President Obama's NEJM Editorial on ACA "Repeal and Replace"

[efle]

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Well that is a pretty bad
We don't have the here
At least for the 2 manor teaching hospitals

Actually that depends
Rural states like NV,OK, and WV have lower pay for example

Adjust for the cost of living / how much property and goods you get per $ in those areas and the blue will darken considerably. Not to mention those are the state averages overall, if you're in MN outside of Minneapolis it's a very different story than being in the city

 

[libertyyne]

https://www.bls.gov/oes/current/oes291062.htm

Adjust for the cost of living / how much property and goods you get per $ in those areas and the blue will darken considerably. Not to mention those are the state averages overall, if you're in MN outside of Minneapolis it's a very different story than being in the city

Plus it is an absurd argument that nationalization would somehow exacerbate the physican shortage problem, the shortage problem was in place before the ACA. Plus the argument that the entire nation should not have health insurance because doctors would get paid less doesnt really hold up to any rational thought. Wouldnt there be massive physican shortages in every industrialized nation then?

 

[efle]

Wouldnt there be massive physican shortages in every industrialized nation then?

I mean there certainly might be issues with pay level if they had to deal with the debt, lawsuits, work hours etc that ours do. You go somewhere like Scandinavia and the doctors go to school for free and work just under 40 hrs/week like everyone else does, so it's just about liking the job and caring about people over there. If it were true that a national public option or single pay would drop everyone to minimal reimbursements overnight it would be a big problem

 

[libertyyne]

I mean there certainly might be issues with pay level if they had to deal with the debt, lawsuits, work hours etc that ours do. You go somewhere like Scandinavia and the doctors go to school for free and work just under 40 hrs/week like everyone else does, so it's just about liking the job and caring about people over there. If it were true that a national public option or single pay would drop everyone to minimal reimbursements overnight it would be a big problem

Nationalization will not lead to overnight reduction in salaries and reimbursement. For a good portion of hospitals uncle same is already the top insurer in terms of medicare, Downward pressure on physician salaries could occur in the current climate with a simple medicare rate change, another reason MD salaries have been pretty stagnant and the reason why you see reimbursement's change like radiologists getting paid less over the past few years. You dont need nationalized healthcare to decimate MD salaries nor does Nationalize healthcare decimate MD salaries by itself. Congress could double residency slots and then make it easier for FMGs to come here depressing MD salaries too!

 

[NeuResurgens]

I like this
www.forbes.com/sites/theapothecary/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/?client=ms-android-hms-tmobile-us

Great find, cool read. Does a good job of explaining the benefits and drawbacks of the Swiss system, but also talks about the political feasibility I hinted at with regards to health reform in a bipartisan country.

 

[Dr.Sticks]

Plus it is an absurd argument that nationalization would somehow exacerbate the physican shortage problem, the shortage problem was in place before the ACA. Plus the argument that the entire nation should not have health insurance because doctors would get paid less doesnt really hold up to any rational thought. Wouldnt there be massive physican shortages in every industrialized nation then?

U.K is pretty bad, Romania is insanely terrible...

Nationalization will not lead to overnight reduction in salaries and reimbursement. For a good portion of hospitals uncle same is already the top insurer in terms of medicare, Downward pressure on physician salaries could occur in the current climate with a simple medicare rate change, another reason MD salaries have been pretty stagnant and the reason why you see reimbursement's change like radiologists getting paid less over the past few years. You dont need nationalized healthcare to decimate MD salaries nor does Nationalize healthcare decimate MD salaries by itself. Congress could double residency slots and then make it easier for FMGs to come here depressing MD salaries too!

Yeah there is no way a republican congress would do that especially with Trump in office.. FMGs are the last thing we will be bringing in over the next 4 and maybe 8 years
Here is the other thing just because we have more FMGs doesn't mean they will get work. Employers will always prefer American medical graduates over FMGs if it comes does to there being a physician surplus due to FMGs.

 

[libertyyne]

U.K is pretty bad, Romania is insanely terrible...


Yeah there is no way a republican congress would do that especially with Trump in office.. FMGs are the last thing we will be bringing in over the next 4 and maybe 8 years
Here is the other thing just because we have more FMGs doesn't mean they will get work. Employers will always prefer American medical graduates over FMGs if it comes does to there being a physician surplus due to FMGs.

