What specialty best insulates me from socialized medicine.

[Tulaner]

I don't want to get political here, just practical. I am an MS2 who still has time to decide what specialty to pursue. I also go to a private medical school that will leave me around $250k in debt by the time I START residency.

I don't care what anyone says about socialized medicine being better for patients (it isn't), for government (it isn't) or for doctors (it most certainly isn't).

I have freaking loans to pay off, and I'd like to do it before my kids have to go to college. I have had a long-term girlfriend for a while now, and we want to get married, but we can't because I don't want to live off of her salary as a (private) school teacher, which is barely enough for her.

I'll be blunt. I want to make some money to have a positive net worth. Now it seems I timed it exactly wrong, the second I have to stop borrowing is the second decides that doctors "make too much" or need to "spread the wealth around" even though what we do can only be done competently by a select few and takes a decade to learn.

What specialty can I go into that will most insulate me from a partial or complete government takeover???? I don't care how selective it is. My grades are fine, I'm prepping for Step 1. I'll get a 280 if I have to. My life as I want to live it literally depends on it.

Oh, and if you think I'm just being greedy, just don't bother to respond. My dad works in a furniture store.

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[mercaptovizadeh]

I don't want to get political here, just practical. I am an MS2 who still has time to decide what specialty to pursue. I also go to a private medical school that will leave me around $250k in debt by the time I START residency.

I don't care what anyone says about socialized medicine being better for patients (it isn't), for government (it isn't) or for doctors (it most certainly isn't).

I have freaking loans to pay off, and I'd like to do it before my kids have to go to college. I have had a long-term girlfriend for a while now, and we want to get married, but we can't because I don't want to live off of her salary as a (private) school teacher, which is barely enough for her.

I'll be blunt. I want to make some money to have a positive net worth. Now it seems I timed it exactly wrong, the second I have to stop borrowing is the second decides that doctors "make too much" or need to "spread the wealth around" even though what we do can only be done competently by a select few and takes a decade to learn.

What specialty can I go into that will most insulate me from a partial or complete government takeover???? I don't care how selective it is. My grades are fine, I'm prepping for Step 1. I'll get a 280 if I have to. My life as I want to live it literally depends on it.

Oh, and if you think I'm just being greedy, just don't bother to respond. My dad works in a furniture store.

General surgery. Brutal lifestyle. Can't be outsourced or farmed out to NPs and PAs. I mean, it probably will be taken over by the government, but since it's a niche it's likely the pay will remain pretty high.

Other possibilities: pathology, IM+"essential" subspecialty (i.e. cardiology)

I think the lifestylers are in for a shock.

 

[docB]

The answer no one want to hear is that it depends. It depends what type of system we wind up with.

Many would say that cash pay specialties like plastics surgery, bariatric surgery and boutique medicne would be the best shielded. And they will IF the system we get does not include some provision against people going outside the socialized system and paying out of pocket. Such a "Berlin Wall" of medicine was a prominant feature of the plan Hillary but I don't think it's as likely to be a corner stone of any of the plans on the horizon.

The most likely scenario is that the majority of docs take a hit on the order of 50% or more. I think that the govt will then start heavily subsidizing med ed with the sting attached that they get to determine what kind of residency you do. This would essentially be a mandatory national health service kind of situation. The people who would get really screwed would be those who accumulated the debt bout can't repay it. I think the govt will step up and all everyone in that boat to get loan forgiveness with a similar string. We'll see.

 

[colbgw02]

The answer is easy, and it's really not even close: cosmesis. Whether you get there by way of dermatology or plastic surgery doesn't matter. You'll essentially be in a cash business.

 

[asmallchild]

The answer is easy, and it's really not even close: cosmesis. Whether you get there by way of dermatology or plastic surgery doesn't matter. You'll essentially be in a cash business.

While I agree with this, I would expect a ton of physicians transitioning to cosmetics should universal healthcare become a reality. OBGYNs and ER docs have already begun grabbing a piece of the cosmetic pie (not to mention all the medispas springing up)

100% Cosmetics-based practices also tend to be hit hard in times like this: recession.

 

[docB]

While I agree with this, I would expect a ton of physicians transitioning to cosmetics should universal healthcare become a reality. OBGYNs and ER docs have already begun grabbing a piece of the cosmetic pie (not to mention all the medispas springing up)

100% Cosmetics-based practices also tend to be hit hard in times like this: recession.

