Why are most doctors against healthcare reform?

Started by uclaussr
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I'm not entirely sure what you are trying to say about the UK. However, at present, there is fairly little difference in what babies are resuscitated and given neonatal care in the UK and most of Western Europe (and Japan, Israel, Australia, and a few other places) than in the US. In general, difference are diminishing in care practices between countries. There is a tendency for more aggressive care in the US, but really, the distinction is currently very small.

And 50K+? That covers the first 10 days, add a zero to the end and you have the approximate neonatal care costs of a 24-25 week preterm infant.

Since you are interested:As of 2010 France only offers palliative care to 24 weekers. Had trouble running it down but this seems correct (UK) "The argument, which was lost in Parliament, followed a cut to the time limit in 1990 when politicians reduced it from 28 weeks to 24 weeks, in line with scientific evidence that foetuses could survive outside the womb at a younger age." Not sure when the switch down to 22 happened. Perhaps you could speak about the climate in the US in the 1990's?
 
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Since you are interested:As of 2010 France only offers palliative care to 24 weekers. Had trouble running it down but this seems correct (UK) "The argument, which was lost in Parliament, followed a cut to the time limit in 1990 when politicians reduced it from 28 weeks to 24 weeks, in line with scientific evidence that foetuses could survive outside the womb at a younger age." Not sure when the switch down to 22 happened. Perhaps you could speak about the climate in the US in the 1990's?

You missed the word "below" in the French guidelines. The US does not apply national guidelines in this sense, but comfort care is widely, although not always used < 24 weeks in the US. We tend to give some range for family judgment at 23 weeks. At 22 weeks very few neonatologists recommend resuscitation, although at times it is done. As I said, the differences between most of Western Europe and the US is relatively small at this time.

http://www.ncbi.nlm.nih.gov/pubmed/20223643

you might find this of interest too regarding the UK

http://www.dailymail.co.uk/news/art...gives-birth-just-days-22-week-care-limit.html
 
Oh no not at all, I just thought it was ironic because I hadn't been to this site in a while and I found it funny that this was a thread. I know there are a lot of condescending jerks on this board, but I'm certainly not one of them lol. I'm pretty down to earth, my life doesn't revolve around me being "pre-med." And in my findings, I discovered that the World Health Organization has America's health system ranked 37th in the world in overall performance. That's kinda low for 'one of the best countries in the world' dontcha think? What is really appalling is that every citizen doesn't have access to health care. And American doctors don't do a good job at preventive care, but they're not paid for preventive care, they're paid for every single test they run (which I think is wrong). The test doesn't even have to necessary. Hmm..no wonder my PCP always draws blood, just to tell me "everything is fine."

Yeah, I guess it's just a lot easier to respond to a post that has some concrete information in it (like this one of yours that I quoted 🙂). The problem with the WHO ranking system is that some of its metrics are a better measure of the population's health than of the healthcare system. The classic example is life expectancy-the rankings take it into account, but it is influenced by so much more than just the healthcare system. Education and cultural values play their part as well. I agree with you that the U.S. sucks at preventive care, but again, there's a lifestyle component to that. We have one of the highest rates of obesity in the world-that isn't a failure of our health system, it's a failure of our cultural values and education system.

My only point with this is that it's a lot more complicated than just what the WHO says. Health in a country isn't just how likely you are to see your doctor. It includes access to healthcare, ability to pay, education, levels of medical and pharmaceutical research, and many other facets. Our system is set up pretty well for things like research in medicine and pharmaceuticals, but unfortunately those aren't part of the rubric used to judge a system's efficacy.

Also, you have my apology for making an assumption about your research paper. It just really is a lot easier to have a discussion with facts or logic than with feelings and vague statements.
 
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And American doctors don't do a good job at preventive care, but they're not paid for preventive care, they're paid for every single test they run (which I think is wrong). The test doesn't even have to necessary. Hmm..no wonder my PCP always draws blood, just to tell me "everything is fine."
This is the part where the grown-ups tell you to stop talking, because you're just making yourself look like a complete idiot.
 