• 32 of the top 41 countries by physicians > per 1,000 people are European.
  1 San Marino 47.35 per 1,000 people 1990
  2 Cuba 5.91 per 1,000 people 2002
  3 Monaco 5.81 per 1,000 people 1995
  4 Saint Lucia 5.17 per 1,000 people 1999
  5 Belarus 4.55 per 1,000 people 2003
  6 Greece 4.4 per 1,000 people 2001
  7 Russia 4.25 per 1,000 people 2003
  8 Italy 4.2 per 1,000 people 2004
  9 Turkmenistan 4.18 per 1,000 people 2002
  10 Georgia 4.09 per 1,000 people 2003
  11 Lithuania 3.97 per 1,000 people 2003
  12 Belgium 3.9 per 1,000 people 2002
  13 Israel 3.82 per 1,000 people 2003
  14 Andorra 3.7 per 1,000 people 2003
  15 Uruguay 3.65 per 1,000 people 2002
  16 Iceland 3.62 per 1,000 people 2004
  17 Switzerland 3.6 per 1,000 people 2002
  18 Armenia 3.59 per 1,000 people 2003
  19 Bulgaria 3.56 per 1,000 people 2003
  20 Azerbaijan 3.55 per 1,000 people 2003
  21 Kazakhstan 3.54 per 1,000 people 2003
  22 Czech Republic 3.5 per 1,000 people 2003
  =23 Austria 3.4 per 1,000 people 2003
  =23 Germany 3.4 per 1,000 people 2003
  25 France 3.37 per 1,000 people 2004
  Former Soviet republics average 3.35 per 1,000 people 2003
  =26 Portugal 3.3 per 1,000 people 2003
  =26 Sweden 3.3 per 1,000 people 2002
  28 North Korea 3.29 per 1,000 people 2003
  29 Lebanon 3.25 per 1,000 people 2001
  =30 Hungary 3.2 per 1,000 people 2003
  =30 Spain 3.2 per 1,000 people 2003
  32 Malta 3.18 per 1,000 people 2003
  Eurozone average 3.18 per 1,000 people 2001
  33 Estonia 3.16 per 1,000 people 2001
  =34 Netherlands 3.1 per 1,000 people 2003
  =34 Slovakia 3.1 per 1,000 people 2003
  =34 Norway 3.1 per 1,000 people 2003
  Europe average 3.06 per 1,000 people 2000
  European Union average 3.05 per 1,000 people 2001
  =37 Argentina 3.01 per 1,000 people 1998
  =37 Latvia 3.01 per 1,000 people 2003
  NATO countries average 2.99 per 1,000 people 2001
  39 Ukraine 2.95 per 1,000 people 2003
  40 Denmark 2.9 per 1,000 people 2002
  High income OECD countries average 2.86 per 1,000 people 2002
  41 Ireland 2.79 per 1,000 people 2004
  Group of 7 countries (G7) average 2.79 per 1,000 people 2002
  42 Uzbekistan 2.74 per 1,000 people 2003
  43 Luxembourg 2.7 per 1,000 people 2003
  44 Moldova 2.64 per 1,000 people 2003
  45 Mongolia 2.63 per 1,000 people 2002
  46 Finland 2.6 per 1,000 people 2003
  Non-religious countries average 2.5 per 1,000 people 2001
  =47 Australia 2.5 per 1,000 people 2002
  =47 Poland 2.5 per 1,000 people 2003
  =47 Kyrgyzstan 2.5 per 1,000 people 2004
  50 Croatia 2.4 per 1,000 people 2004
  51 Cyprus 2.34 per 1,000 people 2002
  52 United States 2.3 per 1,000 people 2002
  53 Slovenia 2.25 per 1,000 people 2002
  54 Qatar 2.22 per 1,000 people 2001
  =55 United Kingdom 2.2 per 1,000 people 2003
• http://www.nationmaster.com/country-info/stats/Health/Physicians/Per-1,000-people

You cherry picked two countries , here is some reference. The system before the ACA was just not working and I am yet to see a good argument as to why nationalization would exacerbate MD shortage. In every country above America physican salaries are below American counterparts, some how you are telling me that people will stop going into medicine.

The argument wasn't what will happen, the argument was that congress can decimate MD salaries without nationalization, so it being a unique disadvantage of nationalization is an absurd reason to not nationalize.

 

[Dr.Sticks]

• 32 of the top 41 countries by physicians > per 1,000 people are European.
  1 San Marino 47.35 per 1,000 people 1990
  2 Cuba 5.91 per 1,000 people 2002
  3 Monaco 5.81 per 1,000 people 1995
  4 Saint Lucia 5.17 per 1,000 people 1999
  5 Belarus 4.55 per 1,000 people 2003
  6 Greece 4.4 per 1,000 people 2001
  7 Russia 4.25 per 1,000 people 2003
  8 Italy 4.2 per 1,000 people 2004
  9 Turkmenistan 4.18 per 1,000 people 2002
  10 Georgia 4.09 per 1,000 people 2003
  11 Lithuania 3.97 per 1,000 people 2003
  12 Belgium 3.9 per 1,000 people 2002
  13 Israel 3.82 per 1,000 people 2003
  14 Andorra 3.7 per 1,000 people 2003
  15 Uruguay 3.65 per 1,000 people 2002
  16 Iceland 3.62 per 1,000 people 2004
  17 Switzerland 3.6 per 1,000 people 2002
  18 Armenia 3.59 per 1,000 people 2003
  19 Bulgaria 3.56 per 1,000 people 2003
  20 Azerbaijan 3.55 per 1,000 people 2003
  21 Kazakhstan 3.54 per 1,000 people 2003
  22 Czech Republic 3.5 per 1,000 people 2003
  =23 Austria 3.4 per 1,000 people 2003
  =23 Germany 3.4 per 1,000 people 2003
  25 France 3.37 per 1,000 people 2004
  Former Soviet republics average 3.35 per 1,000 people 2003
  =26 Portugal 3.3 per 1,000 people 2003
  =26 Sweden 3.3 per 1,000 people 2002
  28 North Korea 3.29 per 1,000 people 2003
  29 Lebanon 3.25 per 1,000 people 2001
  =30 Hungary 3.2 per 1,000 people 2003
  =30 Spain 3.2 per 1,000 people 2003
  32 Malta 3.18 per 1,000 people 2003
  Eurozone average 3.18 per 1,000 people 2001
  33 Estonia 3.16 per 1,000 people 2001
  =34 Netherlands 3.1 per 1,000 people 2003
  =34 Slovakia 3.1 per 1,000 people 2003
  =34 Norway 3.1 per 1,000 people 2003
  Europe average 3.06 per 1,000 people 2000
  European Union average 3.05 per 1,000 people 2001
  =37 Argentina 3.01 per 1,000 people 1998
  =37 Latvia 3.01 per 1,000 people 2003
  NATO countries average 2.99 per 1,000 people 2001
  39 Ukraine 2.95 per 1,000 people 2003
  40 Denmark 2.9 per 1,000 people 2002
  High income OECD countries average 2.86 per 1,000 people 2002
  41 Ireland 2.79 per 1,000 people 2004
  Group of 7 countries (G7) average 2.79 per 1,000 people 2002
  42 Uzbekistan 2.74 per 1,000 people 2003
  43 Luxembourg 2.7 per 1,000 people 2003
  44 Moldova 2.64 per 1,000 people 2003
  45 Mongolia 2.63 per 1,000 people 2002
  46 Finland 2.6 per 1,000 people 2003
  Non-religious countries average 2.5 per 1,000 people 2001
  =47 Australia 2.5 per 1,000 people 2002
  =47 Poland 2.5 per 1,000 people 2003
  =47 Kyrgyzstan 2.5 per 1,000 people 2004
  50 Croatia 2.4 per 1,000 people 2004
  51 Cyprus 2.34 per 1,000 people 2002
  52 United States 2.3 per 1,000 people 2002
  53 Slovenia 2.25 per 1,000 people 2002
  54 Qatar 2.22 per 1,000 people 2001
  =55 United Kingdom 2.2 per 1,000 people 2003
• http://www.nationmaster.com/country-info/stats/Health/Physicians/Per-1,000-people

You cherry picked two countries , here is some reference. The system before the ACA was just not working and I am yet to see a good argument as to why nationalization would exacerbate MD shortage. In every country above America physican salaries are below American counterparts, some how you are telling me that people will stop going into medicine.

