Will IM "keep more options open" in the upcoming future?

[gyngyn]

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A civil discussion, please...or it's off to the SPF with the lot of you.

 

[sargon2123]

I believe need stricter rules that allow for discussion as of now. It’s not just this thread but in others too insults keep getting hurled that prevent points from being made

 

[Ho0v-man]

There's a very good interview online about this that touches on this particular topic. I suggest you look at it, I believe it was through the young turks.

Change in the overall goals in delivering quality care would be good. I’m not sure what that has to do with Medicare for all or why having a single payer system would change the quality of care or the way it’s delivered.

This isn’t meant to be an attack. I genuinely don’t get your point.

 

[Tenk]

OP. To answer your question, if we go to a completely government run healthcare system the only people who won’t be screwed are those taking cash only: ie cosmetics/plastics.

Do whatever specialty you want, they will all be semi-equally screwed.

 

[Goro]

A civil discussion, please...or it's off to the SPF with the lot of you.

And just to clarify, the SPF is the closest thing SDN has to a cesspool, so heed the wise Gyngyn!

 

[sargon2123]

OP. To answer your question, if we go to a completely government run healthcare system the only people who won’t be screwed are those taking cash only: ie cosmetics/plastics.

Do whatever specialty you want, they will all be semi-equally screwed.

Does anyone know if there are other specialties that can feasibly be cash only?

 

[ndafife]

Does anyone know if there are other specialties that can feasibly be cash only?

REI

 

[Ho0v-man]

Does anyone know if there are other specialties that can feasibly be cash only?

Psych, DPC

 

[Goro]

Does anyone know if there are other specialties that can feasibly be cash only?

OMM

 

[BunnyMan17]

For what it's worth I'm in mil med until Uncle Sam's lease on my soul ends and most of our docs double or triple their salary after they retire and go private. GS does a little better than active duty but still not to private sector levels.
Personally I wonder how feasible single payer system would be for us given the overall health of your average american. Mil med budgets are always super tight and we have an incredibly healthy patient population, even with the retirees. Y'all feel free to correct me on that thought. This does force us to be cost conscious with our drugs and judicious with referrals.

 

[libertyyne]

For what it's worth I'm in mil med until Uncle Sam's lease on my soul ends and most of our docs double or triple their salary after they retire and go private. GS does a little better than active duty but still not to private sector levels.
Personally I wonder how feasible single payer system would be for us given the overall health of your average american. Mil med budgets are always super tight and we have an incredibly healthy patient population, even with the retirees. Y'all feel free to correct me on that thought. This does force us to be cost conscious with our drugs and judicious with referrals.

Patient populations are different, but when you compare the us to other oecd countries our costs are twice as much yet our disease burden is not twice as much just using obesity as a good measure. Plus other countries smoke more , yet have lower healthcare expenditures. The cost of American healthcare is an outlier and we don't necessarily have better outcomes .

 

[NickNaylor]

The reality is that it's next to impossible to predict what's going to happen in the near-term - at least with any degree of certainty such that you can make decisions on those possibilities now. I think the reality is that at some point in the future the US is going to transition to a largely government-run healthcare system. When that happens and what that looks like is very unclear. Is that going to happen in the next 10 years or 50? Are we going to transition to a full NHS-like system or something like the Nordic countries or Germany? Who knows.

Barring The Man getting very involved in telling you what you want to do, there will likely be opportunities to work outside of that system if that's what you want to do. I'm sure there will be opportunities to make money if you want to go that route. Obviously thinking about specialties that aren't heavily dependent on third-party payers may make that easier, but even then a good entrepreneuer may find opportunities in other fields as well.

The whims of politics are way too hazy to inform decisions like specialty selection. The fool-proof process will be to choose what you enjoy, find interesting, and can see yourself doing for a career. If you do that, you will likely be able to squeeze out some amount of satisfaction no matter the conditions in which you end up practicing.

 

[BunnyMan17]

The cost of American healthcare is an outlier and we don't necessarily have better outcomes .

I agree. My point being mil med is the closest thing we have to a comprehensive government run, single payer system and right now their efficiency isn't up to snuff should they want take on the general populace. I.e. they're struggling on the tricycle, why would they be able to be able to not wreck the dirt bike?
The military isn't the most efficient of places but it's night and day between us and the government (enter the VA). Current DHA changes are moving in that direction and I think the outcomes over the ~15 years will be telling.

 

[libertyyne]

I agree. My point being mil med is the closest thing we have to a comprehensive government run, single payer system and right now their efficiency isn't up to snuff should they want take on the general populace. I.e. they're struggling on the tricycle, why would they be able to be able to not wreck the dirt bike?
The military isn't the most efficient of places but it's night and day between us and the government (enter the VA). Current DHA changes are moving in that direction and I think the outcomes over the ~15 years will be telling.

