Socialized Health Care?

[deleted77919]

If the US moves to a socialized health care system, are current applicants going to be left out to dry? In Canada a general practition can bill the government about CA$110/hour. After removing overhead costs, the GP takes home CA$75/hour (not including income taxes, just office overhead). That converts to about US $65/hour.

Looking at typical private schools in the US most budgets are around $50-60k/year (not everyone is so lucky as to have a cheap in-state schools, VA schools cost almost what private ones do, UVa's tutuion is something like $28k). Assuming I have to borrow $50k/year for school, I graduate $200,000 in debt. Using a repayment schedule I got from USC, if you borrow $200,000 at 7% interest, and try to pay off your loan in 10 years you have monthly payments of $2,322. That's a pretty stiff payment to have to make on $65/hour.

So, if the US goes to a socialized health system, are current applicants going to be left holding the bag when it comes to finances? I say current applicants because at $65/hour the government would have to subsidize medical school costs a lot more than they already do, or no one would be a physician, heck, we have a nursing shortage and they can pull in $65/hr without medical school loans . . .

Source on CA figures: Dave Rogers, The Ottawa Citizen Oct 29, 2002.

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[pagemmapants]

I think this is one of the biggest arguments against socialized health care. However, in Australia, they DO have socialized health care HOWEVER physician competition is kept alive and well by the fact that while basic health care is covered, it really is BASIC. You do not get to choose your own physician, you do not get specialists, you do not get elective surgeries, etc. Private insurance is available for those who want to go to specific (i.e. more prominent/skillful/etc) physicians or specialists, thus those higher level MDs get more $$.

Perfect system, if you ask me. Unfortunately the tax levels in Australia are somewhat obnoxious.

Then again, I hear you get a mandatory 3 month vacation once you've been working for something like 10 years. Awesome.

If we DO move to a socialized system in the US you can bet it'll probably be far more unwieldy and far less organized than the Australian system, however, so I do think that what you're talking about is a very real concern. That in mind, I plan on keeping my loans to the absolute minimum possible. (Thank you, Baylor!)

 

[golftrippy]

If the US moves to a socialized health care system, are current applicants going to be left out to dry? In Canada a general practition can bill the government about CA$110/hour. After removing overhead costs, the GP takes home CA$75/hour (not including income taxes, just office overhead). That converts to about US $65/hour.

Looking at typical private schools in the US most budgets are around $50-60k/year (not everyone is so lucky as to have a cheap in-state schools, VA schools cost almost what private ones do, UVa's tutuion is something like $28k). Assuming I have to borrow $50k/year for school, I graduate $200,000 in debt. Using a repayment schedule I got from USC, if you borrow $200,000 at 7% interest, and try to pay off your loan in 10 years you have monthly payments of $2,322. That's a pretty stiff payment to have to make on $65/hour.

So, if the US goes to a socialized health system, are current applicants going to be left holding the bag when it comes to finances? I say current applicants because at $65/hour the government would have to subsidize medical school costs a lot more than they already do, or no one would be a physician, heck, we have a nursing shortage and they can pull in $65/hr without medical school loans . . .

Source on CA figures: Dave Rogers, The Ottawa Citizen Oct 29, 2002.

Dakota, most GP's in the US don't make $65/hour...thats $169,000 a year assuming they get paid vacation and work 50 hours a week...I understand your logic though, I would assume doctors would make less, so yes the current medical school applicants could be screwed. But, the physicians lobby in the US is incredibly powerful in the government, so the odds of physician salaries actually dropping are slim...in reality they will probably be frozen some time in the future so that in effect they will be dropping as inflation rises...this is how it was explained to me by a proffessor. Also, the US will not be moving to a socialized system in the near future because of our role in the world as the innovator of both medical technology and drugs...the rest of the world requires a capitalist medical market in the US to spur innovation in these areas, and that allows them to maintain socialist systems while our poor suffer...thats kind of the global situation right now. There are many corrections that could help improve the health care outcomes for the poor in the US without going to a socialized system

 

[pagemmapants]

There are many corrections that could help improve the health care outcomes for the poor in the US without going to a socialized system

Like allowing ERs to kick out frequent fliers and people who come in with their kids with runny noses or cuts that barely require 1 stitch.

