The Ultimate Casualty of COVID-19 Will Be The System

[Old_Mil]

For several years, the topic of some sort of nationalized health care has been discussed both here and in society at large. Let's sum up the two sides with something like "it's good because access" and "it's bad because rationing and lack of innovation."

It's probably time to move past a discussion of whether it is good or bad because realistically it is inevitable. A system that is designed so as to divert societal resources away from the very places they are needed in a time of crisis will (and probably should) be replaced [see the articles on Harvard docs losing retirements and taking pay cuts while the HCA CEO keeps 99% of his compensation intact].

The reason I have started this thread is to facilitate a discussion on how we make "what comes next" as beneficial as possible for our patients and the people who take care of them. It is an attempt to learn from the mistakes of our existing system as well as from the mistakes other nations with a universal/single pay/nationalized system have made so we don't repeat them.

There's no point in having a discussion centered around if at this point and we should get busy making sure what comes next is tolerable.

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[Money-Moniker]

Full midlevel independence is an almost certain outcome of the current crisis, but the one I fear the most is removing the requirement for foreign physicians to complete residency in the USA in order to be licensed. They've already suspended this requirement in NY, and if this expands across the country and becomes permanent then it's game over for this profession in America.

 

[bronx43]

What makes you think that the most likely alternative to the status quo is a government-run nationalized system?

A more plausible and worse outcome would be if Medicare expands coverage, and we get M4A. However, what will end up happening is it will mostly be Medicare Advantage - Medicare run by private payers. Very few people have traditional Medicare these days without supplement. They will even stop offering supplemental plans, since they rather have a system, where they set their own reimbursement rates.

If this happens, the only thing that changes for physicians is our paycheck. Hospitals will run leaner, but the upper level admin will still own your as*. Insurance CEOs will still pull 7 figures. You will still have to practice in a pseudo-private system. You will still have threat of litigation.
And if midlevels are let loose to wreak havoc on the job market and if foreign physicians are allowed to practice, then it’s truly game over. If this happens, the only question is at what point do foreign doctors look at the US healthcare system and say “no thanks.”

 

[d2305]

There's no country with a population as big as us with .gov healthcare. The CCP doesn't have it.

 

[hundreddaysoff]

Whenever I read SDN threads on this topic, while scrolling through and again watching the usual old champions of the two usual old political silos bickerbickerbicker, I am left with at least two big core issues.

STM these two issues have become matters of faith to the two different sides. If the stakeholders can't agree on a way to resolve them, the healthcare question will be answered for us by demagogue politicians based on whatever gets them and theirs the best crony loot and/or the most votes from a very siloed and ignorant public. Much like how ACA was passed?

1. Can our culture afford nationalized healthcare? We're talking about taking an industry that is 20% of our economy and almost certainly expanding it even further by centralizing mission creep and other perverse incentives. We're talking about expanding the national debt even more. Depending on which economic religion you follow (Modern Monetary Theory vs not), this may cause hyperinflation or alternately require crippling tax increases in the future to pay it all back. If it turns out that the principles of personal debt and trust do indeed scale all the way up to the national level and so MMT is not the true economic religion, then this is not the economic future I want for my patients or their families.

This issue is related to the argument that Americans ("unlike those sophisticated Euros") use the healthcare system for silly things and instead we should get some basic health literacy and accept and value as a culture that we are all mortal. One thing that has surprised me in the last few weeks is that given the right incentives, most people who don't need to be in the ER actually are insightful enough to see this for themselves and stay home. This makes me a little optimistic that maybe the right public health education system could actually permanently change American values on this.

2. What, if any, will be the role of health insurance companies in nationalized healthcare? If we pick wrong, we get the ACA, a system in which the government mandated most of its citizens to pay health insurance companies. Unsurprisingly, insurers' profits have gone up up up and I imagine their cronying ability along with it. And so we got the balance billing debacle etc.

I don't have a political horse in this race and I don't know the answers to these questions. Frankly, my family and I are doing quite well under the current system; this is by my design. We come out the best if the status quo holds for a few more years. This observation will win no political arguments and isn't that helpful to my patients.

 

[Birdstrike]

I'm all in favor of ideas to fix our healthcare system, except this one:


"The government is incompetent, the VA is a disaster and they failed the COVID-19 response terribly. Let's have them run everything!"



No. No. No. No.No. No. No. No.No. No. No. No.No. No. No. No.

 

[Old_Mil]

Allowing non residency trained foreign physicians to practice would be a catastrophic development.

What are the parameters that New York used in granting this? Sort of an assistant physician license like Missouri or a full, unrestricted license?

...and Birdstrike, while I agree with you from a philosophical point of view, that (like balanced budgets) is a 20th century argument. Sure, an efficient private health care system controlled by physicians and nurses is the ideal...but too many rent seekers have infested the profession over the past 30 years for us to go back.