You missed the word "below" in the French guidelines. The US does not apply national guidelines in this sense, but comfort care is widely, although not always used < 24 weeks in the US. We tend to give some range for family judgment at 23 weeks. At 22 weeks very few neonatologists recommend resuscitation, although at times it is done. As I said, the differences between most of Western Europe and the US is relatively small at this time.

http://www.ncbi.nlm.nih.gov/pubmed/20223643

you might find this of interest too regarding the UK

http://www.dailymail.co.uk/news/art...gives-birth-just-days-22-week-care-limit.html

I freely admitted already that things have been fixed. The catalyst for that change is almost always what we manage to do (regardless of the cost) was more of what I was driving at (where all that money goes, and what comes of it). The world occasional benefits from what is perceived as our wasteful spending I wonder why they want us to change so much.
 
You know, even Ayn Rand, in her twilight years, collected social security and Medicare.

http://www.alternet.org/teaparty/14...l_security_and_medicare_when_she_needed_them/

Libertarianism is great if you have the money to tell the govt to shove it.

there's really no contradiction in logic there. Libertarians have never advocated that you shouldn't collect SS and medicare, since you HAVE to pay into it by use of force. You are merely getting back what was stolen from you, plus the interest that would have accrued over the years. It's only perpetuating the system had she been an advocate of expanding SS or increasing the benefits of Medicare.

Without Medicare/SS as a mandatory fee, Rand would have opted out of the system and invested money into a personal savings account, such that she could have afforded to purchase private insurance as an elderly women to treat her lung cancer.
 
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I freely admitted already that things have been fixed. The catalyst for that change is almost always what we manage to do (regardless of the cost) was more of what I was driving at (where all that money goes, and what comes of it). The world occasional benefits from what is perceived as our wasteful spending I wonder why they want us to change so much.

The key change was surfactant. A medical innovation to save babies created and first tested in the United States. See the history of surfactant.

There is little basis, in my personal experience, for the idea that the US has driven technological and care advancement in this field beyond what was done and is being done in Europe or Japan. Others, more experienced than I, may feel differently.
 
The article said she used her Medicare to pay for her treatments for lung cancer. Odds are that her treatments cost WAY more than she ever paid in.

Sure, I agree. I'm not here to convince anyone that Ayn Rand was a saint. It doesn't change my views. If I pay in, I am going to collect.
 
A couple thoughts to add fuel to the flames:

In most countries with tighter regulation on healthcare, insurance companies (private ones in Germany, Switzerland, Japan, etc. and single-payer ones, e.g. Canada) have to pay any licensed physician's payment claim within a set amount of time (usually within a week) if it's an officially approved treatment. So, there's less of this:

Dr. Sroka was once deeply idealistic about his profession and used to speak with great feeling about a higher purpose to his work. He still fondly recalls standing on his front porch and stitching up neighborhood kids injured in evening ball games. But when insurers stopped paying extra for after-hours care, he started telling those kids to go to nearby emergency rooms. Like so many in his generation of doctors, the nickel-and-dime efforts of insurers have left him deeply bitter.
2) Regarding the whole Ayn Rand/social programs creating a lazy, undeserving populace, social mobility is higher in most countries with robust social safety nets than in the US.
 
Of course I was talking about cancer you half wit. I apologize I was using copious amounts of auto complete to insult you. Seeing as you are unable to do basic biomedical research I think you need to quit while you are ahead.

Half wit eh? Niiice.

I was afraid I said mortality, 1-year survival for prostate cancer not mortality (but I had figured your a bright guy and could figure it out).

Whoops.

Sorry to rock your world buddy.

Thanks for your condolences, buddy.

Done playing with the kids in this thread.

I'm glad you decided to bring your toys back out and join us again.
 
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Only took 3 pages to get to Ayn Rand? 🙄

"There are two novels that can change a bookish fourteen-year old's life: The Lord of the Rings and Atlas Shrugged. One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs."
 
Read up on medical care before even contributing to this thread. Before you know how things work in the UK, or Japan, or Denmark (and especially the US), save your judgments on socialized medicine.

Then when you think QALYs are the answer to everything, read up on Oregon in the 90s.

