Obamacare is just a symptom of the problem. The real problem is a for-profit medical industry that places managers/MBAs/CEOs ahead of patients and providers.

I don't like the ACA because it doesn't go far enough. A single-payer system will never work in this country, however, that doesn't mean we can't have universal access and coverage. Look at Sweden or Germany, they have a mix of private and public health insurance, pay less in taxes and health costs and still manage to pay their doctors 4-5x the median wage, while ensuring reasonable debt levels and working conditions.

Or Canada, where they enjoy all the perks of a socialized healthcare system and their doctors earn as much or more than US doctors and work less to boot.

Personally, I'm about to give up on this country anyways. The way it's looking, the middle class is going to be decimated anyways. My kids will not have the opportunities that I have and I don't have the opportunities that my parents' generation had. The US squandered 50 years of prosperity since the '80s by worshiping ideology instead of pragmitism.

Universal access is a misnomer. No system has universal access. In any system, the rich will ALWAYS have better access than those with Medicaid and no insurance.
This isn't just in healthcare either, but in all facets of life.

Sweden and Germany actually pay more in taxes through a VAT, with heavy subsidization of medical schools, and their populations are also smaller, more homogeneous and don't have the health problems that we do here in the U.S.. Also you can bet these systems, heavily ration certain treatments, unlike the United States.

 

[circulus vitios]

Well that was exactly what we were talking about, wasn't it? Miles ahead in relation to what? Are you talking gross values? Why wouldn't it be? I'm talking relative compensation to training.

Give an example.

 

[Silent Cool]

Like I said, only in America is it considered socialism when the private medical insurance market expanded more than any other point in history save for WWII.

The ACA is far as from socialism as you can get. It's a massive boon to private insurers.

Secondly, without the ACA, the system was going to reach an impassable obstacle where people shut out of the system would have overburdened the entire health infrastructure. Hell, it'll still happen, except it'll be in 2050 instead of 2020.

Obama put the GOP plan into effect. The ACA was exactly the Heritage Foundation's alternative to HillaryCare in the '90s. It's as far free-market as you can get without going back to the days of heroin in children's cough syrups and any idiot with a pen and paper calling himself a doctor.

False:

 

[Nephronlearner]

The amount of ignorance on this thread is just mind blowing...

Where to start...
First of all, I am writing this as a medical student. Having lived in 'Europe' (even though 'Europe' is quite a broad term since there are very significant differences between countries) my whole life and having a lot of friends from several different European countries, I am familiar with the systems. And I have been to plenty of places as well.
Also, I am writing this as someone who is planning to do residency in the States.

So I will do this in a FAQ form:

1) Claim: 70% income tax
- Nonsense. Taxes are generally closer to 35-40%. Simply googling 'gross-net salary calculator' for each country could provide a lot of valuable (and quite accurate) information. For example, a consultant making 100,000 in UK (gross) would get ~65,000 after tax. In France ~70-75,000.

2) Claim: no freedom to choose healthcare provider
- Nonsense again. People over here generally have more freedom because they don't have to worry about 'out of network' and 'in network' hospitals, which then affects how much they pay. I can literally see any doctor in the country for no cost (besides what has been paid through taxes).

3) Claim: salaries are significantly lower
- True. However, also note that this salary of ~5,000 usually means no additional payments for health insurance, disability insurance, malpractice insurance, retirement fund, in some countries child care, 4-6 weeks of vacation, unlimited number of sick days and a much shorter work week. That being said, those who want to work more are generally able to work in private practices in their 'spare time' and earn extra money.

4) Claim: Europe is in debt
- True. But so is the US. In fact, US has the largest national debt of all the countries in the world.

5) Claim: The healthcare outcomes in Europe are much worse
- Depends. Life expectancy in most of Europe is 2-3 years longer than it is in the US. Infant mortality is lower. Cancer survival (US vs Germany; 5 year survival):
Locally/regionally spread breast cancer: 83% vs 79%
All stages pancreatic cancer: 6% vs 10%
And for any other type of cancer, the rates are very similar.
Also, it is worth noting that everyone gets chemotherapy in Germany/Sweden/UK/France, regardless of how much money and what kind of insurance they have. Furthermore, survival amongst the poor is generally lower for every condition, thereby providing healthcare only to wealthier population could artificially boost the numbers.

6) Claim: Europeans are controlled by their governments
- LOL, What?! Controlled how?! We pay taxes that are 10 or so percent higher than in the US? Yes, we do. But we get some pretty cool benefits for it so...

7) Claim: if you go to the doctor in France/England, the bureaucracy will be your biggest enemy
- I doubt it. In fact, you will not even have to discuss your insurance or call the insurance company. Patients meet doctors and pretty much anything the doctor prescribes is available (without having to check with your HMO).