The argument wasn't what will happen, the argument was that congress can decimate MD salaries without nationalization, so it being a unique disadvantage of nationalization is an absurd reason to not nationalize.

Dude; Those countries don't have the costs associated with being/becoming a physician like we do.
Are you going to make medical school free for everyone?
Subsidize malpractice?

 

[libertyyne]

Dude; Those countries don't have the costs associated with being/becoming a physician like we do.
Are you going to make medical school free for everyone?
Subsidize malpractice?

Dude your argument doesnt make any sense. You are saying that nationalization would reduce the physican supply. We arent nationalized yet we have physican supply in the 50's right below Cyprus. My argument is that even under the status quo and before the ACA there was a physician shortage. We spend more than any other nation, yet we have worse outcomes and dont have full access. Our salaries are higher yet we have a shortage? Your logic is not adding up.

What exactly is the higher salaries buying us?

 

[NeuResurgens]

Dude your argument doesnt make any sense. You are saying that nationalization would reduce the physican supply. We arent nationalized yet we have physican supply in the 50's right below Cyprus. My argument is that even under the status quo and before the ACA there was a physician shortage. We spend more than any other nation, yet we have worse outcomes and dont have full access. Our salaries are higher yet we have a shortage? Your logic is not adding up.

What exactly is the higher salaries buying us?

I'm not going to take sides in yalls debate, but in a vacuum I'd like to challenge the implication that "we have worse outcomes, therefore our healthcare is worse but we spend more on it." Our outcome indicators are often lower, but "worse outcomes" is not in and of itself a reflection of the quality of healthcare received in a country. I once read a well thought out rebuttal of the WHO study that people usually cite when denigrating our healthcare system; among other things, this essay pointed out that the US suffers from a higher rate of traumatic death, especially from car wrecks and shootings/other violent crime. This is a different political debate, but the fact is that this higher rate of trauma affects our life expectancies, rendering it a less reliable indicator of our healthcare quality. Additionally, lifestyle factors play a fairly major role in several of the variables cited here, especially obesity. This lends itself to an argument about mismanagement of public health, which in a way hurts our health quality, but blaming the actual healthcare system for it is a bit disingenuous IMO. Can't find the article otherwise I'd link.

Tl;dr, our system does suffer for lack of universal access and for cultural tendencies that hamper public health efforts, but the actual care provided here is on par with, if not better than, most other industrialized countries. It's just a particular way of framing the argument that I'm very picky about because I think it influences the discussion about what should be done in response to this.

 

[Dr.Sticks]

Dude your argument doesnt make any sense. You are saying that nationalization would reduce the physican supply. We arent nationalized yet we have physican supply in the 50's right below Cyprus. My argument is that even under the status quo and before the ACA there was a physician shortage. We spend more than any other nation, yet we have worse outcomes and dont have full access. Our salaries are higher yet we have a shortage? Your logic is not adding up.

What exactly is the higher salaries buying us?

Yes we have a physician shortage
Why?
Because we can only graduate an x number of physicians a year

What would happen if we nationalized yet medical school and all the other costs stayed the same?
We would have an even greater physician shortage largely in primary care. Also I bet a large number of older physicians who haven't retired will retire right away if it happens...

Anyways as far as health outcomes there have been research studies done and it really isn't about our lack of universal care.
Rather it was found to be an issue with our social spending

Directly quoting
"Inadequate investment in services that address poverty and these broader determinants of health may largely explain the United States’ lag in health outcomes."
http://pediatrics.aappublications.org/content/135/6/961

 

[Dr.Sticks]

I'm not going to take sides in yalls debate, but in a vacuum I'd like to challenge the implication that "we have worse outcomes, therefore our healthcare is worse but we spend more on it." Our outcome indicators are often lower, but "worse outcomes" is not in and of itself a reflection of the quality of healthcare received in a country. I once read a well thought out rebuttal of the WHO study that people usually cite when denigrating our healthcare system; among other things, this essay pointed out that the US suffers from a higher rate of traumatic death, especially from car wrecks and shootings/other violent crime. This is a different political debate, but the fact is that this higher rate of trauma affects our life expectancies, rendering it a less reliable indicator of our healthcare quality. Additionally, lifestyle factors play a fairly major role in several of the variables cited here, especially obesity. This lends itself to an argument about mismanagement of public health, which in a way hurts our health quality, but blaming the actual healthcare system for it is a bit disingenuous IMO. Can't find the article otherwise I'd link.

Tl;dr, our system does suffer for lack of universal access and for cultural tendencies that hamper public health efforts, but the actual care provided here is on par with, if not better than, most other industrialized countries. It's just a particular way of framing the argument that I'm very picky about because I think it influences the discussion about what should be done in response to this.

Is this it?
http://pediatrics.aappublications.org/content/135/6/961

 

[Dr.Sticks]

https://www.ncbi.nlm.nih.gov/books/NBK154469/
This article adds that along with lack of social spending Americans are fat, we have a high STD/Teen pregnancy rate, more drug deaths, etc
See page 11 and read from there
This is probably what @UNMedGa was referencing

 

[libertyyne]

I agree that there are complex reasons that may be contributing to our adverse outcomes. However, we spend almost 3 times as much, dont cover each person, and have worse outcomes(the study says that all the variability cant be explained by the confounding variables, that doesnt mean some of the variability is not related to poor delivery of care). I am still not sold on the idea that nationalization would exacerbate the physican maldistribution problem. How about this , a part of nationalization go ahead an increase residency slots and mandate a specific portion be FM, also legislate any foriegn MD's coming into the country have to serve 5 years in an underserved area.