 

[Birdstrike]

Sure, an efficient private health care system controlled by physicians and nurses is the ideal...but too many rent seekers have infested the profession over the past 30 years for us to go back.

Right now, we have a bad system run by "too many rent seekers" like you said. We agree 100% on that. Insurance companies suck pus and administrators don't "get it" and never will. But not a single frickin' one of us is sitting here thinking, "You know what, eff this. I'm calling my Congressman tomorrow to demand to be let into the government-run VA system right NOW!"

Like I said, I'm open to new ideas. But, there's only one idea worse than doing nothing and changing nothing. It is, "Let's have the government that f'd up the VA and COVID-19 run everything." It's as tired, stale and failed as any idea I"ve ever heard. New ideas? Sure, bring 'em on. But, "Let's take the system away from the grifters and have the incompetents fix it," is a terrible idea.

Some people think they can make the idea of a square wheel work if, only if, they can be in charged and have, "Just one more try." Not me.

New ideas my friend. New ideas.

 

[Brigade4Radiant]

The thing is that while you can say the government botched the response ultimately they are the only ones who can respond asking if we can afford it is like asking if we can afford to quarantine.

Physicians will be apart of some government control. Sorry you can’t have something kill 200000 Americans and disrupt the lives of every American and business.

The system is bloated due to the system after this we will have to rebuild just like we have to rebuild our economy.

People say VA hospitals are a disaster but ultimately everyone relies on Medicaid and since we are going to a depression we can’t go back to what we had.

 

[bronx43]

New ideas my friend. New ideas.

What new ideas that don't involve pie in the sky scenarios?

The overlords are coming with a hatchet, and there's not a damned thing any of us can do about it.

 

[Birdstrike]

What new ideas that don't involve pie in the sky scenarios?

I don't have any. That's why I asked Wilcoworld for them. My point is that having a lack of new ideas, is not a reason we need to accept old, bad, and worse ideas.

The overlords are coming with a hatchet, and there's not a damned thing any of us can do about it.

They may be coming with a hatchet, but there's plenty we can do about it.

 

[bronx43]

They may be coming with a hatchet, but there's plenty we can do about it.

Like what?

 

[Birdstrike]

Like what?

As citizens, we can use the political process. As physicians, we always have the nuclear option of work stoppage. I hope we never need to do that and I'm not suggesting we do it, but physicians in other countries have. There are individual choices many of us can make regarding specialty choices, early retirement (for those close), and opting out of the system where able.

None of them are quick fixes, but there are always options. No one holds a gun to our heads and tells us to do any of what we do.

 

[RustedFox]

Right now, we have a bad system run by "too many rent seekers" like you said. We agree 100% on that. Insurance companies suck puss and administrators don't "get it" and never will.

Psst. "Pus" has one "s".

 

[bronx43]

As citizens, we can use the political process. As physicians, we always have the nuclear option of work stoppage. I hope we never need to do that and I'm not suggesting we do it, but physicians in other countries have. There are individual choices many of us can make regarding specialty choices, early retirement (for those close), and opting out of the system where able.

None of them are quick fixes, but there are always options. No one holds a gun to our heads and tells us to do any of what we do.

Except the country doesn't care about you, me or any of us. They won't vote in our favor.
Physicians (as a majority) will never stop work, and will never stand up to the man. This is pie in the sky.

It's each man for himself, and the best we can do is prepare for the hatchet when it comes down.

 

[Birdstrike]

It's each man for himself

Agree

the best we can do is prepare for the hatchet when it comes down.

Already made my move.

 

[Birdstrike]

Psst. "Pus" has one "s".

Lol thanks
Close call there. I almost went full Freudian slip, didn't I?

 

[RustedFox]

Lol thanks
Close call there. I almost went full Freudian slip, didn't I?

Yes, the other word you want is: "Purulent".
You can't put puss-ey in the chart. Gramatically speaking, there should be no trailing "e" before the "y".
SOURCE: My aunt was an English teacher. My childhood was ruined with her constant grammar lessons. Now, I'm cursed to be an a-hole on internet discussion forums for the rest of my life for correcting grammar/usage errors.

 

[Birdstrike]

Now, I'm cursed to be an a-hole on internet discussion forums for the rest of my life for correcting grammar/usage errors.

Some may call you an "a-hole on the internet," for this behavior. Let them know you're an underappreciated warrior making the world a better place donating your spell-check services to those in need.

 

[GeneralVeers]

As I've said before, my side is going to lose this fight eventually. This catastrophe will only accelerate things, because more people will be on Medicaid for the forseeable future.