8) Claim: Europeans are brainwashed so they don't realise the benefits of the American system
- Actually, we have passed that stage long time ago. Europe used to be 'only for the rich' centuries ago. But with French Revolution (late 18th century) it started to change and workers demanded more rights and benefits for the hours they put in. And post-WWII, nothing has changed, in fact most support the 'socialised' system. So, yeah, people have seen it and people haven't liked it.

9) Claim: America will go bankrupt if the health care system changes
- I am pretty sure you spend a lot more on health care than any other developed nation already, so maybe this isn't the best system to save money.



10) SO AFTER YOU HAVE SAID ALL THIS; WHY ON EARTH DO YOU WANT TO TRAIN IN AMERICA????
- In my post so far I have focused only on some ridiculous and ignorant claims made by some. However, I appreciate plenty of things in the American system as well. One of them is organisation. The training is much more organised and I'd go as far as to say 'resident friendly'. Residency training over here lasts far too long and simply isn't as efficient, which is why it takes 6-7 years to become a general internist after medical school, compared to 3 over there. And if it takes twice as long to achieve the same level of competence, then obviously the training there is more efficient. Furthermore, the whole application process is much more straight forward and... simply better handled. Also, board exams (steps) are quite a challenge and a nice way to make sure you know the material.
Then there is diversity - huge country and one language. Over here if one wants to move from Austria to Spain - he actually has to learn Spanish. And if he chooses to go to Sweden afterwards... well - learn Swedish.
Research opportunities in America are generally better than in most of Europe (excluding maybe Germany and UK, which might be similar, but even that is debatable).
And finally, I like American lifestyle more - less oriented on drinking in pubs.


Also, note that I am not saying that the American healthcare system is terrible - it isn't. There are advantages that have been mentioned enough times already so I don't have to repeat it all.

So which system is better overall? I have no idea. Depends on the person, I suppose. However, it would be wise for a lot of posters to actually do some research before writing on public boards.

 

[DermViser]

10) SO AFTER YOU HAVE SAID ALL THIS; WHY ON EARTH DO YOU WANT TO TRAIN IN AMERICA????
- In my post so far I have focused only on some ridiculous and ignorant claims made by some. However, I appreciate plenty of things in the American system as well. One of them is organisation. The training is much more organised and I'd go as far as to say 'resident friendly'. Residency training over here lasts far too long and simply isn't as efficient, which is why it takes 6-7 years to become a general internist after medical school, compared to 3 over there. And if it takes twice as long to achieve the same level of competence, then obviously the training there is more efficient. Furthermore, the whole application process is much more straight forward and... simply better handled. Also, board exams (steps) are quite a challenge and a nice way to make sure you know the material.
Then there is diversity - huge country and one language. Over here if one wants to move from Austria to Spain - he actually has to learn Spanish. And if he chooses to go to Sweden afterwards... well - learn Swedish.
Research opportunities in America are generally better than in most of Europe (excluding maybe Germany and UK, which might be similar, but even that is debatable).
And finally, I like American lifestyle more - less oriented on drinking in pubs.

The reason that residency training is shorter in the U.S. is bc the hours are much much longer. Not to mention if residency training was even longer, the level of compounding interest would be unsustainable for most U.S. AMG trainees.

As far as, "I like American lifestyle more - less oriented on drinking in pubs."

"Also, board exams (steps) are quite a challenge and a nice way to make sure you know the material."

 

[Nephronlearner]

The reason that residency training is shorter in the U.S. is bc the hours are much much longer. Not to mention if residency training was even longer, the level of compounding interest would be unsustainable for most U.S. AMG trainees.

As far as, "I like American lifestyle more - less oriented on drinking in pubs."

"Also, board exams (steps) are quite a challenge and a nice way to make sure you know the material."

Yeah that was supposed to be a way to make quite a serious post a bit 'lighter', apparently I succeeded with that at least I did make two Step 1 related threads afterall, so I had to defend it somehow, lol, maybe I could have used an emoticon or 2, but I hoped people would realise that this wasn't the most serious part of the post anyway...

It is true, however, that Americans are generally much more into actually doing something in their free time (be it sports or whatever). Life here is generally a step slower.

On the serious side, as someone living here I had to write as some people have literally made it seem as if we didn't even have healthcare systems over here.

Also in response to 'rationing' treatments - are you sure the insurance companies don't do that? (if you are referring to approved and non-approved treatments) I am pretty sure insurance companies do not approve every single treatment either (either because they are experimental or whatever) and people have to pay out of pocket. Well, you can pay out of pocket here too.

Again, things aren't nearly as black and white as some posters make it seem.