 

[deleted77919]

There are many corrections that could help improve the health care outcomes for the poor in the US without going to a socialized system

I completely agree. I personally think there are many things that can and should be done to lower costs without having a fully socialized system. I do, however, think that there is support for socialized health care, and that is what concerns me.

 

[golftrippy]

I completely agree. I personally think there are many things that can and should be done to lower costs without having a fully socialized system. I do, however, think that there is support for socialized health care, and that is what concerns me.

There is definately support for that system, and I USED to be one of them....I didn't change my mind because of my futrue salary though, I changed it because I began to understand our role in the world, as I said above, and the impossibility of that system here in the US, unless some other country wants to become the capitalist medical powerhouse. I wouldn't worry, honestly popular opinion is in no way equal to the power that the physician lobby has over congress, so while I wouldn't count on making bank as a doctor, I also wouldn't expect a drop in salary...hopefully there will be some attempt to partially and keep physician salaries...because we need to attract the best and the brightest to this profession, and we have to at least offer them security and for all they go through, physicians are definately not overpaid

 

[cryogen9]

It's really survival of the fittest once again. It seems with declining reimbursement doctors are doing all sorts of thing to compensate. Some increase paraprofessionals in their practice to increase volume, others don't accept or limit lower paying plans. There's also boutique service, cash only practices. Some physicians get revenue from ASC's and other such ventures. There are value added services where the insurer pays a base fee and if you want a VAS you pay cash out of pocket eg. in oph a patient can have a cataract removed and Doc gets 700 but they can have a multifocal lens implant for 2000 out of pocket --medicare covers base fee for doc and hospital or asc but not the value added service. So you see you'll make a living, it really depend what your objectives are and how you want to get there.

 

[beastmaster]

unless some other country wants to become the capitalist medical powerhouse

It's possible, in my opinion, for another country to emerge as the innovation/capitalism center of the world (even though all of our markets and industries are highly regulated, thats still sort of what we are to the world).

But it may take upto a century for this to happen. And if I had to make a prediction, it would be either South America or Asia... not Europe.

 

[gary5]

Socialized medicine will destroy the medical occupation, clear and simple. If it happens, prepare to be poor. Physicians in Europe make $60k.

 

[macadamianut]

Socialized medicine will destroy the medical occupation, clear and simple. If it happens, prepare to be poor. Physicians in Europe make $60k.

Are you seriously considering someone who makes 60k a year poor? You have a really warped sense of society.

 

[DrBowtie]

Are you seriously considering someone who makes 60k a year poor? You have a really warped sense of society.

In high cost places like SF, NY that won't go very far.

 

[Rafa]

It's good to know the "what's in it for me?" syndrome is well-engrained within our future doctors here on SDN.

 

[deleted77919]

It's good to know the "what's in it for me?" syndrome is well-engrained within our future doctors here on SDN.

There isn't any reason to go deep into debt and spend a lot of time in school not earning money if compensation is less than that of a hot shot engineering grad.

 

[medhacker]

Investment in biomedical research indoubtedly directly influences pharmaceutical innovation. However, why must such investment, obligatorily come from a capitalyst system. This issue has a huge political facet. The failure of the respective actors, in capriciously disregarding other models of investing, is what makes the general public sympathetic to a socialized health care system.

 

[medhacker]

There isn't any reason to go deep into debt and spend a lot of time in school not earning money if compensation is less than that of a hot shot engineering grad.

I vehemently disagree. Personally, compensation is not among a top reason to enter medicine.

 

[butmylipshurtrealbad]

It doesn't make sense to compare incomes in Europe to those in NY or SF, etc... The costs and standard of living are totally different, and of course, our salaries are as well. Sure, it would be nice to be able to pay off our loans quickly and easily, but I agree with Rafa-- becoming a doctor shouldn't be about what you will gain from it (not saying that's what you mean). Basically, if socialized health care were to happen, it probably wouldn't be anytime soon, and wouldn't effect any of us in terms of costs of medical school. Because of the specialized services in the US, there will also probably always be a portion that remains privitized. If it does eventually happen, there will have to be a change in the cost or types of loans/money available for med students because I'm sure there are many people who feel like you do about it. There are a lot of changes that need to be made in our system so that every patient is receiving the care that they need. That is what we should be worrying about as future doctors. If we have to take a dip in salary until we can work that out, I'm willing to take it. It really doesn't make sense to me to worry about making less than 169,000 a year when there are so many uninsured and needlessly ill people in the US who need people like us to advocate for them.

