What are the top 5 issues in regard to healthcare?

[sekem]

---

Members do not see this ad.

What are the top 5 issues in regard to healthcare?

 

[DrVanNostran]

1. Access
2. Quality
3. Cost
4. and 5. Variants

 

[crazy_cavalier]

1. Horrible American lifestyle - diet and lifestyle (smoking / drinking, lack of exercise, driving to places instead of walking, being stressed form working like slaves all the time, etc.) leading to obesity and diabetes epidemics, not to mention heart disease.
2. Poor access to health care (lack of insurance, lack of service in under-served areas, etc.)
3. Poor delivery of health care (bad health-care delivery by physicians, neglect by nursing home assistants, poor nursing, bad health care training, etc.)
4. Rising demand with a projected deficit in service (i.e. baby-boomers and inability to meet their needs)
5. Privatization of health care sector ( --> leads to rising costs for drugs, competing interests in health care delivery, compromises integrity of medicine)
6. Lazy medical students who can't think of anything on their own and make annoying threads on SDN

(6 was a joke.)

 

[Rafa]

^ I like 6. You (the OP) should use that in your interviews (or if you're slacking, in your secondaries).

 

[DrVanNostran]

1. Horrible American lifestyle - diet and lifestyle (smoking / drinking, lack of exercise, driving to places instead of walking, being stressed form working like slaves all the time, etc.) leading to obesity and diabetes epidemics, not to mention heart disease.
2. Poor access to health care (lack of insurance, lack of service in under-served areas, etc.)
3. Poor delivery of health care (bad health-care delivery by physicians, neglect by nursing home assistants, poor nursing, bad health care training, etc.)
4. Rising demand with a projected deficit in service (i.e. baby-boomers and inability to meet their needs)
5. Privatization of health care sector ( --> leads to rising costs for drugs, competing interests in health care delivery, compromises integrity of medicine)
6. Lazy medical students who can't think of anything on their own and make annoying threads on SDN

(6 was a joke.)

Much more detailed then my answer But, Crazy is definitely right. Good post 👍

 

[MonkeyNuts!]

What are the top 5 issues in regard to healthcare?

Understanding Health Policy by Bodenheimer and Grombach. Nice book.

 

[mshheaddoc]

If anyone is interested, there is the top link in my signature in which I'm trying to compile resources to answer questions like these so we can also build up readers in the Topics of Healthcare. Any suggestions for the forum are welcome as well. Help is appreciated to bring resources to our SDN users 🙂

 

[DropkickMurphy]

1. Obesity, smoking and other forms of general stupidity personified
2. Malpractice claims and malpractice insurance rates
3. Decreased physician income ('insurance reimbursements')
4. The two dudes (if you don't get it, see the EM forum)
5. Increasing amount of health care being handled by midlevels (PA's, CRNA's and NP's)

 

[DropkickMurphy]

Oh, and the realization that #1 means that Darwin was right.

 

[Trismegistus4]

1. Obesity, smoking and other forms of general stupidity personified
2. Malpractice claims and malpractice insurance rates
3. Decreased physician income ('insurance reimbursements')
4. The two dudes (if you don't get it, see the EM forum)
5. Increasing amount of health care being handled by midlevels (PA's, CRNA's and NP's)

Something tells me that stating #2, 3, and 5 when asked about this topic on interviews isn't exactly what adcoms want to hear. Won't that give off the impression that we're all wealthy republican elitists who just want to make a lot of money and join the old boys' network? Don't they want to hear that we have a passion for the underserved, that we think the greatest problem in American health care is the lack of universal coverage and non-recognition of the "right" to health care, and that we think doctors should make peanuts and be happy members of the health care "team" content to work "alongside" midlevels?

 

[zimmie256]

Something tells me that stating #2, 3, and 5 when asked about this topic on interviews isn't exactly what adcoms want to hear. Won't that give off the impression that we're all wealthy republican elitists who just want to make a lot of money and join the old boys' network? Don't they want to hear that we have a passion for the underserved, that we think the greatest problem in American health care is the lack of universal coverage and non-recognition of the "right" to health care, and that we think doctors should make peanuts and be happy members of the health care "team" content to work "alongside" midlevels?

I see your point, but I would add that declining reimbursement rates combined with increased malpractice insurance in certain specialties could reduce the number of interested physicians. As a result, access becomes harder for even more people. Basically my point is that a lot of these problems in health care are interrelated.