 

[hsmooth]

"Inadequate investment in services that address poverty and these broader determinants of health may largely explain the United States’ lag in health outcomes."


This article adds that along with lack of social spending Americans are fat, we have a high STD/Teen pregnancy rate, more drug deaths, etc

I actually agree to this. Which delves into another discussion about political and social idealogy which leaves me so frustrated and concerned.

Trying to defund Planned Parenthood, a program that provides many women's health services often to those with the most difficulty accessing healthcare, on the basis that you don't agree philosophically with one out of the many services they provide (elective abortion)? Seems wrong.

Decry sexual education, preach abstinence to teens, repeal the ACA which provides women access to free or low copay birth control, shame a teen mother into having the baby, yet there are no social support programs to help baby and mother once baby is born? Seems wrong.

The U.S. is the only developed nation that does not ensure a parent can be home with a new child and put food on the table for at least a block of weeks. The maternity leave propose by the PEOTUS is flawed and restrictive, while complely leaving fathers out of the provision. Seems wrong.

Repeal the ACA / obamacare without any planned replacement, potentially leaving those most in need without healthcare just because you don't like the name of the president that passed the legislation? Seems wrong

Picking cabinet members with a history of opposing raises to minimum wage salary, keeping the poor, poor? Seems wrong.

So many future potential political maneuvers seem to be just so wrong at a societal level with the consequences seemingly directly contraindicating your view that we need more investment in addressing poverty and inequality.

And lastly, as a resident alien that has lived in the States now for almost the past 10 years it just seems weird to me that a large portion of Americans view health care as a business commodity. It's a privilege you get by working hard to pay for the best insurance coverage you can buy on the free market - the free market that is supposed to regulate itself by competition to keep costs low even though they are in the business to make money off you being sick.

While a large portion of Canadians, despite some inherent flaws to their medical system, view their universal system as a source of pride - that it is a constitutional right to be able to access health care regardless of your socioeconomic status; it's not something that you buy if you have money. What do Americans take pride in as a constitutional right? The right to bear arms and have a gun. Go figure.

https://www.ncbi.nlm.nih.gov/books/NBK154469/
This article adds that along with lack of social spending Americans are fat, we have a high STD/Teen pregnancy rate, more drug deaths, etc
See page 11 and read from there
This is probably what @UNMedGa was referencing

 

[Dr.Sticks]

I agree that there are complex reasons that may be contributing to our adverse outcomes. However, we spend almost 3 times as much, dont cover each person, and have worse outcomes(the study says that all the variability cant be explained by the confounding variables, that doesnt mean some of the variability is not related to poor delivery of care). I am still not sold on the idea that nationalization would exacerbate the physican maldistribution problem. How about this , a part of nationalization go ahead an increase residency slots and mandate a specific portion be FM, also legislate any foriegn MD's coming into the country have to serve 5 years in an underserved area.

I prefer the German system where they do have national care but you only have to be part of it if you make less than a certain amount
I think that is a better plan than full blown single payer like the U.K

"Inadequate investment in services that address poverty and these broader determinants of health may largely explain the United States’ lag in health outcomes."


This article adds that along with lack of social spending Americans are fat, we have a high STD/Teen pregnancy rate, more drug deaths, etc

I actually agree to this. Which delves into another discussion about political and social idealogy which leaves me so frustrated and concerned.

Trying to defund Planned Parenthood, a program that provides many women's health services often to those with the most difficulty accessing healthcare, on the basis that you don't agree philosophically with one out of the many services they provide (elective abortion)? Seems wrong.

Decry sexual education, preach abstinence to teens, repeal the ACA which provides women access to free or low copay birth control, shame a teen mother into having the baby, yet there are no social support programs to help baby and mother once baby is born? Seems wrong.

The U.S. is the only developed nation that does not ensure a parent can be home with a new child and put food on the table for at least a block of weeks. The maternity leave propose by the PEOTUS is flawed and restrictive, while complely leaving fathers out of the provision. Seems wrong.

Repeal the ACA / obamacare without any planned replacement, potentially leaving those most in need without healthcare just because you don't like the name of the president that passed the legislation? Seems wrong

Picking cabinet members with a history of opposing raises to minimum wage salary, keeping the poor, poor? Seems wrong.

So many future potential political maneuvers seem to be just so wrong at a societal level with the consequences seemingly directly contraindicating your view that we need more investment in addressing poverty and inequality.

And lastly, as a resident alien that has lived in the States now for almost the past 10 years it just seems weird to me that a large portion of Americans view health care as a business commodity. It's a privilege you get by working hard to pay for the best insurance coverage you can buy on the free market - the free market that is supposed to regulate itself by competition to keep costs low even though they are in the business to make money off you being sick.

While a large portion of Canadians, despite some inherent flaws to their medical system, view their universal system as a source of pride - that it is a constitutional right to be able to access health care regardless of your socioeconomic status; it's not something that you buy if you have money. What do Americans take pride in as a constitutional right? The right to bear arms and have a gun. Go figure.

I don't think k you can legislate the poor into prosperity.
If you actually take into consideration the PPP most of Europe's except a few nations are poorer than the poorest U.S state.

With that said I don't really have any qualms about life quality in the U.S, even our poorest states residents on average how more purchasing power than the majority of Europeans.

Also if Trump didn't propose Maternity leave it would not even be up for consideration in a Republican majority congress/senate.
Even considering it is unorecedent
Forgot about the flaws, this wouldn't even be dreamed about by a republican.

As for the repeal I agree that they should have their plan ready.. This is a bit ridiculous
The ACA was a horrible plan though.. It basically tried a swiss model but butchered it epically.

Also I think it is a bit of a cultural difference for you especially in the Midwest.
Yes guns are a source of pride
It is symbolic of the pioneer spirit that built this nation.
It is a culture and I don't expect anyone foreign to it to understand.(that includes people in NYC, L.A, etc)
I am from an area where people like to hunt, fish, shoot for fun, have a great distrust of government, guns are a part of life here.
We don't pick our culture, so it isn't really easy to explain.