 

[wjs010]

The problem with bleeding-heart progressive policies, especially in today's political environment, is that the trade-off is almost never clearly articulated.

It's easy for progressive politicians to garner support for generous government assistance programs like universal healthcare, immigration reform, increased minimum wage, etc b/c there's a crystal clear upside to the uneducated voter. Who doesn't want free healthcare, better wages, and citizenship for well-meaning illegal aliens?

The problem is that there's a trade-off for everything, and progressives like Pelosi, Reid, Obama, and Zeke Emanuel almost NEVER paint the trade-off in an accurate light. Just look at the "if you like your plan, you can keep it" fiasco. A clear trade-off for the ACA that was swept under the rug because it was unsavory and could have halted public approval of the ACA.

Unfortunately for conservatives and libertarians, they are rightly concerned with the trade-offs and are easily villianized in the media as being anti-middle class and pro-1%. Being level headed and concerned with negative consequences doesn't buy you any favor in the public eye in today's political environment.

You're right. It's really sad. Free healthcare sounds all dreamy and great, so if you're against it, you're a bad person. ..

 

[BestDoctorEver]

@Nephronlearner ...We have become a nation of talking points...

 

[Drrrrrr. Celty]

Did all of you forget that we pay state taxes on top of federal taxes? No one in this country pays just 28%, they're paying much less.

Now lets factor in no student debt. Free medical care. 4-10 weeks vacation. Paid maternity leave. Much more advanced public transportation systems. And many more things and I think we can honestly say that life is a little bit more sweet.

Point being is we're not taking into account a lot of expenses that Americans have that Europeans cannot even begin to fathom.

 

[PL198]

The amount of ignorance on this thread is just mind blowing...

Where to start...
First of all, I am writing this as a medical student. Having lived in 'Europe' (even though 'Europe' is quite a broad term since there are very significant differences between countries) my whole life and having a lot of friends from several different European countries, I am familiar with the systems. And I have been to plenty of places as well.
Also, I am writing this as someone who is planning to do residency in the States.

So I will do this in a FAQ form:

1) Claim: 70% income tax
- Nonsense. Taxes are generally closer to 35-40%. Simply googling 'gross-net salary calculator' for each country could provide a lot of valuable (and quite accurate) information. For example, a consultant making 100,000 in UK (gross) would get ~65,000 after tax. In France ~70-75,000.

2) Claim: no freedom to choose healthcare provider
- Nonsense again. People over here generally have more freedom because they don't have to worry about 'out of network' and 'in network' hospitals, which then affects how much they pay. I can literally see any doctor in the country for no cost (besides what has been paid through taxes).

3) Claim: salaries are significantly lower
- True. However, also note that this salary of ~5,000 usually means no additional payments for health insurance, disability insurance, malpractice insurance, retirement fund, in some countries child care, 4-6 weeks of vacation, unlimited number of sick days and a much shorter work week. That being said, those who want to work more are generally able to work in private practices in their 'spare time' and earn extra money.

4) Claim: Europe is in debt
- True. But so is the US. In fact, US has the largest national debt of all the countries in the world.

5) Claim: The healthcare outcomes in Europe are much worse
- Depends. Life expectancy in most of Europe is 2-3 years longer than it is in the US. Infant mortality is lower. Cancer survival (US vs Germany; 5 year survival):
Locally/regionally spread breast cancer: 83% vs 79%
All stages pancreatic cancer: 6% vs 10%
And for any other type of cancer, the rates are very similar.
Also, it is worth noting that everyone gets chemotherapy in Germany/Sweden/UK/France, regardless of how much money and what kind of insurance they have. Furthermore, survival amongst the poor is generally lower for every condition, thereby providing healthcare only to wealthier population could artificially boost the numbers.

6) Claim: Europeans are controlled by their governments
- LOL, What?! Controlled how?! We pay taxes that are 10 or so percent higher than in the US? Yes, we do. But we get some pretty cool benefits for it so...

7) Claim: if you go to the doctor in France/England, the bureaucracy will be your biggest enemy
- I doubt it. In fact, you will not even have to discuss your insurance or call the insurance company. Patients meet doctors and pretty much anything the doctor prescribes is available (without having to check with your HMO).

8) Claim: Europeans are brainwashed so they don't realise the benefits of the American system
- Actually, we have passed that stage long time ago. Europe used to be 'only for the rich' centuries ago. But with French Revolution (late 18th century) it started to change and workers demanded more rights and benefits for the hours they put in. And post-WWII, nothing has changed, in fact most support the 'socialised' system. So, yeah, people have seen it and people haven't liked it.

9) Claim: America will go bankrupt if the health care system changes
- I am pretty sure you spend a lot more on health care than any other developed nation already, so maybe this isn't the best system to save money.