For another example, as more people are obese, they will need more treatment early in their lives and for more illnesses, which will increase costs of healthcare. Can also reduce their ability to work, resulting in less money to pay said bills, or could cost them insurance if they were to lose their job.

 

[Sol Rosenberg]

5. Privatization of health care sector ( --> leads to rising costs for drugs, competing interests in health care delivery, compromises integrity of medicine)
6. Lazy medical students who can't think of anything on their own and make annoying threads on SDN

Great answers (esp. 6) but I think your reasoning is off WRT rising costs of drugs becuase of privatization. Drug companies have always been (and will most likely remain) private, so any rise in cost of drugs is not due to privatization.

 

[spicedmanna]

Don't forget the squeezing out of the doctor-patient relationship, and the role of doctor as healthcare advocate for their patients, due to covert rationing by managed care, insurance and rising healthcare costs.

Here's an interesting read:

http://www.yourdoctorinthefamily.com/grandtheory/

 

[Oculus Sinistra]

I see your point, but I would add that declining reimbursement rates combined with increased malpractice insurance in certain specialties could reduce the number of interested physicians. As a result, access becomes harder for even more people. Basically my point is that a lot of these problems in health care are interrelated.

For another example, as more people are obese, they will need more treatment early in their lives and for more illnesses, which will increase costs of healthcare. Can also reduce their ability to work, resulting in less money to pay said bills, or could cost them insurance if they were to lose their job.

Good call.

 

[crazy_cavalier]

Great answers (esp. 6) but I think your reasoning is off WRT rising costs of drugs becuase of privatization. Drug companies have always been (and will most likely remain) private, so any rise in cost of drugs is not due to privatization.

I don't think the logic is off. Privatization can give rise to monopolization in the drug industry. Brand name drugs are more expensive than the generic drugs, partly because pharmaceuticals have exclusive licensing rights that are extended to them as part of the patent on those drugs. In this way, privatization increases the cost to the end-user (i.e. the patient). This is not surprising in the least. If I'm the only one with a cure to Alzheimer's, I can sell it at any cost I want.

 

[Trismegistus4]

I don't think the logic is off. Privatization can give rise to monopolization in the drug industry. Brand name drugs are more expensive than the generic drugs, partly because pharmaceuticals have exclusive licensing rights that are extended to them as part of the patent on those drugs. In this way, privatization increases the cost to the end-user (i.e. the patient). This is not surprising in the least. If I'm the only one with a cure to Alzheimer's, I can sell it at any cost I want.

I think what jota_jota was getting at is that privatization of medicine is not something that is actually occuring. The word "privatization" describes a process of being transferred from public or governmental control to private control. That is not currently happening in medicine--in fact, it's moving in the opposite direction. Medicare accounts for a greater percentage of total health care dollars spent with each passing year.

You might think that medicine is still too privately controlled, but in that case you should say that you think "the fact that drug companies are private" is the problem, rather than "drug companies are becoming privatized", which they're not.

Incidentally, someone's got to pay for the research. If you advocate the abolition of for-profit companies who need to charge enough to recoup research costs and fund research for new drugs, and the substitution of government-funded research in their place, then you necessarily must advocate much higher taxes.

 

[DrBowtie]

I don't think the logic is off. Privatization can give rise to monopolization in the drug industry. Brand name drugs are more expensive than the generic drugs, partly because pharmaceuticals have exclusive licensing rights that are extended to them as part of the patent on those drugs. In this way, privatization increases the cost to the end-user (i.e. the patient). This is not surprising in the least. If I'm the only one with a cure to Alzheimer's, I can sell it at any cost I want.

You do realize without the incentive of these companies to turn a profit, pharma research wouldn't exist.

The possibility of profit is what drives new drugs to be developed.

 

[DropkickMurphy]

Something tells me that stating #2, 3, and 5 when asked about this topic on interviews isn't exactly what adcoms want to hear. Won't that give off the impression that we're all wealthy republican elitists who just want to make a lot of money and join the old boys' network? Don't they want to hear that we have a passion for the underserved, that we think the greatest problem in American health care is the lack of universal coverage and non-recognition of the "right" to health care, and that we think doctors should make peanuts and be happy members of the health care "team" content to work "alongside" midlevels?

The question wasn't the answers we would give during an interview, but rather what we actually saw as problems. 😉

 

[Rafa]

You do realize without the incentive of these companies to turn a profit, pharma research wouldn't exist.