There isn't any reason to go deep into debt and spend a lot of time in school not earning money if compensation is less than that of a hot shot engineering grad.

 

[beastmaster]

Investment in biomedical research indoubtedly directly influences pharmaceutical innovation. However, why must such investment, obligatorily come from a capitalyst system. This issue has a huge political facet. The failure of the respective actors, in capriciously disregarding other models of investing, is what makes the general public sympathetic to a socialized health care system.

LOL.

No one is "capriciously" disregarding other models of investing. Anyone in this country is free to use other business models. The reason they aren't used is because they are abysmal failures. The general public is sympathetic because it has been hoodwinked.

If you want an example of an economic system disregarding other forms of investment, go to a socialist country and open a small private business that offers the same service as the government. Automatic death sentence for you and the family.

 

[Gut Shot]

If the US moves to a socialized health care system,

To do that would require government takeover of all existing healthcare infrastructure and manpower. Ain't gonna happen, so fear not.

 

[deleted77919]

I vehemently disagree. Personally, compensation is not among a top reason to enter medicine.

I don't think compensation should be the overriding reason to enter medicine either. It'd be great if there were lots of people so overwhelmingly devoted to helping others that they would do whatever was necessary to enter medicine. However, as an issue of supply and demand I think that a future supply of competent doctors is best satisfied by adequate compensation, and should be commensurate with the debts taken and time spent in training not earning an income.

 

[TexasFool]

I'm mindful of both sides of the argument. If you read a book that promotes socialized medicine, it will sound like God himself loves it.

However, the USA is not the same as Europe.

Socialized medicine would solve so many problems, yet it would create a medical and financial catastrophe here.

-Socialized programs of the past have been wonderful examples of the lack of the ability and competence of the government in doing anything right. Social security. Our K-12 school system, which is worse than other countries that have less money funded into education. Find one example of the US government doing something properly? I challenge you.

-Our medical system does promote more innovation and production of technology. For example, because the government does not pay for all of our tuition they have money to award to colleges so that they can do research. Students are responsible for their education, and the government can send the money to advance science. Actually because the government does pay for some of our education, there seems to be a balance. If they had to pay for everyone's medical care, look for a very large amount of funding to universities across the country to dry up.

-Go eat at a buffet. What is the general thing we Americans do at a buffet? We eat until we almost die because you may as well get as much out of your dollar as you can. Expect people to visit the clinic every time they have a fever, soar throat, stiff neck, or just feeling bad. When I worked at a first aid stations at air shows, and other events in San Antonio, people would visit the station with ant bite wounds, sun burns, minor cuts and scrapes etc, when in any normal situation we would just live with it. If it is free and available, it is over-used unless it is restricted. So who will decide who's "emergency" is real or not?

-The government is not likely to be able to make the medical system more efficient, so it will end up being less efficient and at 13% of our GDP, it is not possible for the government to take it over. Unless you want 98% income tax rates, and inter-city, inter-state travel taxes, international travel taxes.

-we represent capitalism, which in and of it self seems evil. We consider a patient as a client or a paying customer. The idea of capitalism is that our system promotes advancement of society to a point where someday just donations and volunteerism will give us the ability to take care of everyone's basic needs. Is this true today? No. But it's not true in Socialist Cuba either, nowhere near truth, even though the government there is supposed to take care of everyone's needs.

GDP of our medical system is 13%. Has anyone ever subtracted the amount which is due to the foreign clients, who tend to pay full price? No. So if patients from Europe or canada that want good and prompt medical care venture to the USA, does that mean that the percent of GDP resulting from the medical system in Canada is misleading because some of it is transferred to the USA? Yes.

Can we use age expectancy to judge health care systems? No
Age expectancy has genetic determination and each country will vary no matter what medical system is used. Also if the average person in the USA is more of a risk taker then the average European, or if there is more crime in the USA, or we fight more wars, etc, then our average life expectancy will be less.