This is all true. There's a clinic near me that has a huge sign saying they do Botox, sclerotherapy, dermabrasion, basically anything that's kinda medical and mainly cosmetic that you can do. The name on the shingle (big shingle) is So and So, MD FACEP which if you know what it means is broadcasting the fact that the doc there has never been trained in any of the stuff he's doing.

Especially true is the fact that all of these little cash pay areas of medicine get hit hard by tough times.

You also have to remember that if you try to do something like boutique primary care you're not going to be competeing with the system the way it is now with random copays, deductibles and so on. You'll be competeing with the socialized system. Grated the service is going to be horrible but it has to be really horrible to get people to pony up real dough to see you outside the system.

 

[Good Solutions]

This is all true. There's a clinic near me that has a huge sign saying they do Botox, sclerotherapy, dermabrasion, basically anything that's kinda medical and mainly cosmetic that you can do. The name on the shingle (big shingle) is So and So, MD FACEP which if you know what it means is broadcasting the fact that the doc there has never been trained in any of the stuff he's doing.

Especially true is the fact that all of these little cash pay areas of medicine get hit hard by tough times.

You also have to remember that if you try to do something like boutique primary care you're not going to be competeing with the system the way it is now with random copays, deductibles and so on. You'll be competeing with the socialized system. Grated the service is going to be horrible but it has to be really horrible to get people to pony up real dough to see you outside the system.

Primary care.

As DocB just alluded to, the system has to get really bad for people to want to penny up the cash to leave the system. We are steaming full speed ahead into that abyss. Primary care also gets first crack at patients if being a cosmetic junky is your thing...

Primary care will also afford you the best flexibility for locations and practice options. Let's not forget in this direct access/retainer/concierge practice you will make equal to a specialist.

 

[badasshairday]

Primary care.

As DocB just alluded to, the system has to get really bad for people to want to penny up the cash to leave the system. We are steaming full speed ahead into that abyss. Primary care also gets first crack at patients if being a cosmetic junky is your thing...

Primary care will also afford you the best flexibility for locations and practice options. Let's not forget in this direct access/retainer/concierge practice you will make equal to a specialist.

You have a point there. Primary care seems to be the thing that can definitely be run as a cash only practice model.

 

[Steiner]

Move to Hollywood and do boutique peds. Charge all the celebs a $1500/month per child fee to be available after hours and in your practice only serve the boutiques from 2-5, and run it like a psych practice. 45 minute visits, and 15 minutes of write-up time. No one will ever be waiting and you'll clean up. You might get some crazy late night calls and deal with lunatics more often, but you limit your patient number and probably make more. I want 10% if you do this.

 

[Slack3r]

You'll be competeing with the socialized system. Grated the service is going to be horrible but it has to be really horrible to get people to pony up real dough to see you outside the system.

Depends on the area. In areas with lots of money, these type things aren't a bad option. They already have lots of for-cash private practice ER's for people that can pay for the service. I'm sure you could do something similar for primary care.

And don't you know you can become a "cosmetic surgeon" and do the stuff you see on Dr. 90210. I know a girl who got a nosejob for HS grad from one of those clowns for a mere $16k. Simple fact of the matter, most people don't know the difference between a board-certified plastic surgeon and one certified by the cosmetic board, whatever it's called.

 

[docB]

Depends on the area. In areas with lots of money, these type things aren't a bad option. They already have lots of for-cash private practice ER's for people that can pay for the service. I'm sure you could do something similar for primary care.

Where is there a cash only ER? I've never heard of such a thing. Do you mean an Urget Care?

 

[Slack3r]

Apologies, I meant Urgent Care centers.

 

[frank51]

The most likely scenario is that the majority of docs take a hit on the order of 50% or more.

While most doc may take a hit, I seriously don't believe it will be in the order to 50%, if it is that severe, especially when you take into consideration the very likely inflation we will face, you can bet that a lot of smart people won't be entering medicine, its also not totally unreasonable to expect people to start moving to other countries.

 

[asmallchild]

While most doc may take a hit, I seriously don't believe it will be in the order to 50%, if it is that severe, especially when you take into consideration the very likely inflation we will face, you can bet that a lot of smart people won't be entering medicine, its also not totally unreasonable to expect people to start moving to other countries.

50% seems unreasonable too at a time when student loans are already unbearable.