The possibility of profit is what drives new drugs to be developed.

True - but when the possibility of profit is put infintesimally beyond the capacity of people to *have* these new drugs, it doesn't matter whether you have pharma research or not. Drugs aren't useful if people can't afford them. The majority of other countries aren't nearly as lobsided as we are in the balance between profitability and availability. The longer we continue to stick our heads in the sand and pretend the bottom line is all that matters, the larger the disparity we'll have between our levels of healthcare and those of the rest of the developed world.

 

[DropkickMurphy]

The majority of other countries aren't nearly as lobsided as we are in the balance between profitability and availability.

But of course, America is one of the few countries I would practice in....simply for the fact that I don't want to be underpaid for my work. Take your pick- either be paid appropriately or have socialized medicine where everyone has some degree of access to health care (until the system begins to fall apart and waiting times become even more excessive than they are over the current system).

 

[DrBowtie]

True - but when the possibility of profit is put infintesimally beyond the capacity of people to *have* these new drugs, it doesn't matter whether you have pharma research or not. Drugs aren't useful if people can't afford them. The majority of other countries aren't nearly as lobsided as we are in the balance between profitability and availability. The longer we continue to stick our heads in the sand and pretend the bottom line is all that matters, the larger the disparity we'll have between our levels of healthcare and those of the rest of the developed world.

It would be interesting to see how many new patents for healthcare come out of America versus other non-capitalistic countries. I'd speculate we are pumping out the most innovations.

 

[Rafa]

It would be interesting to see how many new patents for healthcare come out of America versus other non-capitalistic countries. I'd speculate we are pumping out the most innovations.

I'm not sure, but I know we're definitely falling behind in several areas (if not already trailing, which I suspect we are) - stem cell research is one of many that comes to mind. That's more of a political ******ation/stagnation than a pharmaceutical-led one, but there's definitely progress being made all over the world right now. We're still very much up there, but the issue arises that even if we were at the very untouchable top, when you took into account the ability of our citizens to make *use* of said innovation, we'd be right back at the bottom again. Cancer-curing drugs mean nothing to 99% of the population if only 1% can afford them. A 3rd generation retroviral treatment that only people like Magic Johnson et al will ever see won't do a fraction as much for the people - the people the drugs are *supposed* to be for - as a 2nd gen. drug (sold overseas) that maybe 50% of the people who need it can afford.

But of course, America is one of the few countries I would practice in....simply for the fact that I don't want to be underpaid for my work. Take your pick- either be paid appropriately or have socialized medicine where everyone has some degree of access to health care (until the system begins to fall apart and waiting times become even more excessive than they are over the current system).

I agree that we get more money here compared to in countries with socialized medicine, but I think the costs of life are also significantly less in those countries. It isn't normal to have to take out a $160,000 loan for a 4-year education anywhere else on Earth but here. In those countries, college is far less expensive, as is med school, and a lot of other things. I'm definitely no expert on how things work overseas, but I do suspect things balance out at least as much in, say, France or Germany, as they do here. It comes as a trade-off of things being more communal, and less individual. I'd kind of see that as an advantage (instead of the 'every-man-for-himself' approach to higher education we have here today).

 

[DropkickMurphy]

Take a look at the tax rates and the cost of living in Europe then think long and hard before assuming that it all balances out in the end.

 

[DropkickMurphy]

I'd kind of see that as an advantage (instead of the 'every-man-for-himself' approach to higher education we have here today).

This is where you and I differ, because I don't believe that higher education is a necessity for everyone. In fact, I believe our nation wastes HUGE sums of money on attempting to obtain bachelors degrees in the name of some supposed theory of equality through education. If people have to earn their position in college, then perhaps there would less in the way of the lowbrow idiots we see as our classmates for a semester or two before they fail out.

 

[Rafa]

Take a look at the tax rates and the cost of living in Europe then think long and hard before assuming that it all balances out in the end.

What do you think those taxes do? Build castles in the sky? Everything comes around. Except the money helps more people there. If you want to pay low taxes, come to the US - and pray you're one of the ones who makes enough money to be able to ignore those around you who don't. That seems to be the strategy in society these days.

This is where you and I differ, because I don't believe that higher education is a necessity for everyone. In fact, I believe our nation wastes HUGE sums of money on attempting to obtain bachelors degrees in the name of some supposed theory of equality through education. If people have to earn their position in college, then perhaps there would less in the way of the lowbrow idiots we see as our classmates for a semester or two before they fail out.