Also medicine technically is a business... Staff has to be paid, supplies have to be bought, it basically is a business.
It isn't a for profit business though for the most part..
Also everyone deserves care, that is why the E.R will not deny.
However there has to be a better way of going about it.
I think a swiss model or mixture of the German model would be good.
I am 100% against full blown single payer though

 

[libertyyne]

I prefer the German system where they do have national care but you only have to be part of it if you make less than a certain amount
I think that is a better plan than full blown single payer like the U.K


I don't think k you can legislate the poor into prosperity.
If you actually take into consideration the PPP most of Europe's except a few nations are poorer than the poorest U.S state.

With that said I don't really have any qualms about life quality in the U.S, even our poorest states residents on average how more purchasing power than the majority of Europeans.

Also if Trump didn't propose Maternity leave it would not even be up for consideration in a Republican majority congress/senate.
Even considering it is unorecedent
Forgot about the flaws, this wouldn't even be dreamed about by a republican.

As for the repeal I agree that they should have their plan ready.. This is a bit ridiculous
The ACA was a horrible plan though.. It basically tried a swiss model but butchered it epically.

Also I think it is a bit of a cultural difference for you especially in the Midwest.
Yes guns are a source of pride
It is symbolic of the pioneer spirit that built this nation.
It is a culture and I don't expect anyone foreign to it to understand.(that includes people in NYC, L.A, etc)
I am from an area where people like to hunt, fish, shoot for fun, have a great distrust of government, guns are a part of life here.
We don't pick our culture, so it isn't really easy to explain.

Also medicine technically is a business... Staff has to be paid, supplies have to be bought, it basically is a business.
It isn't a for profit business though for the most part..
Also everyone deserves care, that is why the E.R will not deny.
However there has to be a better way of going about it.
I think a swiss model or mixture of the German model would be good.
I am 100% against full blown single payer though

Well lets hope you retain that belief if you ever end up having a chronic illness, have been denied coverage, and have lost your job because you missed too many days at work.

 

[efle]

I prefer the German system where they do have national care but you only have to be part of it if you make less than a certain amount
I think that is a better plan than full blown single payer like the U.K

One of the biggest criticisms of the ACA early on was the lack of a national public option. It was originally planned to be a much better mix of gov care and private market than what we got.

If you actually take into consideration the PPP most of Europe's except a few nations are poorer than the poorest U.S state.

PPP adjusted GDP per capita (I assume you're referring to something like this) is a terrible way to measure which population is "poorer." If you and nine other families live in a ghetto, but then you win the lottery, reporting the street as a street of per-capita millionaires doesn't paint a very accurate picture. Look at the overall distributions and then tell me that, reincarnated as a random citizen in a random place next life, you'd really be hoping for Alabama or Missouri over the UK or Sweden

 

[efle]

Also I want to just recommend in general to anyone with the option at their school, take a healthcare economics class. The one I took stands out as one of the most valuable non-BCPM classes I had in college, it can be hard to really understand all these alternative systems without having it taught in a well presented semester long course. It's also great for your med school interviews!

 

[wizzed101]

I agree that there are complex reasons that may be contributing to our adverse outcomes. However, we spend almost 3 times as much, dont cover each person, and have worse outcomes(the study says that all the variability cant be explained by the confounding variables, that doesnt mean some of the variability is not related to poor delivery of care). I am still not sold on the idea that nationalization would exacerbate the physican maldistribution problem. How about this , a part of nationalization go ahead an increase residency slots and mandate a specific portion be FM, also legislate any foriegn MD's coming into the country have to serve 5 years in an underserved area.

Per your graph, almost 2 times...Don't do that comrade. This is not a journalist forum.

That aside, your idea sounds like this, which is objectively very nice!


I don't know what your idea of medicine is, but doctors are not slaves. All these things about putting patients' interests first and altruism and blah blah are nice and all, but the REAL #1 priority is still our welfare. That is just human nature. And "maldistribution" of anything is what nationalization does. I mean you may ironically think that the Soviets back then had IQs in the 80s so they didn't know that to offset a shortage in, say, wheat they would've just simply shift the production there. BAM! Shortage solved! How stoooopid the Soviets were!!!

No they were smart people shackled by what you are proposing.

Well lets hope you retain that belief if you ever end up having a chronic illness, have been denied coverage, and have lost your job because you missed too many days at work.

You only see people dying of acute illness and confirmed diagnosis, because I guess it is more dramatic, more graphic, more sensational! Mine, you should seriously consider journalism. What about those seemingly healthy who have no diagnosis yet? What about those dying while waiting in the line with a life threatening condition but deemed non-urgent? Of those with condition "not urgent enough?" They don't exist?

Trying to defund Planned Parenthood, a program that provides many women's health services often to those with the most difficulty accessing healthcare, on the basis that you don't agree philosophically with one out of the many services they provide (elective abortion)? Seems wrong.

Just 3% of the service they provide is abortion. But there was an allegation that 86% of PPP's revenue is from abortion. PPP did not deny that figure. Not to say that it is true but it really makes you think!

Now let just say that only 3% of its revenue is from abortion, why don't they just scrap those 3% and save the rest? It will also improve public relation. Not all women support abortion either. I don't have a figure but I wager that it is way more than 3% of them. So for me, the calculus is pretty simple. If you run a clinic, and there is a procedure you only run 3% of the time that would alienate say, 30% of your targeted population, is it ethical to run that procedure?

 

[libertyyne]

Per your graph, almost 2 times...Don't do that comrade. This is not a journalist forum.

That aside, your idea sounds like this, which is objectively very nice!


I don't know what your idea of medicine is, but doctors are not slaves. All these things about putting patients' interests first and altruism and blah blah are nice and all, but the REAL #1 priority is still our welfare. That is just human nature. And "maldistribution" of anything is what nationalization does. I mean you may ironically think that the Soviets back then had IQs in the 80s so they didn't know that to offset a shortage in, say, wheat they would've just simply shift the production there. BAM! Shortage solved! How stoooopid the Soviets were!!!