I'm afraid of a medical system run by the US government. Lord have mercy!

 

[medhacker]

LOL.

No one is "capriciously" disregarding other models of investing. Anyone in this country is free to use other business models. The reason they aren't used is because they are abysmal failures. The general public is sympathetic because it has been hoodwinked.

If you want an example of an economic system disregarding other forms of investment, go to a socialist country and open a small private business that offers the same service as the government. Automatic death sentence for you and the family.

Dude...

Have you ever looked into the FBI files for leaders of the U.S. communist party? have you been informed of how free they are to use or advocate other economic models?

Use the privacy act of ____ (year)? and access the files if you wish to know how free we are to explore other models, huge fallacy

My family had a business (health care by the way - OB/GYN) in a socialist country whose government also offered socialized medicine and my family's business survived quite well, it thrived actually.

 

[macadamianut]

I'm mindful of both sides of the argument. If you read a book that promotes socialized medicine, it will sound like God himself loves it.

However, the USA is not the same as Europe.

Socialized medicine would solve so many problems, yet it would create a medical and financial catastrophe here.

-Socialized programs of the past have been wonderful examples of the lack of the ability and competence of the government in doing anything right. Social security. Our K-12 school system, which is worse than other countries that have less money funded into education. Find one example of the US government doing something properly? I challenge you.

-Our medical system does promote more innovation and production of technology. For example, because the government does not pay for all of our tuition they have money to award to colleges so that they can do research. Students are responsible for their education, and the government can send the money to advance science. Actually because the government does pay for some of our education, there seems to be a balance. If they had to pay for everyone's medical care, look for a very large amount of funding to universities across the country to dry up.

-Go eat at a buffet. What is the general thing we Americans do at a buffet? We eat until we almost die because you may as well get as much out of your dollar as you can. Expect people to visit the clinic every time they have a fever, soar throat, stiff neck, or just feeling bad. When I worked at a first aid stations at air shows, and other events in San Antonio, people would visit the station with ant bite wounds, sun burns, minor cuts and scrapes etc, when in any normal situation we would just live with it. If it is free and available, it is over-used unless it is restricted. So who will decide who's "emergency" is real or not?

-The government is not likely to be able to make the medical system more efficient, so it will end up being less efficient and at 13% of our GDP, it is not possible for the government to take it over. Unless you want 98% income tax rates, and inter-city, inter-state travel taxes, international travel taxes.

-we represent capitalism, which in and of it self seems evil. We consider a patient as a client or a paying customer. The idea of capitalism is that our system promotes advancement of society to a point where someday just donations and volunteerism will give us the ability to take care of everyone's basic needs. Is this true today? No. But it's not true in Socialist Cuba either, nowhere near truth, even though the government there is supposed to take care of everyone's needs.

GDP of our medical system is 13%. Has anyone ever subtracted the amount which is due to the foreign clients, who tend to pay full price? No. So if patients from Europe or canada that want good and prompt medical care venture to the USA, does that mean that the percent of GDP resulting from the medical system in Canada is misleading because some of it is transferred to the USA? Yes.

Can we use age expectancy to judge health care systems? No
Age expectancy has genetic determination and each country will vary no matter what medical system is used. Also if the average person in the USA is more of a risk taker then the average European, or if there is more crime in the USA, or we fight more wars, etc, then our average life expectancy will be less.

I'm afraid of a medical system run by the US government. Lord have mercy!

Some great points. However, regarding the buffet analogy, a first aid station is different than a doctor's office. A visit to a doctor is not the most exciting or pleasant thing. It usually takes hours and hours of your time, something that most people even with insurance avoid if they can. So the "moral hazard" argument is somewhat suspect.

Also, scientific innovation is great, but I don't think at the cost of 45 million uninsured people. Who gets the benefits of scientific innovation? Probably not those 45 million uninsured people.

It's obvious that for extending life, we have the best health care system by far. But that needs to be supplemented somehow by increasing coverage.

 

[beastmaster]

My family had a business (health care by the way - OB/GYN) in a socialist country whose government also offered socialized medicine and my family's business survived quite well, it thrived actually.

If you wish to open a business, and compete with a tax-run bloated bureaucracy that offers the same service without concern for market principles, I'm sure there are plenty of socialist countries that will accomodate your desire.