Should that day come, I might flee the country myself and see what my skills can net me elsewhere

 

[seelee]

My wife has asked a few times; "what will we do if they cut your pay in half." My feeling is, if they cut my pay down too much, guess who's loans get defaulted on.

I keep hearing about doctors who don't take insurance, or medicaid. They quote a fee for a service, and then the patient is responsible for getting reimbursed. I think this would solve a major problem of wasteful cost and would allow market forces to play a bigger factor. I know that people would oppose this, but seriously, how much money do doctors loose on the average insurance, or medicare patient. This is how the scene would play out if we were dealing with an auto mechanic.

Auto Mechanic-I will fix your car for 200.

Customer-well, my dad said that he would pay to have my car fixed, but he only has $75. You will have to do it for that.

AM: sorry, that won't even cover my cost. have a nice day.

C (pulls out a gun): Fix my car! Do it now for $75 or else.

Notice that this is exactly what happens with medicine today (with the exception, that doctors aren't required to accept medicaid...yet).

I think that if Doctors organized and they all stopped taking insurance and medicaid/medicare, that this thievery would be come more apparent.

 

[asmallchild]

My wife has asked a few times; "what will we do if they cut your pay in half." My feeling is, if they cut my pay down too much, guess who's loans get defaulted on.

Sadly, student loans are the only loans you cannot default on.

 

[seelee]

Sadly, student loans are the only loans you cannot default on.

Why not? What happens if you just stop paying?

 

[asmallchild]

Why not? What happens if you just stop paying?

I was told at my exit interview they take it straight out of your residency paycheck.

 

[seelee]

What about after residency? I am not planning on defaulting on my loans (provided the dick-****s in Washington don't cut my pay to 50k).

 

[asmallchild]

What about after residency? I am not planning on defaulting on my loans (provided the dick-****s in Washington don't cut my pay to 50k).

I'm not entirely clear either but I guess it's conceivable they could continue culling it straight from your paycheck as long as you continue to work for a hospital.

The fact that your SSN is attached to the loan really makes it hard to escape.

 

[Winged Scapula]

I'm not entirely clear either but I guess it's conceivable they could continue culling it straight from your paycheck as long as you continue to work for a hospital.

The fact that your SSN is attached to the loan really makes it hard to escape.

As long as you are getting a check from some employer, they can attach your wages.

 

[docB]

It's important to remember that not everyone in medicine has loans. Attendings that have been out more than 10 years will have paid down their debt. So for the field as a whole the issue of loans is not paramount. To students and residents it seems like it is but, trust me on this, loans and med ed expenses will be a distant afterthought in any system that emerges.

The government also doesn't care if we see quality people refuse to go into medicine because of the pay cuts. All they want is someone with a white coat, a title and paid up malpractice insurance who they can send the masses to for a pittance. Quality is not on the agenda.

Americans want the absolute best healthcare they can get without every paying a dime out of pocket. Beyond that they'll accept truly miserable service as long as they don't have to pay anything. After we get what's coming to us people will complain but few will pay their way out.

 

[SocialistMD]

General surgery. Brutal lifestyle. Can't be outsourced or farmed out to NPs and PAs. I mean, it probably will be taken over by the government, but since it's a niche it's likely the pay will remain pretty high.

This is an insane answer. Compared to any other surgical specialty, reimbursement for general surgery is at least 20% lower, and the gap widens every year. Sure we can't be outsourced to physician extenders, but they just cut our reimbursement, something that most fear will only worsen with socialized medicine.

 

[gryffindor]

Americans want the absolute best healthcare they can get without every paying a dime out of pocket. Beyond that they'll accept truly miserable service as long as they don't have to pay anything. After we get what's coming to us people will complain but few will pay their way out.

Why do you assume few will pay their way out? Why is medicine any different from other areas where there is a choice from the standard government issue - private high schools, FedEx & UPS, cable TV? As was pointed out on another thread, plenty of Canadians come here to pay out of pocket for medicine to get around whatever is being offered for "free" back home. I think there will be Americans who will do the same.

 

[docB]

Why do you assume few will pay their way out? Why is medicine any different from other areas where there is a choice from the standard government issue - private high schools, FedEx & UPS, cable TV? As was pointed out on another thread, plenty of Canadians come here to pay out of pocket for medicine to get around whatever is being offered for "free" back home. I think there will be Americans who will do the same.

I think people will do it some but I see people in the ED every day who are waiting on some distant specialist appointment, MRI, run out of their meds and so on just because their insurance is holding them up and they won't pay for it out of pocket.