No they were smart people shackled by what you are proposing.


You only see people dying of acute illness and confirmed diagnosis, because I guess it is more dramatic, more graphic, more sensational! Mine, you should seriously consider journalism. What about those seemingly healthy who have no diagnosis yet? What about those dying while waiting in the line with a life threatening condition but deemed non-urgent? Of those with condition "not urgent enough?" They don't exist?


Just 3% of the service they provide is abortion. But there was an allegation that 86% of PPP's revenue is from abortion. PPP did not deny that figure. Not to say that it is true but it really makes you think!

Now let just say that only 3% of its revenue is from abortion, why don't they just scrap those 3% and save the rest? It will also improve public relation. Not all women support abortion either. I don't have a figure but I wager that it is way more than 3% of them. So for me, the calculus is pretty simple. If you run a clinic, and there is a procedure you only run 3% of the time that would alienate say, 30% of your targeted population, is it ethical to run that procedure?

So a majority of the industrialized world is communist. Perhaps you are the journalist. Maybe you should spend less time trolling on the internet and more time reading ayn rand and researching /pol to hone your trolling skills first?

 

[bonedoc5576]

No one is discussing the real problem which is the blatant over-utilization of resources in managing end-stage illness.
Physicians should be advocating for outcomes-based utilization of limited public resources (RATIONING), else the alternative can only be steadily declining reimbursement for services until physicians are priced out of the market entirely.
Clearly such policy is too unpopular to be embraced by those voted into office, nonetheless the trend of diminishing reimbursement rates compensating for over-utilization of resources in an aging population will be the death of medicine

 

[wizzed101]

So a majority of the industrialized world is communist. Perhaps you are the journalist. Maybe you should spend less time trolling on the internet and more time reading ayn rand and researching /pol to hone your trolling skills first?

Nice straw man there, comrade. I am not sure Ayn Rand comes from and what is /pol?. Is it a reddit thing? I have never read her. I assume you are denying the human nature of self-preservation? Go to the allo-forums and see how many of them want a 70% slash to their pay check with all debt forgiven.
Besides, you are wrong as usual...
https://truecostblog.com/2009/08/09/countries-with-universal-healthcare-by-date/

I count.. 16 out of 33 with a single-payer system. Though, I don't know if in Soviet Russia, that was considered a majority. Or the term nationalized does not mean what you think it means.

 

[libertyyne]

No one is discussing the real problem which is the blatant over-utilization of resources in managing end-stage illness.
Physicians should be advocating for outcomes-based utilization of limited public resources (RATIONING), else the alternative can only be steadily declining reimbursement for services until physicians are priced out of the market entirely.
Clearly such policy is too unpopular to be embraced by those voted into office, nonetheless the trend of diminishing reimbursement rates compensating for over-utilization of resources in an aging population will be the death of medicine

There is a financial incentive to do more for proceduralists. They don't want their gravy train to dry up. So we will continue down this path until healthcare takes over GDP, they gut medicare or both. But it seems like most people are in the "I got mine, F**" you" court.

 

[libertyyne]

Nice straw man there, comrade. I am not sure Ayn Rand comes from and what is /pol?. Is it a reddit thing? I have never read her. I assume you are denying the human nature of self-preservation? Go to the allo-forums and see how many of them want a 70% slash to their pay check with all debt forgiven.
Besides, you are wrong as usual...
https://truecostblog.com/2009/08/09/countries-with-universal-healthcare-by-date/

I count.. 16 out of 33 with a single-payer system. Though, I don't know if in Soviet Russia, that was considered a majority. Or the term nationalized does not mean what you think it means.

You are saying this as if doctors are the only stakeholders in medicine.
Sorry comrade for this non communist definition of majority:
https://www.merriam-webster.com/dictionary/majority
"3.
c : the greater quantity or share <the majority of the time>"

I didn't realize Canada, Japan, and Finland were such communist countries someone should call North Korea and let them know.

Also, I dont think communism means what you think it means comrade!

 

[efle]

Nice straw man there, comrade. I am not sure Ayn Rand comes from and what is /pol?. Is it a reddit thing? I have never read her. I assume you are denying the human nature of self-preservation? Go to the allo-forums and see how many of them want a 70% slash to their pay check with all debt forgiven.
Besides, you are wrong as usual...
https://truecostblog.com/2009/08/09/countries-with-universal-healthcare-by-date/

I count.. 16 out of 33 with a single-payer system. Though, I don't know if in Soviet Russia, that was considered a majority. Or the term nationalized does not mean what you think it means.

Most of those two-tier have 95% of coverage and services by the public system with a tiny sliver of private service for elective or instant care for the wealthier. They are effectively a single payer for most citizens. Similarly many of the mandated insurance nations also have a competitive public option that most citizens use, again resembling much more closely single payer than the American style for huge swaths of their populations. Attacking technicalities and definitions makes you look like you lack real, substantive points.

 

[wizzed101]

You are saying this as if doctors are the only stakeholders in medicine.
Sorry comrade for this non communist definition of majority:
https://www.merriam-webster.com/dictionary/majority
"3.
c : the greater quantity or share <the majority of the time>"

I didn't realize Canada, Japan, and Finland were such communist countries someone should call North Korea and let them know.

Also, I dont think communism means what you think it means comrade!

I never said such thing. Oh so now, only those 3 countries count. Classic!

Most of those two-tier have 95% of coverage and services by the public system with a tiny sliver of private service for elective or instant care for the wealthier. They are effectively a single payer for most citizens. Similarly many of the mandated insurance nations also have a competitive public option that most citizens use, again resembling much more closely single payer than the American style for huge swaths of their populations. Attacking technicalities and definitions makes you look like you lack real, substantive points.

I just went down the list and checked the following countries: New Zealand, Netherlands, and Denmark. And they are in the order appeared on that website so I am not cherrypicking. I found: New Zealand 77%, Netherlands, 73%, Denmark 86%.

The private part surely is insignificant. I mean, 20 millions affected is what ~7% of the US population, just a comparatively tiny sliver...