Health care reform demands more than jingoisms and bumper-sticker rhetoric. The majority of medical students and doctors don't know how the system works, and I doubt a room of pre-meds would be any better informed.
 
Health care reform demands more than jingoisms and bumper-sticker rhetoric. The majority of medical students and doctors don't know how the system works, and I doubt a room of pre-meds would be any better informed.

That's pretty much where I am. I would kind of hope, though, that in this thread we could try to learn from what little we do know, recognize what we don't, and not engage in personal attacks.
 
Only took 3 pages to get to Ayn Rand? 🙄

"There are two novels that can change a bookish fourteen-year old's life: The Lord of the Rings and Atlas Shrugged. One is a childish fantasy that often engenders a lifelong obsession with its unbelievable heroes, leading to an emotionally stunted, socially crippled adulthood, unable to deal with the real world. The other, of course, involves orcs."

It's amazing how often this quote appears in Ayn Rand debates. You would think it would be a more useful tactic to address the content of her ideas instead of ridiculing her supporters, though I suppose the former involves a bit more effort. 🙄
 
It's amazing how often this quote appears in Ayn Rand debates. You would think it would be a more useful tactic to address the content of her ideas instead of ridiculing her supporters, though I suppose the former involves a bit more effort. 🙄

I brought it up jokingly. I'm experienced enough to know not to discuss Ayn Rand on the internet 😉
 
It's amazing how often this quote appears in Ayn Rand debates. You would think it would be a more useful tactic to address the content of her ideas instead of ridiculing her supporters, though I suppose the former involves a bit more effort. 🙄

Imagine a group of men on a crowded subway, on a long commute to work. None of them are particularly comfortable, but they are enjoying the closest approximation of comfort that subway can provide. Suddenly, though, one passenger begins to swing his arms wildly, forcing his fellow passengers to flee from him. Now he alone is comfortable and his fellow passengers are much worse off than before. However when any of the passengers asks the man to share the space he becomes furious at them. He insists that he created the space, that they are thieves for trying to take what is rightfully his. Furthermore, he insists, if they would just stop complaing as start waving their arms like he did they would all have the same amount of space that he has.

Ann Rand's view on wealth is as simplistic as that man's view of his space. She sees any altruism or taxation as equivalent to theft because she simply cannot concieve of a world where the 'natural' distribution of resources is anything other than completely fair, where the line between 'taking' and 'generating' wealth is not perfectly clear. She spends endless novels defending the right of her individuals not to be bothered by society, but she never considers that society might be under assault by her individuals. In her books such a conflict never occurs: in her stories great men can raise edifices and even empires without infringing on another man's rights if only they are left alone. That view is every bit as simplistic as Tolkin's armies of good and evil, without the inconvience of acknowledging that the story is a fantasy.
 
did a newby just tell us to use the search function? I feel angry and confused.

Nah, that account will turn up down the road posting some sort of ad spam. Some of the time they post-pad before they do, especially if they're going to start a thread with a question about clothing..."should I wear this suit to my interview?" and once I even saw "should I buy this tie for my premed boyfriend?" When these bots have a few posts under there belt it generates more discussion and more clicks on whatever link they post.

If you check out their post history, it often contains 10 - 15 posts of that little blip about using the search function. The odds of them randomly posting it in a repeat thread are pretty high. I will say that spamming is getting much more sophisticated.
 
Imagine a group of men on a crowded subway, on a long commute to work. None of them are particularly comfortable, but they are enjoying the closest approximation of comfort that subway can provide. Suddenly, though, one passenger begins to swing his arms wildly, forcing his fellow passengers to flee from him. Now he alone is comfortable and his fellow passengers are much worse off than before. However when any of the passengers asks the man to share the space he becomes furious at them. He insists that he created the space, that they are thieves for trying to take what is rightfully his. Furthermore, he insists, if they would just stop complaing as start waving their arms like he did they would all have the same amount of space that he has.