10) SO AFTER YOU HAVE SAID ALL THIS; WHY ON EARTH DO YOU WANT TO TRAIN IN AMERICA????
- In my post so far I have focused only on some ridiculous and ignorant claims made by some. However, I appreciate plenty of things in the American system as well. One of them is organisation. The training is much more organised and I'd go as far as to say 'resident friendly'. Residency training over here lasts far too long and simply isn't as efficient, which is why it takes 6-7 years to become a general internist after medical school, compared to 3 over there. And if it takes twice as long to achieve the same level of competence, then obviously the training there is more efficient. Furthermore, the whole application process is much more straight forward and... simply better handled. Also, board exams (steps) are quite a challenge and a nice way to make sure you know the material.
Then there is diversity - huge country and one language. Over here if one wants to move from Austria to Spain - he actually has to learn Spanish. And if he chooses to go to Sweden afterwards... well - learn Swedish.
Research opportunities in America are generally better than in most of Europe (excluding maybe Germany and UK, which might be similar, but even that is debatable).
And finally, I like American lifestyle more - less oriented on drinking in pubs.


Also, note that I am not saying that the American healthcare system is terrible - it isn't. There are advantages that have been mentioned enough times already so I don't have to repeat it all.

So which system is better overall? I have no idea. Depends on the person, I suppose. However, it would be wise for a lot of posters to actually do some research before writing on public boards.

Hey how are Italy, Portugal, Greece, Spain and Ireland doing? Oh yeah, that's right. Are you really going to tell me everything is all good over there? You realize the EU literally banned the word bankrupt, right? Like they banned a word, because it had such a negative connotation and was being used so frequently. Carry on though, your system is great.

 

[PL198]

Did all of you forget that we pay state taxes on top of federal taxes? No one in this country pays just 28%, they're paying much less.

Now lets factor in no student debt. Free medical care. 4-10 weeks vacation. Paid maternity leave. Much more advanced public transportation systems. And many more things and I think we can honestly say that life is a little bit more sweet.

Point being is we're not taking into account a lot of expenses that Americans have that Europeans cannot even begin to fathom.

Ok so feel free to move over there. Tell me how many Americans leave USA for Europe, and then tell me how many Europeans come to America. Oh yeah that's right...

 

[Drrrrrr. Celty]

Kinasepro, your entire argument detracts from the fact that the Republican fan base is an entirely populist one filled with ill equipped losers who's only hope is for a theocratic instillation that constantly feeds them good old pro-american opioids.

 

[PL198]

Kinasepro, your entire argument detracts from the fact that the Republican fan base is an entirely populist one filled with ill equipped losers who's only hope is for a theocratic instillation that constantly feeds them good old pro-american opioids.

^ lol and you call yourself progressive? Oh right, only white males that are republicans can be bigots, talk about religious inferiority and label huge bodies of people. The liberal movement is the biggest hypocrisy ever seen on the earth. You remind me of the college professor who was rounding up the conservative newspapers and destroying them.

 

[Drrrrrr. Celty]

Hey how are Italy, Portugal, Greece, Spain and Ireland doing? Oh yeah, that's right. Are you really going to tell me everything is all good over there? You realize the EU literally banned the word bankrupt, right? Like they banned a word, because it had such a negative connotation and was being used so frequently. Carry on though, your system is great.

I've been to all of those nations during the American caused global recession. All of them are doing socially better than we are due to largely the recession being spread out between everyone.
They have their issues namely large unemployment in youth. But it's actually far less than America especially given that like what? 30% of our entire working population is either unemployed or given up entirely on finding a job.

 

[Drrrrrr. Celty]

^ lol and you call yourself progressive? Oh right, only white males that are republicans can be bigots, talk about religious inferiority and label huge bodies of people. The liberal movement is the biggest hypocrisy ever seen on the earth. You remind me of the college professor who was rounding up the conservative newspapers and destroying them.

Uh.. I don't believe I labeled myself anything. I'm part of the everyone should stop breathing my air club. Sorry, I'm not going to ask you to join.


Also burning conservative newspapers... next your going to say that God is not dead is a true story bro.

 

[Drrrrrr. Celty]

.

 

[PL198]

I've been to all of those nations during the American caused global recession. All of them are doing socially better than we are due to largely the recession being spread out between everyone.
They have their issues namely large unemployment in youth. But it's actually far less than America especially given that like what? 30% of our entire working population is either unemployed or given up entirely on finding a job.

Ok, settle down and let the grown ups talk. The America caused global recession? k bud... due to the recession being spread out? Do you understand anything about economics? America's plight is due to the fact that the average American is a lazy piece of crap. But hey, we don't have to ban the word bankrupt, so that's probably significant. Carry on though, with all your freedom and choice.