 

[medsRus]

If I just don't pay my Stafford loans, what will happen?

 

[Impromptu]

If you pay Obama's staff some money, they'll arrange a bailout for you. All the companies that got the freshly printed money had recently paid big bucks to his staff. I hear they don't even care if you've paid your income taxes.

 

[sirus_virus]

Primary care physicians are the only ones protected in socialized healthcare. Socialized healthcare = primary care 1st, everything next.

 

[gryffindor]

I think people will do it some but I see people in the ED every day who are waiting on some distant specialist appointment, MRI, run out of their meds and so on just because their insurance is holding them up and they won't pay for it out of pocket.

This is why the insurance company needs to be removed from the equation. What is it about the almighty insurance companies that the American public can't see it is a huge source of so many problems?

 

[Terpskins99]

Primary care physicians are the only ones protected in socialized healthcare. Socialized healthcare = primary care 1st, everything next.

Maybe its because I'm still a med student (heheh for a few more weeks), but wouldn't primary care be among the LEAST protected in a socialized healthcare system?

I know this scenario isn't real yet, but what happens if a law is passed where a physician will not be allowed to turn away medicare patients? Lawsuits have already occurred with state officials suing doctors for refusing medicare patients.

Also, isn't there going to be an increase in competition from the growing number of nurse practitioners and PA's assuming PCP roles?

 

[sirus_virus]

Maybe its because I'm still a med student (heheh for a few more weeks), but wouldn't primary care be among the LEAST protected in a socialized healthcare system?

I know this scenario isn't real yet, but what happens if a law is passed where a physician will not be allowed to turn away medicare patients? Lawsuits have already occurred with state officials suing doctors for refusing medicare patients.

Also, isn't there going to be an increase in competition from the growing number of nurse practitioners and PA's assuming PCP roles?

I am just going of the hundreds of socialized systems out there. They all pump money into primary care, and cut everything else. If you have been paying attention to Obama and his new HHs secretary, you would have noticed that they can't make a healthcare related sentence without using the words "primary care".

 

[Terpskins99]

I am just going of the hundreds of socialized systems out there. They all pump money into primary care, and cut everything else. If you have been paying attention to Obama and his new HHs secretary, you would have noticed that they can't make a healthcare related sentence without using the words "primary care".

Thats terrific and all, but do you honestly believe any democrat president is going to increase Medicare compensation to a PCP?

Its not happening. EVERYONE is going to get a paycut. The PCP folks won't get hit as hard as the procedure-heavy specialists, but in no way does that translate into a raise in salary.

The best I see Obama doing for primary care docs is possibly providing incentives by way of tuition reinbursement.

 

[sirus_virus]

Thats terrific and all, but do you honestly believe any democrat president is going to increase Medicare compensation to a PCP?

Its not happening. EVERYONE is going to get a paycut. The PCP folks won't get hit as hard as the procedure-heavy specialists, but in no way does that translate into a raise in salary.

The best I see Obama doing for primary care docs is possibly providing incentives by way of tuition reinbursement.

He already said he plans on giving primary care physicians tuition relief and increased reimbursements. This is straight out of his own mouth, and I am not sure people are paying attention to that stuff.

 

[Acherona]

Primary care physicians are the only ones protected in socialized healthcare. Socialized healthcare = primary care 1st, everything next.

In Canada the pay inequity is pretty much the same as in the US with the family docs making the least and the procedure heavy specialties making the most. Just because it's the government who is paying now instead of an insurance company doesn't change the fact that it is very difficult to quantify the work that family docs/psychiatrist/internist does vs. a procedure. I will say that there is not as much a potential for exhorbitant wealth with the higher paying specialties in canada which IMO is a good thing.

 

[sirus_virus]

In Canada the pay inequity is pretty much the same as in the US with the family docs making the least and the procedure heavy specialties making the most. Just because it's the government who is paying now instead of an insurance company doesn't change the fact that it is very difficult to quantify the work that family docs/psychiatrist/internist does vs. a procedure. I will say that there is not as much a potential for exhorbitant wealth with the higher paying specialties in canada which IMO is a good thing.

Yes, and the last time I checked, the pay difference in Canada between a specialist and a primary care physician was not significant enough to even account for the extra training. The british system is flat out more profitable for primary care physicians BTW.