Ann Rand's view on wealth is as simplistic as that man's view of his space. She sees any altruism or taxation as equivalent to theft because she simply cannot concieve of a world where the 'natural' distribution of resources is anything other than completely fair, where the line between 'taking' and 'generating' wealth is not perfectly clear. She spends endless novels defending the right of her individuals not to be bothered by society, but she never considers that society might be under assault by her individuals. In her books such a conflict never occurs: in her stories great men can raise edifices and even empires without infringing on another man's rights if only they are left alone. That view is every bit as simplistic as Tolkin's armies of good and evil, without the inconvience of acknowledging that the story is a fantasy.

The person on the bus sounds like a total dick.

👍 for the fantasy part though. Oh why of course, in a free market free of regulation all corporations will compete fairly and ethically. 🙄
 
Imagine a group of men on a crowded subway, on a long commute to work. None of them are particularly comfortable, but they are enjoying the closest approximation of comfort that subway can provide. Suddenly, though, one passenger begins to swing his arms wildly, forcing his fellow passengers to flee from him. Now he alone is comfortable and his fellow passengers are much worse off than before. However when any of the passengers asks the man to share the space he becomes furious at them. He insists that he created the space, that they are thieves for trying to take what is rightfully his. Furthermore, he insists, if they would just stop complaing as start waving their arms like he did they would all have the same amount of space that he has.

Ann Rand's view on wealth is as simplistic as that man's view of his space. She sees any altruism or taxation as equivalent to theft because she simply cannot concieve of a world where the 'natural' distribution of resources is anything other than completely fair, where the line between 'taking' and 'generating' wealth is not perfectly clear. She spends endless novels defending the right of her individuals not to be bothered by society, but she never considers that society might be under assault by her individuals. In her books such a conflict never occurs: in her stories great men can raise edifices and even empires without infringing on another man's rights if only they are left alone. That view is every bit as simplistic as Tolkin's armies of good and evil, without the inconvience of acknowledging that the story is a fantasy.

Now, I'm not an objectivist. I believe that, in a free market, nobody starves and alturism exists. The former is supported by the fact that industrialized nations can produce vastly more food than required by their population, even/especially without government interference in the food supply. Furthermore, the latter point is proven by the fact that people are already greatly altruistic, even when 30% of their wealth is removed via taxes annually.

However, the first paragraph is a disanalogy. It presents a zero-sum view of economics, which is untrue. Furthermore, it also assumes that people cannot better their situation or the situation of others through production due to unchanging, strictly limited resources. That is not the case.

A correct analogy would include the ability for one subway member to, alone or with the help of specialized labor of multiple subway riders, create a new car for the subway train.
 
Now, I'm not an objectivist. I believe that, in a free market, nobody starves and alturism exists. The former is supported by the fact that industrialized nations can produce vastly more food than required by their population, even/especially without government interference in the food supply. Furthermore, the latter point is proven by the fact that people are already greatly altruistic, even when 30% of their wealth is removed via taxes annually.

However, the first paragraph is a disanalogy. It presents a zero-sum view of economics, which is untrue. Furthermore, it also assumes that people cannot better their situation or the situation of others through production due to unchanging, strictly limited resources. That is not the case.

A correct analogy would include the ability for one subway member to, alone or with the help of specialized labor of multiple subway riders, create a new car for the subway train.

Damn, Flow. I thought clothes were the only thing you could talk about 😉
 
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Now, I'm not an objectivist. I believe that, in a free market, nobody starves and alturism exists. The former is supported by the fact that industrialized nations can produce vastly more food than required by their population, even/especially without government interference in the food supply. Furthermore, the latter point is proven by the fact that people are already greatly altruistic, even when 30% of their wealth is removed via taxes annually.

However, the first paragraph is a disanalogy. It presents a zero-sum view of economics, which is untrue. Furthermore, it also assumes that people cannot better their situation or the situation of others through production due to unchanging, strictly limited resources. That is not the case.

A correct analogy would include the ability for one subway member to, alone or with the help of specialized labor of multiple subway riders, create a new car for the subway train.

Uh? Nobody starves? Nobody starves in this country? Really? Remove food stamps/welfare and we'll see how many MORE people don't have money for food.

Yeah it's super easy to change your living condition! Don't worry that you can't afford college or have any practical skills, just open up a convenience store next to the local Walmart and see how it turns out.