Democrats are out for blood. They lost what they thought was their election to win by right in 2016. If they win the Presidency and regain the Senate in 2020, some sort of Medicare For All will be their number one priority. They will use COVID-19 as their opportunity to convince a terrified, and demoralized public that government-run national healthcare is the way to go. As Birdstrike has pointed out they are still fixated on terrible ideas from the past, and can't seem to come up with anything new.

We need a system that promotes better resource allocation, innovation, and flexibility than our current one. More government will simply result in the opposite.

If this is a top issue for any of you, the only thing you can do is vote Trump to slow down this transition. Regardless of what you think of him personally, or his other policies, Trump and the Senate are all that stands between us and a complete "transformation" of our healthcare system.

 

[deleted109597]

As many people as can hear me have heard me say that this is the end of our system.
The only way Bernie Sanders and the party for socialized medicine doesn't win is if we don't have an election in November. Nothing else can do it. Trump was cruising to a win. Biden was cruising for winning his primary. Now it's all up in the air.

But yes, we will have Medicare for all. Insurance CEOs will get corporate bailouts by the .gov. They'll be folded into the admin of the new system. Docs will, once again, get left out.

 

[bronx43]

As I've said before, my side is going to lose this fight eventually. This catastrophe will only accelerate things, because more people will be on Medicaid for the forseeable future.

Democrats are out for blood. They lost what they thought was their election to win by right in 2016. If they win the Presidency and regain the Senate in 2020, some sort of Medicare For All will be their number one priority. They will use COVID-19 as their opportunity to convince a terrified, and demoralized public that government-run national healthcare is the way to go. As Birdstrike has pointed out they are still fixated on terrible ideas from the past, and can't seem to come up with anything new.

We need a system that promotes better resource allocation, innovation, and flexibility than our current one. More government will simply result in the opposite.

If this is a top issue for any of you, the only thing you can do is vote Trump to slow down this transition. Regardless of what you think of him personally, or his other policies, Trump and the Senate are all that stands between us and a complete "transformation" of our healthcare system.

What makes you think Trump will not push M4A if things do indeed get bad enough. They will do what is necessary to appease the majority of the people. Furthremore, M4A doesn't necessarily mean a "government-run" system. My suspicion is that Medicare Advantage will be expanded to cover most if not all. Then it becomes corporate run, government backed healthcare.

We all thought 3 months ago that cash handout to the people will never happen under a Trump presidency, and yet here we are... talking about additional trillion dollar stimuli.

 

[GeneralVeers]

What makes you think Trump will not push M4A if things do indeed get bad enough. They will do what is necessary to appease the majority of the people.

He might. He's somewhat unpredictable. I put that chance at 15%. That's still better than the 100% chance under the Democrats.

We all thought 3 months ago that cash handout to the people will never happen under a Trump presdiency, and yet here we are... talking about additional trillion dollar stimuli.

I know. I completely disagree with most of the ruinous economic actions our government has taken during this pandemic.

For me, I'm strongly a one issue voter which is why I support anyone who isn't a Democrat.

 

[bravotwozero]

The only way Bernie Sanders and the party for socialized medicine doesn't win is if we don't have an election in November. Nothing else can do it. Trump was cruising to a win. Biden was cruising for winning his primary. Now it's all up in the air.

You underestimate the corruption of the democratic primary and their ability to screw over candidates they don't like. Anytime there is a huge discrepancy between exit polls and actual election outcomes, you have to consider electoral fraud as a possibility, and by law in many places that is supposed to trigger a recount. Did not happen so far in the democratic primaries where Bernie was leading in the polls and came out behind Joe Biden.

 

[turkeyjerky]

As I've said before, my side is going to lose this fight eventually. This catastrophe will only accelerate things, because more people will be on Medicaid for the forseeable future.

Democrats are out for blood. They lost what they thought was their election to win by right in 2016. If they win the Presidency and regain the Senate in 2020, some sort of Medicare For All will be their number one priority. They will use COVID-19 as their opportunity to convince a terrified, and demoralized public that government-run national healthcare is the way to go. As Birdstrike has pointed out they are still fixated on terrible ideas from the past, and can't seem to come up with anything new.

We need a system that promotes better resource allocation, innovation, and flexibility than our current one. More government will simply result in the opposite.

If this is a top issue for any of you, the only thing you can do is vote Trump to slow down this transition. Regardless of what you think of him personally, or his other policies, Trump and the Senate are all that stands between us and a complete "transformation" of our healthcare system.

Cause our current system is really kicking corona's ass, huh?

As many people as can hear me have heard me say that this is the end of our system.
The only way Bernie Sanders and the party for socialized medicine doesn't win is if we don't have an election in November. Nothing else can do it. Trump was cruising to a win. Biden was cruising for winning his primary. Now it's all up in the air.