 

[libertyyne]

I never said such thing. Oh so now, only those 3 countries count. Classic!


I just went down the list and checked the following countries: New Zealand, Netherlands, and Denmark. And they are in the order appeared on that website so I am not cherrypicking. I found: New Zealand 77%, Netherlands, 73%, Denmark 86%.

The private part surely is insignificant. I mean, 20 millions affected is what ~7% of the US population, just a comparatively tiny sliver...

You said nationalization is communist. Those countries have nationalized healthcare are they currently erecting monuments to Marx? Classic avoidance, comrade journalism.

 

[efle]

I never said such thing. Oh so now, only those 3 countries count. Classic!


I just went down the list and checked the following countries: New Zealand, Netherlands, and Denmark. And they are in the order appeared on that website so I am not cherrypicking. I found: New Zealand 77%, Netherlands, 73%, Denmark 86%.

The private part surely is insignificant. I mean, 20 millions affected is what ~7% of the US population, just a comparatively tiny sliver...

Keep in mind that the minorities with some private coverage are often just paying to boost their coverage for things like dental or their medications. In Denmark for example 100% of citizens get the gov health plan and it's a small group that chooses to supplement. Or if you're looking at expenditure percents, keep in mind that the elective type services are going to cost a lot more than your typical HTN, diabetes management, giving a very misleading idea of how much private is really caring for the population. This is not an area you're going to gain ground in. There are some reasonable qualms to have about singlepay but this whole chain of ideas you're putting forward about communism and private still being huge in western nations has been nonsense.

 

[wizzed101]

You said nationalization is communist. Those countries have nationalized healthcare are they currently erecting monuments to Marx? Classic avoidance, comrade journalism.

Oh no, I said that nationalization is a communist move. Straw maneee.

Keep in mind that the minorities with some private coverage are often just paying to boost their coverage for things like dental or their medications. In Denmark for example 100% of citizens get the gov health plan and it's a small group that chooses to supplement. Or if you're looking at expenditure percents, keep in mind that the elective type services are going to cost a lot more than your typical HTN, diabetes management, giving a very misleading idea of how much private is really caring for the population. This is not an area you're going to gain ground in. There are some reasonable qualms to have about singlepay but this whole chain of ideas you're putting forward about communism and private still being huge in western nations has been nonsense.

uhm.... 40% of them buy the complementary coverage. I was being generous and honest when I used that 86% figure, can you say the same? Page 6

http://www.commonwealthfund.org/~/m.../jan/1802_mossialos_intl_profiles_2014_v7.pdf

 

[Dr.Sticks]

Well lets hope you retain that belief if you ever end up having a chronic illness, have been denied coverage, and have lost your job because you missed too many days at work.

See that is why I am frugal
Financial Independence is much more easier to attain if you don't wish to have a lofty lifestyle.
For me all I need is a cabin and some land without debt and it doesn't matter if I have a job.
I have the land to provide for me.

 

[libertyyne]

Oh no, I said that nationalization is a communist move. Straw maneee.

uhm.... 40% of them buy the complementary coverage. I was being generous and honest when I used that 86% figure, can you say the same? Page 6

http://www.commonwealthfund.org/~/m.../jan/1802_mossialos_intl_profiles_2014_v7.pdf

Sure thing man. As soon as we move towards single payer capitalism will die. Just like it has died in 16 Developed countries. Comrade thanks for showing me the light, are you sure you arent in politics because your logic is commendable, and your ability to defend a statement unheard of !

 

[wizzed101]

Sure thing man. As soon as we move towards single payer capitalism will die. Just like it has died in 16 Developed countries. Comrade thanks for showing me the light, are you sure you arent in politics because your logic is commendable, and your ability to defend a statement unheard of !

Calm down!

 

[efle]

uhm.... 40% of them buy the complementary coverage.

That's 40%, already a minority, and includes any smaller addition like physio or dental or meds. We're not talking about almost half the population buying a private health package in lieu of the government coverage like you seemed to think was common in "two-tier" systems. 100% get the core healthcare package simply by being citizens.

You want to argue about how we need to keep a healthy small private sector available for the extras, sure, I agree. But so far you've been pulling data you don't understand out to try and make a point that isn't valid about primarily government driven systems.

 

[Astra]

See that is why I am frugal
Financial Independence is much more easier to attain if you don't wish to have a lofty lifestyle.
For me all I need is a cabin and some land without debt and it doesn't matter if I have a job.
I have the land to provide for me.

Bro, could you stop? Nearly all of your threads end up with you talking about how frugal you are or how you can live off the land.

Not everyone is you.

Ignoring harsh realities in our society because somehow it won't affect you is foolish and does nothing to solve the actual issues

 

[efle]

See that is why I am frugal
Financial Independence is much more easier to attain if you don't wish to have a lofty lifestyle.
For me all I need is a cabin and some land without debt and it doesn't matter if I have a job.
I have the land to provide for me.

Dude why pursue medicine if your dream is to live off the land in the middle of nowhere and you don't even care if you're employed? Very painful way to get there with all the years of education

 

[NeuResurgens]

Is this it?
http://pediatrics.aappublications.org/content/135/6/961

https://www.ncbi.nlm.nih.gov/books/NBK154469/
This article adds that along with lack of social spending Americans are fat, we have a high STD/Teen pregnancy rate, more drug deaths, etc
See page 11 and read from there
This is probably what @UNMedGa was referencing

These weren't the article I read, but they do illustrate the point I'm making that we need to take an approach that is direct about the causes of our disadvantages. I ultimately think that we need to unite our healthcare system with a particular model (this doesn't mean single payer though, necessarily - just not having multiple models like VA, Medicare/Medicaid, employer based, out of pocket all coexisting). I do think the German and Swiss models are both politically feasible and able to help us bring coverage to all in America.

Per your graph, almost 2 times...Don't do that comrade. This is not a journalist forum.

That aside, your idea sounds like this, which is objectively very nice!

As bad of an idea of communism is, is it weird that I think the Soviet Union's anthem is an amazing piece of music? The Russian feredation still uses the tune for their anthem, just with different lyrics.