People can be altruistic in a free market, but corporations will have a really hard time being so. Do you really believe that if we remove ALL regulations from insurance companies or food/other manufacturers they'll start hiring more Americans and selling better products for less because that's how capitalism is supposed to work?
 
This didn't go against Rand's ideals at all... as others have pointed out, she viewed it as moral to take back as much of the hundreds of thousands she contributed to the government as she could.

You guys realize Atlas Shrugged is a work of fiction, right?
 
Uh? Nobody starves? Nobody starves in this country? Really? Remove food stamps/welfare and we'll see how many MORE people don't have money for food.

Yeah it's super easy to change your living condition! Don't worry that you can't afford college or have any practical skills, just open up a convenience store next to the local Walmart and see how it turns out.

People can be altruistic in a free market, but corporations will have a really hard time being so. Do you really believe that if we remove ALL regulations from insurance companies or food/other manufacturers they'll start hiring more Americans and selling better products for less because that's how capitalism is supposed to work?

The united states is by no measure a free market. The rest of your argument is predicated on that assumption; given that assumption is false, there is no reason to try and argue additional points based on a false assumption.

There is no "supposed to work." Unhindered economics works. The supply will meet the demand at the intersection point, yielding optimal cost and quality.
 
Imagine a group of men on a crowded subway, on a long commute to work. None of them are particularly comfortable, but they are enjoying the closest approximation of comfort that subway can provide. Suddenly, though, one passenger begins to swing his arms wildly, forcing his fellow passengers to flee from him. Now he alone is comfortable and his fellow passengers are much worse off than before. However when any of the passengers asks the man to share the space he becomes furious at them. He insists that he created the space, that they are thieves for trying to take what is rightfully his. Furthermore, he insists, if they would just stop complaing as start waving their arms like he did they would all have the same amount of space that he has.

Ann Rand's view on wealth is as simplistic as that man's view of his space. She sees any altruism or taxation as equivalent to theft because she simply cannot concieve of a world where the 'natural' distribution of resources is anything other than completely fair, where the line between 'taking' and 'generating' wealth is not perfectly clear. She spends endless novels defending the right of her individuals not to be bothered by society, but she never considers that society might be under assault by her individuals. In her books such a conflict never occurs: in her stories great men can raise edifices and even empires without infringing on another man's rights if only they are left alone. That view is every bit as simplistic as Tolkin's armies of good and evil, without the inconvience of acknowledging that the story is a fantasy.

Her books may be as hyperbolic as that story, but not quite as simplistic. Are all resources akin to space on a subway? Is that all it takes to "generate" wealth in your mind? Should all men's time, thought, and effort be pooled and then divided among society? Should those that put in MORE time, MORE thought, and MORE effort into their lives, be subject to increasing penalties and decreasing returns (not just in absolute terms, but relative as well) , to support others? Resources =/= Wealth. Wealth is the product of the human mind, acting on those resources. That's the whole point of her books. Ability and ingenuity generate wealth, and just because some people lack ability in certain areas (my mind just can't make this analogous to arm waving on a subway, however hilarious that analogy is), doesn't give them the "right" to the product of someone else's ability.

I fully agree there are plenty of resources that are subject to the "tragedy of the commons," and need to be protected and distributed by society. The role of government is to PROTECT those resources and individuals' rights from infringement, not to redistribute wealth. Tax us to build roads, maintain an army, and enforce the law. But don't put a gun in my face, take my money, and give it to someone who doesn't work. If I feel that someone was down on their luck, had a horrible accident, etc., and needed my help, that charity should be at my discretion.
 
The united states is by no measure a free market. The rest of your argument is predicated on that assumption; given that assumption is false, there is no reason to try and argue additional points based on a false assumption.

There is no "supposed to work." Unhindered economics works. The supply will meet the demand at the intersection point, yielding optimal cost and quality.

You said the United States and other industrialized nations produce enough food to feed their populations. Yes we do, the problem is we don't distribute it equally, so while some households throw away over 50% of what they buy, others have to take turns eating. How would a free market solve this? I don't mean a free market in a conservative Utopia, I mean a free market in the real world, where things aren't as easy as a supply and demand curve void of any confounding variables.

It works? In which country and when?