 

[Good Solutions]

Placing a prohibition on free market medicine will never work. It didn't work with alcohol prohibition, it isn't working with the current drug war, and it will not work with something like medicine either. The government may try to mandate or stipulate requirements to medical licenses that make us all defacto government employees, but people will continue to seek out and pay for the quality that government destroyed. Just like the canadians coming to the US do.

We will offer descreetly through the back door of the office.
We will set up cruise ships of the us coast, equipped as complete hospitals.
We will partner with indian reservations that will permit hospitals to be built for a price on their land.

Government loan payback schemes are rediculous. There is a reason why people are not flocking to military medicine. There is a reason why people are not flocking to the underserved health scholarship programs. You are financially worse off entering these programs then had you taken on the debt yourself. You are also saddled with stipulations that limit your personal freedom in where you live, how you practice, and the populations you serve.

Any new government methods to have primary care loan repayment will undboubetedly come with a hitch. A hitch that will always be far worse than not accepting it. Primary care is alive and well. Opt out of insurance. Opt out of medicare. Take cash only or even enter a retainer practice. Your patients will thank you and the freedom you feel in your job will be priceless. You will thank yourself.

 

[Terpskins99]

Placing a prohibition on free market medicine will never work. It didn't work with alcohol prohibition, it isn't working with the current drug war, and it will not work with something like medicine either. The government may try to mandate or stipulate requirements to medical licenses that make us all defacto government employees, but people will continue to seek out and pay for the quality that government destroyed. Just like the canadians coming to the US do.

This doesn't have to do with what is right or wrong, whether it'll work or not. Just what will happen.

Europe (particularly France) has been lowering compensation to their docs for years.

 

[Acherona]

Yes, and the last time I checked, the pay difference in Canada between a specialist and a primary care physician was not significant enough to even account for the extra training. The british system is flat out more profitable for primary care physicians BTW.

um, no. The average family doc in canada makes around 200K while the average specialist makes around 330K.

 

[Slack3r]

$200k in Canada = ~$150k in the US.

 

[gonogo]

It baffles me that physicians are getting all these pay cuts, while CEOs, lawyers, bankers, etc... have been consistently making more money. Somehow this isn't fair, especially when getting into med school and residency is so competitive and requires so many years of training.

 

[asmallchild]

Market doesn't look so hot for lawyers now

Or for that matter bankers

And in this economy, CEOs aren't exactly laughing to the bank either

 

[Slack3r]

Market is oversaturated with lawyers because they've been cranking out JD's like their candy. I believe top-20 law school grads aren't doing too bad. Law is definitely one of those fields where the name on your degree gets you some looks.

 

[Excelsius]

I personally don't believe that physician salaries are going to be affected in any major way. While Obama is a liberal, he is very intelligent and understands how the market works. I never got anything from his message that hints on lowering salaries for doctors. I actually agree with him that we need focus on prevention, rather than treatment. Think about it. The reason the healthcare system is so overloaded and dysfunctional is the overwhelming number of ill patients, often terminally. We are basically wasting our money trying to cure patients who are never going to be cured. Once more prevention is implemented, everyone will benefit. Right now things are out of control.

Finally, even if you think that Obama is going to completely demolish the free market in medicine, think about what happens after eight (or maybe four) years when he is out of office. You might get a conservative republican who will reverse all of his changes in the healthcare system. I also don't think it is going to be possible to pass any radical healthcare agendas in a congress or the senate even with democratic majority (which again is not going to last forever). Let's also not forget that part of the reason why healthcare is getting scrutinized right now is because the country is in such a bad place. Also don't forget who put us here. Having a president who just might pull us out of the financial gutter will benefit everyone, including doctors. This is why it is not right to look at Obama only as far as his healthcare plans are concerned. Bush may have not done any damage to doctor's salaries directly, but he placed us in such a vulnerable position that we are going to pay for his mistakes for decades to come. At this point, you should worry more about TAXES. At some point in the past they were as high as 90%. Once that happens, it really won't matter how much money you are making. Given that China has basically bought USA, I won't be surprised if taxes hit all-time highs.

There is a severe shortage of doctors in this country and even the best models show that the shortage is going to get only worse. In such an environment, doctors are always going to be in high demand, and where there is demand, there is commensurate compensation. The moment salaries are decreased to the same amounts as other professionals earn, guess what's going to happen? The vast majority of students are going to take the four year path to their goal, rather than the 11 year one (assuming higher end fellowships). This will create even more shortage. Our country is very different from the rest of the world and I highly doubt that we will see any form of government intervention in the free market.