Haha - but the cost of college here has been steadily increasing by ridic amounts over the past several years. If anything, right now we're making it a lot *harder* for the average person to get through college. Nowadays, it is virtually *impossible* to work enough as a student to be able to completely pay one's way through college. It really is. Tuition, books, shelter, food, etc surpass the most lucrative jobs one can hold with a full-time schedule in school. So if that's what you support, I assure you, it's working. We're increasingly heading toward the point where only the wealthy will be able to afford college educations in this country. And (of course) that'll only widen the gap between the people able to afford those oh-so-expensive drugs, and the people struggling in our 'individualized' healthcare system (the non-doctors in society).

The sad thing is that there's more than enough money to go around - to fund research, to fund education, to fund healthcare - but we've spent decades consistently choosing to throw the money in one particular direction, at the expense of pretty much everything else in society (from the perspective of someone not in the triple-digit bracket). This is by far the wealthiest country on Earth at the moment, yet you wouldn't know it from watching how we treat the not-well-off. Bah. I'm done here. Good evening, y'all.

 

[DropkickMurphy]

pray you're one of the ones who makes enough money to be able to ignore those around you who don't. That seems to be the strategy in society these days.

You bet your butt it is. One I happen to embrace wholeheartedly- more people need to believe that if you're not happy with your place in life then get off your butt and work harder.

What do you think those taxes do? Build castles in the sky? Everything comes around. Except the money helps more people there.

Socialized medicine is not the solution to very many things, except for obliterating job satisfaction among many American physicians....go work in Canada or one of the EU countries for a while and then see how great it is. The closest thing in the US is the military medical corps which is an utter clusterf--k.

 

[kidthor]

Socialized medicine is not the solution to very many things, except for obliterating job satisfaction among many American physicians....go work in Canada or one of the EU countries for a while and then see how great it is. The closest thing in the US is the military medical corps which is an utter clusterf--k.

Hmm... note though that the VA is an example of a socialized system that's operating pretty well nowadays!

 

[DropkickMurphy]

Nowadays, it is virtually *impossible* to work enough as a student to be able to completely pay one's way through college. It really is. Tuition, books, shelter, food, etc surpass the most lucrative jobs one can hold with a full-time schedule in school.

Speak of what you know. I happen to be paying my own way through school. I currently have zero in student loans.

 

[DropkickMurphy]

Hmm... note though that the VA is an example of a socialized system that's operating pretty well nowadays!

Not as well as civilian health systems.....have you ever been treated or REALLY worked (something beyond CNA, etc) at a VA facility?

 

[DropkickMurphy]

This is by far the wealthiest country on Earth at the moment, yet you wouldn't know it from watching how we treat the not-well-off. Bah. I'm done here. Good evening, y'all.

*looks around for a mop to clean up all the blood from your bleeding heart*
If you need me, I'll be on the porch....I see you're already on the cross..... 🙄

 

[Sol Rosenberg]

It would be interesting to see how many new patents for healthcare come out of America versus other non-capitalistic countries. I'd speculate we are pumping out the most innovations.

👍 Easily....And R&D costs money....And FDA approval takes time....And a patent only lasts so long, leaving drug companies with few years to recoup their investment. Hence the high prices. They are only lower overseas because the socialized systems of other countries refuse to pay the market price for the drugs, and the pharma companies are left having to take it or leave it (they usually take it.) That serves to further inflate prices here.

As has been alluded to here, the other effect of this is that certain drugs are just not profitable for private companies to develop. About 2 years ago, I believe the the number of new drugs to fight AIDS that were being developed by private companies (with no government funding involved) was exactly zero. That may have changed, however, but I doubt by very much.

 

[Trismegistus4]

I see your point, but I would add that declining reimbursement rates combined with increased malpractice insurance in certain specialties could reduce the number of interested physicians. As a result, access becomes harder for even more people. Basically my point is that a lot of these problems in health care are interrelated.

True, but the liberal admissions committee member could then say that only proves that we need to admit more selfless people into med school, people who don't lose interest in medicine because of decreasing remuneration. That we need to reject all the white men and fill our class with native American lesbians who have a demonstrable long-standing interest in practicing primary care in underserved areas, who will fight the power and stand up to the man and transform medicine into what it should be: a caring profession that works for social justice and empowerment of the disenfranchised and good things for all the little boys and girls on the other side of the mountain.