It strikes me as odd that somehow everyone who's read Atlas Shrugged thinks they've landed upon some kind of economic gold mine. A perfect economic system...that for some reason hasn't been implemented yet anywhere at anytime.
 
You said the United States and other industrialized nations produce enough food to feed their populations. Yes we do, the problem is we don't distribute it equally, so while some households throw away over 50% of what they buy, others have to take turns eating. How would a free market solve this? I don't mean a free market in a conservative Utopia, I mean a free market in the real world.

It works? In which country and when?

The united states is anti-free market, especially in terms of food supply. We pay producers to waste food. Food is so cheap to produce --WITHOUT trade sanctions, tariffs, fees, mandatory waste, etc-- that anyone with a job could afford it. In a free market, anyone can get a job. The minimum wage keeps many people from having jobs. i.e. the mentally/physically handicapped, who instead go without a job.

It works in any country which the government decides to loosen restrictions. There is significant data which proves that government intervention hurts economic progress, distribution of wealth, etc. Furthermore, some other countries which recently switched to reduced-intervention methods have seen significant increases in their economy and QOL. I.e. Chile.
 
The united states is anti-free market, especially in terms of food supply. We pay producers to waste food. Food is so cheap to produce --WITHOUT trade sanctions, tariffs, fees, mandatory waste, etc-- that anyone with a job could afford it. In a free market, anyone can get a job. The minimum wage keeps many people from having jobs. i.e. the mentally/physically handicapped, who instead go without a job.

It works in any country which the government decides to loosen restrictions. There is significant data which proves that government intervention hurts economic progress, distribution of wealth, etc. Furthermore, some other countries which recently switched to reduced-intervention methods have seen significant increases in their economy and QOL. I.e. Chile.

Food isn't cheap OR easy to produce. Especially for over 300 million people. Cheap and easy are also extremely relevant terms, so I don't really know what you mean by that without some kind of a source.

Where would these jobs come from exactly? Either they will all be outsourced, or we'll have to work for what the competition overseas works for. That's certainly not going to help us afford food.

You're talking about something else there. Reduced-intervention and a completely free market without ANY government intervention (FDA, USDA, etc) are not the same thing.

How about this, would you support the government lifting all regulations on who can deliver healthcare? No more keeping IMGs out, no more requiring foreign physicians to complete US residencies. Hell, why not just outsource radiology? Do you really think the average patient will notice the difference in the quality of care from a U.S grad and one from India or China? So then why keep them out?
 
🙂 And one for YOU sir. Let's just get drunk instead of discussing this.

That's what's wrong with this country. All you pre-meds just want to drink beer rather than discuss things that could potentially save the lives of your future patients. And you all want to be doctors?!?

/obligatory invocation of Burnett's law
 
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That's what's wrong with this country. All you pre-meds just want to drink beer rather than discuss things that could potentially save the lives of your future patients. And you all want to be doctors?!?

/obligatory invocation of Burnett's law

Don't tell the adcoms I'm a filthy drunk 🙁
 
That's what's wrong with this country. All you pre-meds just want to drink beer rather than discuss things that could potentially save the lives of your future patients. And you all want to be doctors?!?

/obligatory invocation of Burnett's law

Hahaha. I've been impressed with this thread (for the most part). It made it through 4 pages including an Ayn Rand tangent without a total meltdown. Granted it was 1/3 discussion, 1/3 predicting the doom of the thread, and 1/3 douche-bag. But I would say that's better than par for the course.
 
Hahaha. I've been impressed with this thread (for the most part). It made it through 4 pages AND an Ayn Rand tangent without a total meltdown. Granted it was 1/3 discussion, 1/3 predicting the doom of the thread, and 1/3 douche-bag. But I would say that's better than par for the course.

Yeah, other than some petty namecalling, there was some legitimate and thoughtful discussion -- an endangered species on this here SDN. The doomsday posts provided much needed comic relief.
 
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In the 2 years I've been here, we've had this topic AT LEAST 20 times. Needless to say, we've refined the art of arguing about it without getting banned. 😉
 
best part was the pre-med lecturing the attending neonatologist of many years about standards of care in the NICU 🙄