Students who haven't started medschool yet will very likely miss the turmoil in the healthcare system altogether because radical changes tend to not survive changes in administration, especially when another party takes over. If Biden chooses to run after eight year, I'm pretty sure he will lose. Hillary is already a secretary of state and is unlikely to run. I don't see any replacements for Obama. Unless Republicans don't get their **** together and end up nominating Palin, chances are high that a republican will take over in eight years. Jindal is very awkward for now, but he may just mature in eight years and be ripe for presidency.

 

[asmallchild]

While I love the optimistic viewpoint, I have to ask: when have taxes ever been 90%? I would have remembered the rioting and the burning of Capitol Hill

 

[Excelsius]

While I love the optimistic viewpoint, I have to ask: when have taxes ever been 90%? I would have remembered the rioting and the burning of Capitol Hill

1944 and 1945 they were whopping 94% on incomes over 200K. From 1951 to 1963 they were over 90% (up to 92%).

Check it out: http://www.truthandpolitics.org/top-rates.php

 

[asmallchild]

Good lord that's horrifying. I can assure you I'll be happily waiting in the welfare line should that day come. What's the point in working if they take away all the benefits of working?

(In all seriousness, I'm sure there are other countries that could use the services of a US-trained physician)

 

[Excelsius]

Good lord that's horrifying. I can assure you I'll be happily waiting in the welfare line should that day come. What's the point in working if they take away all the benefits of working?

(In all seriousness, I'm sure there are other countries that could use the services of a US-trained physician)

Keep in mind the tax shelters in US. Other countries are usually known for very high tax rates, no tax shelters, and even lower salaries. Might be the same in the end, assuming we don't go much over 50-60%.

 

[michaelrack]

Good lord that's horrifying. I can assure you I'll be happily waiting in the welfare line should that day come. What's the point in working if they take away all the benefits of working?

There would still be a point in working, just not hard. IF the US again instituted confiscatory tax rates, I would just cut down my hours and income to keep my marginal federal income tax rate at under 50%.

 

[Slack3r]

While Obama is a liberal, he is very intelligent and understands how the market works.

Raising taxes on high wage earners doesn't solve problems. Those people create jobs, increasing their taxes leads to decrease in jobs since it's not beneficial to pay higher taxes AND more salaries. Democrats seems to think that increasing taxes above $250k is the answer, and that everyone will just say "Aw shucks! Now I have more taxes!". No, people decrease productivity to stay under the increased tax brackets. Decreasing productivity seems like a brilliant idea in a recession, eh?

And increasing government spending is supposed to spark the economy? How about creating some jobs that contribute to the GDP, not increasing bureaucracy and pointless govt agencies? For a "smart guy" most of the crap he's pushing seems to contradict basic economic concepts.

 

[dragonfly99]

Guys, remember that that 90% or whatever tax rate Excelcius speaks of is a MARGINAL tax rate that is only imposed on the money over the limit (i.e. everything over 200k or 250k is taxed at 90%, while the first 200k would be taxed at whatever lower tax rate that income falls into). I don't think you can use 1940's tax rates as a good example...that was probably war time (and/or preparations for war) and depression-era policies. I do agree that if income >150k or 200k was taxed at 95%, I'd probably just choose not to work more if I was one of the folks who made 150k.

Excelcius, the government already DOES/has interfered with the health care market, as have monopolistic health insurance companies. Doctors are not really able to collectively bargain due to the existence of laws that were set up years ago to protect multistate pension plans, but now protect the insurance companies to a large degree.

I think preventive medicine is important, but not sure it will save us a lot of money in the long run. It is also difficult or impossible to get the public to do preventive care such as diet and exercise if they are not motivated to do so...and unfortunately I have found out in practice that a lot of them are not...but can keep trying. I think for one thing, we should spend more on antismoking campaigns aimed at teens and kids....
If we decide to do preventive medicine by taking money away from things like end of life care and spending it on prevention (or prenatal care, etc.) that might improve our overall health outcomes, but will displease many of the elderly and their family members, etc. who value their individual lives very highly (even if they are expensive to save or prolong). People in the US just won't like hearing that grandma can't have dialysis or a heart valve replacement unless she is able to pay for it out of her own pocket, because our gov't sponsored insurance plan doesn't allow dialysis for people over 65...

p.s. I voted for Obama as well and agree that one should not vote for political candidates based on one or a few issues....