You pick the country, I'll split the plane ticket with you. You and your patients can sit around a camp-fire reading Karl Marx, while the rest of the civilized world moves into the 21st century.

 

[gary5]

Are you seriously considering someone who makes 60k a year poor? You have a really warped sense of society.

Yes, it is poor, considering the $220,000 med school loan. That chops $20k off the top every year, leaving you with $40k. Having the country switch to socialized medicine after you borrow the $220k will put you in the worst financial shape of any generation of doctors in U.S. history.

 

[TexasFool]

Some great points. However, regarding the buffet analogy, a first aid station is different than a doctor's office. A visit to a doctor is not the most exciting or pleasant thing. It usually takes hours and hours of your time, something that most people even with insurance avoid if they can. So the "moral hazard" argument is somewhat suspect.

Also, scientific innovation is great, but I don't think at the cost of 45 million uninsured people. Who gets the benefits of scientific innovation? Probably not those 45 million uninsured people.

It's obvious that for extending life, we have the best health care system by far. But that needs to be supplemented somehow by increasing coverage.

yeah, we need to increase coverage. This is something our generation of doctors needs to think about. What if we expanded medicare to cover anyone without insurance coverage, but then how do we keep companies and employed people from dropping insurance plans? That would be a move toward socialization but our complex system would still exist and they'd have to have an incentive to stay on insurance, like more flexability.

I think in the end each doctor should do what he or she can to help people and improve our current system.

and for my buffet argument. It explains the nature of americans. It is a fact that when something is free, we will utilize it. If you set up a table with free flashlights and leave a sign for everyone to take one. The first 5 people will walk off with everything. That's the way it is. In germany chess game pieces can be left out in the street overnight, but in the US, they'd be gone. We are consumers to the max, and we will consume everything available and take everything that is not nailed down. The only way the government can combat over use or abuse of the system would be to make wait times really long and make the whole experience more obnoxious.

 

[CameronFrye]

I have a couple questions. In these other countries with "socialized medicine", is college and med school free? Also, does the govt cover malpractice insurance?

If so, would the posters here be more amenable to lower salaries if they weren't weighed down with student loans and future malpractice coverage? As of now, I don't really have an opinion, but I was interested in other people's thoughts.

 

[Gavanshir]

I cant agree with the buffet analogy really, at least not entirely. I don't think the average citizen would indeed exploit free clinics and visit every week just because it's free. The only people who I can see doing this are unemployed individuals with mental problems (e.g. depression).

As you may already know we have free clinics here in Canada and everyone has medical insurance. The biggest problems arise from waiting lists for operations such as joint replacements and the "buffet" problem is, well, hardly a problem. But then again you can argue about the intrinsic differences between Canadians and Americans.

Although the Canadian system is generally known to be socialist, the private secter is very much alive here. And I believe the US healthcare system is already about 50% funded by the government so I would say that the proposal should only be to increase government funding rather than a complete overhaul by the government and the placement of a socialist healthcare system.

 

[Gavanshir]

I have a couple questions. In these other countries with "socialized medicine", is college and med school free? Also, does the govt cover malpractice insurance?

If so, would the posters here be more amenable to lower salaries if they weren't weighed down with student loans and future malpractice coverage? As of now, I don't really have an opinion, but I was interested in other people's thoughts.

Hi, this is a great point! Although the tuition rates vary according to the province, in Canada, a higher education is extremely cheap and most medical students graduate with around 20K in debt at the maximum. For the same reason, there are a lot more students who choose to continue on to higher education rather than going after employment with a high school degree.

For example, total cost of medical education at McGill Medical School which is currently ranked #1 in Canada and known as "The Harvard of Canada" is 11K CND (for all 4 years).

 

[cryogen9]

If you read the news I think you'll see that what's being proposed is not really a socialized system. I think the government would like to intensify managed care and pay for performance. The Bush administration would like to keep everything including Medicare private. Everyone is correct in that Medicine has a big target on it because all American corporations are complaining to the government they can't compete because of health care costs.

 

[SMRT]

Hi, this is a great point! Although the tuition rates vary according to the province, in Canada, a higher education is extremely cheap and most medical students graduate with around 20K in debt at the maximum. For the same reason, there are a lot more students who choose to continue on to higher education rather than going after employment with a high school degree.

