I have to be frank and I hope that this does not get deleted but I am not a medical student but I happened across the article referred to in Forbes and wrote a rather long response but despite doing all the tomfoolery of registering and logging in I still could not post, so googling I found this site and will post what I wrote HERE as I think what makes a lot of common sense and those that do not agree with me, please post here.
Initially after reading the article and seeing that since doctors in the U.S. are the second highest paid next to the Netherlands (and sometimes there´s a disparity of almost 100K even with other developed westernized countries) I thought yes, they were, but then I read another article in Forbes about the overtime pay in New York City, where some of the employees that were not highly technically trained (like adjusting the thermostat) were getting salaries over a hundred thousand, sometimes more than the head of their dept. (as a newbie I can NOT post a link to the article but google ¨
Start Spreading The News! NYC Mayor de Blasio Paid City Employees $2B For 33 Million Overtime Hours¨
and then thought not, doctors here are NOT overpaid.
My proposal is let us have a two type healthcare system in this country, one like the ACA or what they have in other countries, first a one payer system funded by the government and the citizens have to pay for it other than payroll deductions or just paying a monthly fee and. This was staffed by doctors who had their medical training subsidized by the government at public colleges and in return they would have to spend at least a decade serving in government owned hospitals, clinics, and doctor offices staffed by physicians that are like civil service employees with comfortable salaries, (no need to earn very high salaries as no debt to pay off) working offices where they do not have to worry about paying office rent, office staff, malpractice insurance (government may have arbitration agreements) get all benefits that public employees get (public service supposedly pays less than private industry but supposedly gives you better retirement) no insurance hassles to deal with at ALL, no need to worry about admitting privileges. After they serve their obligatory terms they can go into private practice as they wish, maybe better compensation but more headaches, so some who primary desire to be a doctor is compassion and dealing with the interesting problems they face is more important than the money will most likely stay in the system but in another positive twist, is that doctors with a little experience under their belt, through this, may be more likely to set up a successful practice.
For those who do NOT want to government physicians they have the option of shopping around and buying a private plan and choosing doctors who want to be entrepreneurial and more independent of government overseeing bu not entirely as for quality standards. These doctors can go to the most prestigious private colleges and set up fancy offices in affluent areas and deal with the insurance companies, as can some doctors who may go into practices that are in poorer areas because they may have come from that background or be socially conscious. The insurance companies should have two types of plans that doctors could join, both offering the same services but the doctors where the patients pay a higher premium are ones who have nicer offices, went to more prestigious schools, are board certified and more published and thus more highly compensated than the second tier of doctor who serve patients whose premiums are lower and are located in poorer neighborhoods and their patients may have to wait a little longer to be seen or wait longer in the offices that are more crowded as their doctors may have to do more volume to offset the lower compensation. Unlike the government where only legal residents, citizens or travelers who pay for their services upfront to us and get reimbursed by their government or travel insurance, the private doctors can take whoever they like including undocumented aliens who HAVE to be allowed to be able to buy any health insurance they can afford without prejudice.
These private insurance plans can offer the high deductible, catastrophic insurance that some young people want (but the charges have to be in line with the insurance companies payments for those whose bills are covered by them.) Employees can buy their insurance from private insurance companies that need to offer the same things that are national insurance offers. Instead of the fines imposed for people who do not have health insurance, we would not impose them, BUT we would have the edict that everyone would have to register to get any type of health care including ER and if you did not, you did not get ANY help. We would need to have to have a program to reach everyone including the homeless and indigent and unless you were really, truly poor and not be able to afford anything, everyone would have to pay something.
Of course there should be some oversight that the salaried doctors are not slacking off and seeing their fair share of patients. I once went to a student health center to see a psychiatrist and after a few minutes of talking he whipped out his prescription pad and started writing one out, when I protested and said I wanted to work out my problems, he ACTUALLY said to me ¨Your problems bore me¨ (sorry that I was not bi-polar, schizophrenic or had multiple personalities) and was too young and naiive at that time I should have reported him, another time saw a psychiatrist who kept checking his watch every five minutes making me feel, our my problems too boring for him also? I mention these incidents only in that I felt both these doctors wanted to just draw a salary and not work, but there will be a certain number of patients that doctors would be required to see and not be able to just turn patients away
I am under Medi-Cal and the HMO plan I an under now is horrendous, where the only orthopedic surgeon I can use is two hours away, (Torrance attracts may elderly because it has FOUR hospitals nearby and many, MANY doctor offices, clinics and urgent care offices but none near me are available in specialties under the state health plan as most residents do not have to have Medi-Cal) and works only two days a MONTH. I would like to change to Covered CA the state plan. but at 62, my premiums would equal what I get from soc. sec. which is $600, since I have savings I can draw upon it for at least a thousand a month so I can afford to live, so I CAN afford to pay the subsidized price which is $39 a month with copays for visit, but since I am eligible for the Medi-Cal, if I don´t take it they will most likely not approve the subsidized cost private cost. Because most private doctors have office expenses and thus do not want to take Medi-Cal the only choice for the working poor (like I was) or truly indigent is under government health care whose offices are far away with doctors who were foreign trained or on the cusp of retirement with one star reviews on Yelp. If we had a government plans as initially suggested with doctors who are salaried employee with benefits, there will be more and better doctors available for the low income and in more areas.
As for the doctor who in the Forbes article said that many people would not become a physician because what they feel is the low reimbursement rate for the cost of training, this might be a good thing. Many of the procedures that people come in for, do not demand a great deal of education or expertise, and can be handled by nurse practitioners who are now handling many of the general physician and internal medicine jobs that people who want to become doctors are not wanting to do because of the lower salaries. They could also be used more in the national doctors office and clinics vs. the private ones as doctors afraid of the threat to the profession have been fighting them tooth and nail but if it is for government funded medical practices they may be less likely to fight. Ahhh..if I could only run health care in this country, I DO hope that maybe someone in the government has read this and gives my suggestion SOME food for thought.