But yes, we will have Medicare for all. Insurance CEOs will get corporate bailouts by the .gov. They'll be folded into the admin of the new system. Docs will, once again, get left out.

I was waiting for the calls to cancel the election to start coming. I'm a little surprised it's taken this long, to be honest.


Let me get this straight: we have absolutely the most ill-equipped, unprepared and flat out incompetent head of state and political administration imaginable, and you people want to, not just re-elect him, but declare him **president for life**????

Mother of god

 

[deleted109597]

Cause our current system is really kicking corona's ass, huh?

Can you show me another system that is doing better? Perhaps Spain, France, or the UK?
Australia doesn't count because it's not there yet.

I was waiting for the calls to cancel the election to start coming. I'm a little surprised it's taken this long, to be honest.


Let me get this straight: we have absolutely the most ill-equipped, unprepared and flat out incompetent head of state and political administration imaginable, and you people want to, not just re-elect him, but declare him **president for life**????

Mother of god

Wait, where did I say I was calling for it? All I said was the only way Trump doesn't lose is if it doesn't happen.
Man, TDS is tough on people.

 

[RustedFox]

You underestimate the corruption of the democratic primary and their ability to screw over candidates they don't like.

Such a good quality in a political party, eh?

 

[Birdstrike]

All I said was the only way Trump doesn't lose is if it doesn't happen.
Man, TDS is tough on people.

TRIGGER WARNING

The funny thing is, since this whole corona$hitbomb exploded, Trump's approval polls have increased to their highest level ever. I'm not saying it means anything, but it is what the average of all the big polls is showing. Bettors are also putting their money on him 2:1, over Biden who they're giving 2.4:1 odds, according to Betfair. Again, I'm not saying that predicts anything or that it should or shouldn't be that way. The only guarantee is these numbers will change multiple times between now and election day. But this is where we are today. The numbers seem to show the opposite of the conventional wisdom.

 

[bravotwozero]

Such a good quality in a political party, eh?

To be fair, I don't think the GOP is that much better. They more or less did the same thing with Ron Paul, the one republican I actually liked.

 

[hundreddaysoff]

The numbers seem to show the opposite of the conventional wisdom.

Wow, I had assumed the CW was that Trump is more likely to win a second term now. I thought that presidential approval usually goes up in the middle of a crisis. Isn't that how FDR got 4 terms?

 

[Birdstrike]

Isn't that how FDR got 4 terms?

It worked for him.

 

[GeneralVeers]

It worked for him.

I wouldn't be upset with 4 Trump terms.....considering the alternatives.

Unfortunately with 30% unemployment rate, and a destroyed economy I think we are in for a degree of higher taxes, and authoritarianism for the foreseeable future regardless of who's in charge. Many of these measures will be put into place by power hungry, fame-seeking Governors.

 

[Birdstrike]

Unfortunately with 30% unemployment rate, and a destroyed economy I think we are in for a degree of higher taxes, and authoritarianism for the foreseeable future regardless of who's in charge. Many of these measures will be put into place by power hungry, fame-seeking Governors.

F- them and f- that.

 

[turkeyjerky]

Honestly, what have the republicans ever done for you guys?

Also, where's my liability reform?

 

[WilcoWorld]

I don't have any. That's why I asked Wilcoworld for them. My point is that having a lack of new ideas, is not a reason we need to accept old, bad, and worse ideas.

They may be coming with a hatchet, but there's plenty we can do about it.

I don't recall this reference to me - can you please clarify?

 

[WilcoWorld]

Psst. "Pus" has one "s".

I'm glad that you pointed that out, because I don't regard sucking puss to be an insult, and I value the fact that you, @Birdstrike, and myself can all agree on insulting insurance companies.

 

[RustedFox]

I'm glad that you pointed that out, because I don't regard sucking puss to be an insult, and I value the fact that you, @Birdstrike, and myself can all agree on insulting insurance companies.

The fact that they act as the "gatekeepers" has instead led them to be the "goalies" of care. What should be facilitated is instead obfuscated.

 

[WilcoWorld]

I completely disagree with most of the ruinous economic actions our government has taken during this pandemic.

I'm not sure you give a #*!% what I appreciate, but I appreciate your honesty.

 

[Franzd'Epinay]

Unfortunately with 30% unemployment rate, and a destroyed economy I think we are in for a degree of higher taxes, and authoritarianism for the foreseeable future regardless of who's in charge. Many of these measures will be put into place by power hungry, fame-seeking Governors.

By authoritarianism do you mean the shelter-in-place orders or something else?

 

[GeneralVeers]

By authoritarianism do you mean the shelter-in-place orders or something else?

Yes. Also using drones: Pandemic drones: Useful for enforcing social distancing or for creating a police state? -- GCN

Arresting people for canoeing by themselves could be considered authoritarian.