For example, total cost of medical education at McGill Medical School which is currently ranked #1 in Canada and known as "The Harvard of Canada" is 11K CND (for all 4 years).

While post-secondary education is generally cheaper in Canada than in the US, your numbers are off here. Where did you get this number about $20K in debt after med school? I would say that's average for after undergrad. I know that I will personally be around $120K in debt after med school. The number that I've heard at all the financial aid talks we've had at school is usually around $100K for med students in Ontario (the Ontario med schools have the highest tuitions in Canada).

The tuition you quote for McGill is for Quebec residents only. The out-of-province tuition is three times that. For other schools, the numbers I remember from when I was applying a couple of years ago are in the range of ~ $8000/year in Manitoba and Saskatchewan to $17000/year at Toronto.

Sorry this is kind of off topic, but I just wanted to correct that.

 

[Gavanshir]

While post-secondary education is generally cheaper in Canada than in the US, your numbers are off here. Where did you get this number about $20K in debt after med school? I would say that's average for after undergrad. I know that I will personally be around $120K in debt after med school. The number that I've heard at all the financial aid talks we've had at school is usually around $100K for med students in Ontario (the Ontario med schools have the highest tuitions in Canada).

The tuition you quote for McGill is for Quebec residents only. The out-of-province tuition is three times that. For other schools, the numbers I remember from when I was applying a couple of years ago are in the range of ~ $8000/year in Manitoba and Saskatchewan to $17000/year at Toronto.

Sorry this is kind of off topic, but I just wanted to correct that.

You are right, I quoted Quebec's tuition rates which are the lowest in the country, and you quoted Ontario's, highest in the country.
But nonetheless what I was pointing to was McGill's ranking and its low tuition rate. Even for out of province students, the total debt would come to around 35K after four years, which is still considerably lower compared to US schools.
I do remember reading a report on how Ontario's tuition rates have doubled since 2000, explaining the significant difference between Quebec and Ontario.

Funny thing is that regardless of Quebec's low tuition rates, there are still student activists here protesting "high tuition rates", haha.

 

[chef_NU]

Kind of off-topic, but with Bush's SotU address coming up tonight, this article is worth a read:

http://www.realclearpolitics.com/Commentary/com-1_30_06_SP.html

 

[TMD06E]

Taking such financial burdens into consideration, many pre-medical and medical students are now questioning the stability of their prospective careers and now even considering changing their direction in life because being a doctor just wont be FINANCIALLY worth it! Granted, not to say that it's all about money....but after all the years of hard work and dedication and financial debt accumulated with trying to reach the ultimate goal of becoming a physician, not getting properly compensated for these investments will make it very difficult for future practitioners.

Yes, it is poor, considering the $220,000 med school loan. That chops $20k off the top every year, leaving you with $40k. Having the country switch to socialized medicine after you borrow the $220k will put you in the worst financial shape of any generation of doctors in U.S. history.

[FONT='PrimaSans BT,Verdana,sans-serif']http://www.progressiveu.org/102850-universal-healthcare-is-a-sham
.[FONT='PrimaSans BT,Verdana,sans-serif']http://www.cato.org/pub_display.php?pub_id=8172
http://www.heartland.org/policybot/results.html?artId=23230
http://www.balancedpolitics.org/universal_health_care.htm.

....so, as a prospective medical applicant for the following application term, where does this put me?? I've been advised to look for another direction....change my major and look into another field thats more steady, despite my love for medicine. beacuse the reality is, as much as i love the field, the stability of my future financial position is important to me and my future family.

 

[Dr.Millisevert]

I have a couple questions. In these other countries with "socialized medicine", is college and med school free? Also, does the govt cover malpractice insurance?

If so, would the posters here be more amenable to lower salaries if they weren't weighed down with student loans and future malpractice coverage? As of now, I don't really have an opinion, but I was interested in other people's thoughts.

Yes, and Yes.

Which is why if ANY plan to create a system like this in the US MUST also include medical education subsidization or gov loan repayment programs for everyone. They must also include some tort reform laws to curtail the amount of malpractice insurance required.

 

[Miami_med]

Where did you guys find this 2 and a half year old thread?