 

[wizzed101]

That's 40%, already a minority, and includes any smaller addition like physio or dental or meds. We're not talking about almost half the population buying a private health package in lieu of the government coverage like you seemed to think was common in "two-tier" systems. 100% get the core healthcare package simply by being citizens.

You want to argue about how we need to keep a healthy small private sector available for the extras, sure, I agree. But so far you've been pulling data you don't understand out to try and make a point that isn't valid about primarily government driven systems.

Now you switched from tiny to minority. That point is irrelevant. You were arguing those adopting the 2 tier-system were effectively 1 payer. And you were wrong. I indulged in your straw man arguments but arguing with such dishonesty is a chore. There is no point. I know what you pride your self on data and stuffs so this hurts. But whatever, I clearly don't understand data. Peace.

As bad of an idea of communism is, is it weird that I think the Soviet Union's anthem is an amazing piece of music?

It is.

 

[efle]

Now you switched from tiny to minority. That point is irrelevant. You were arguing those adopting the 2 tier-system were effectively 1 payer. And you were wrong.

They are effectively 1-payer for their core, GP provided healthcare plus whatever specialty care the GP recommends. People do not pay for private coverage to upgrade their core health coverage, they pay for private boosters to extras like dental. They are 1 payer for the huge, central pillar of primary care and hospital specialty service to their citizens. You've no idea what you're talking about, which is fine, I didn't either before spending a semester living there and taking courses about European healthcare systems.

 

[Dr.Sticks]

One of the biggest criticisms of the ACA early on was the lack of a national public option. It was originally planned to be a much better mix of gov care and private market than what we got.



PPP adjusted GDP per capita (I assume you're referring to something like this) is a terrible way to measure which population is "poorer." If you and nine other families live in a ghetto, but then you win the lottery, reporting the street as a street of per-capita millionaires doesn't paint a very accurate picture. Look at the overall distributions and then tell me that, reincarnated as a random citizen in a random place next life, you'd really be hoping for Alabama or Missouri over the UK or Sweden

More like this
https://mises.org/blog/poor-us-are-richer-middle-class-much-europe
And
https://mises.org/blog/if-sweden-and-germany-became-us-states-they-would-be-among-poorest-states
Quote 2nd
"We Should Adjust for Purchasing-Power Differences Among States "

 

[Dr.Sticks]

Dude why pursue medicine if your dream is to live off the land in the middle of nowhere and you don't even care if you're employed? Very painful way to get there with all the years of education

Because I like it
In my fantasy world I would be a physician and be doing it in exchange for goods/services
Not like it is now

 

[Dr.Sticks]

Bro, could you stop? Nearly all of your threads end up with you talking about how frugal you are or how you can live off the land.

Not everyone is you.

Ignoring harsh realities in our society because somehow it won't affect you is foolish and does nothing to solve the actual issues

Socialized medicine creates new issues

Also you missed the point; People need to build their own safety net not think oh I will be young and able who needs to save..
Save save save
You could become paralyzed in an accident the next day, American society consumes more than it saves.
That is an issue

 

[efle]

More like this
https://mises.org/blog/poor-us-are-richer-middle-class-much-europe
And
https://mises.org/blog/if-sweden-and-germany-became-us-states-they-would-be-among-poorest-states
Quote 2nd
"We Should Adjust for Purchasing-Power Differences Among States "

Where is their adjustment for what gov provides though? If all education is covered, healthcare covered, etc then your disposable/housing/food income for your typical Swede is going to beat your typical American, no?

Oh I see mention here of healthcare being factored in. I'd love to see it rerun with free college, free grad school, and adjusted for hours worked/year though.

 

[Dr.Sticks]

Where is their adjustment for what gov provides though? If all education is covered, healthcare covered, etc then your disposable/housing/food income for your typical Swede is going to beat your typical American, no?

Not really; The poor at that level in America also get housing, food, and other welfare funds. Oh and Pell grants

 

[efle]

Not really; The poor at that level in America also get housing, food, and other welfare funds. Oh and Pell grants

You think your typical American gets food stamps and Pell grants??

 

[Dr.Sticks]

You think your typical American gets food stamps and Pell grants??

15.7 million households is a lot
The lowest state had nearly 6% of people on food stamps
http://www.governing.com/gov-data/food-stamp-snap-benefits-enrollment-participation-totals-map.html

 

[Dr.Sticks]

http://www.politifact.com/truth-o-m...trump/trump-43-million-americans-food-stamps/
And that figure is right

 

[Astra]

Also you missed the point; People need to build their own safety net not think oh I will be young and able who needs to save..
Save save save
You could become paralyzed in an accident the next day, American society consumes more than it saves.
That is an issue

take someone who makes 60k per year for a family of 4. How are they supposed to save for a medical emergency that costs 200,000 ( for one person) along with planning for retirement and investing in their children's futures?

Assume you found a way, do you not see anything wrong with people having to save that much for medical emergencies? (

 

[efle]

15.7 million is a lot
The lowest state had nearly 6% of people on food stamps
http://www.governing.com/gov-data/food-stamp-snap-benefits-enrollment-participation-totals-map.html

I thought we were talking about the overall populations though, where it looks like the typical Swede is only in the low end of US states if they do no education after highschool. And even then, they work ~37 hours/week while the American working class is significantly more, plus far less paid time off.

Basically I think the math does work out in some cases to show incomes/GDPs are strong for the US, but you'd be very hard pressed to find good analysis that put the pay per hour and standard of living for the middle and lower portions on par with each other. I know having been in Scandinavia I'd much rather be an average Joe there than middle and southern America.

 

[Dr.Sticks]

take someone who makes 60k per year for a family of 4. How are they supposed to save for a medical emergency that costs 200,000 ( for one person) along with planning for retirement and investing in their children's futures?

Assume you found a way, do you not see anything wrong with people having to save that much for medical emergencies? (

You are wrong
I believe the out of pocket maximum is 13k for families
So that is what they would have to save

That is for the most high deductible cheap insurance plan