I think there are efficiencies to be gained by bargaining for meds and cutting out middlemen, etc. I don't think American exceptionalism applies to healthcare and other industrialized nation's have been able to accomplish universal coverage and access with better outcomes for less cost per capital.

 

[BunnyMan17]

I think there are efficiencies to be gained by bargaining for meds and cutting out middlemen, etc. I don't think American exceptionalism applies to healthcare and other industrialized nation's have been able to accomplish universal coverage and access with better outcomes for less cost per capital.

I think we're missing each other at the pass. American exceptionalism doesn't really have anything to do with it and I recognize other industrialized nations are able to achieve better outcomes with less cost. Mil med is already bargaining for meds, cutting out middlemen, staffing its own physicians, etc. If America wants a single payer system it's going to have increase its efficiency quite a bit over its current model. Up their game so to speak. Which I think would require a lot more legislators to be on the same page than there are at the moment.

 

[libertyyne]

I think we're missing each other at the pass. American exceptionalism doesn't really have anything to do with it and I recognize other industrialized nations are able to achieve better outcomes with less cost. Mil med is already bargaining for meds, cutting out middlemen, staffing its own physicians, etc. If America wants a single payer system it's going to have increase its efficiency quite a bit over its current model. Up their game so to speak. Which I think would require a lot more legislators to be on the same page than there are at the moment.

I was pre-empting any argument of why America is different with the "exceptionalism" reference.

The problem is there are still middlemen in milmed: Verification of benefits, % disability, not all services are available so you have to contract out, EMRs that dont talk to each other or if a veteran gets benefits elsewhere. Also milmed's budget is problematic because of the way the government assigns money to milmed and how you essentially cut your own budget for the next year if you come in under budget. There are also problems with visn autonomy for making changes quickly.

I dont think milmed is a good petri dish in terms of outcomes or setup or efficiency for universal coverage.

There are also difficult conversations that need to be had in terms of end of life care, and services that do not provide improved outcomes as a culture and the standards of care these things create. which in turn spills over into milmed.

The current estimates IIRC are ~33% of total spending is wasted in adminstrative, pre-auth etc. and roughly the same in overutilzation of services, repeats of tests, and procedures or tests that do not necessarily improve outcomes. Even putting a dent in those by half would bring us inline with the rest of the industrialized world.

 

[VA Hopeful Dr]

I honestly think you're over-reacting with medicare for all. Like other posters have stated, it saves money in the long run, cuts down on unnecessary paperwork. Not one single politician is advocating to cut physician salaries. Try different news sources every now and again.

If we went to Medicare universal coverage right now at current Medicare rates, 95% of physicians would have to take a pay cut. I'm FP, Medicare reimburses about 70% of what private insurance does in my area.

 

[VA Hopeful Dr]

I was pre-empting any argument of why America is different with the "exceptionalism" reference.

The problem is there are still middlemen in milmed: Verification of benefits, % disability, not all services are available so you have to contract out, EMRs that dont talk to each other or if a veteran gets benefits elsewhere. Also milmed's budget is problematic because of the way the government assigns money to milmed and how you essentially cut your own budget for the next year if you come in under budget. There are also problems with visn autonomy for making changes quickly.

I dont think milmed is a good petri dish in terms of outcomes or setup or efficiency for universal coverage.

There are also difficult conversations that need to be had in terms of end of life care, and services that do not provide improved outcomes as a culture and the standards of care these things create. which in turn spills over into milmed.

The current estimates IIRC are ~33% of total spending is wasted in adminstrative, pre-auth etc. and roughly the same in overutilzation of services, repeats of tests, and procedures or tests that do not necessarily improve outcomes. Even putting a dent in those by half would bring us inline with the rest of the industrialized world.

America is different because we're much much fatter than everyone else (with all the associated comorbidities).

We're also a bunch of independent jerks who don't like being told what to do (like taking your medicine or stop eating doughnuts for breakfast every day).

 

[libertyyne]

America is different because we're much much fatter than everyone else (with all the associated comorbidities).

We're also a bunch of independent jerks who don't like being told what to do (like taking your medicine or stop eating doughnuts for breakfast every day).

Yes we are fatter , but we still spend more money even if you adjust for difference . There are other countries that smoke a lot more than us yet manage to maintain their per capital spending at average levels. Agree with the we don't like being told what to do tho.

 

[Thesimplelifeofamyloid]

If we went to Medicare universal coverage right now at current Medicare rates, 95% of physicians would have to take a pay cut. I'm FP, Medicare reimburses about 70% of what private insurance does in my area.

There's some talks to raise that if that were the case.

 

[VA Hopeful Dr]

There's some talks to raise that if that were the case.

A) It absolutely is the case

B) I'm sure there are. Won't actually happen though.

 

[VA Hopeful Dr]

Yes we are fatter , but we still spend more money even if you adjust for difference . There are other countries that smoke a lot more than us yet manage to maintain their per capital spending at average levels. Agree with the we don't like being told what to do tho.

I'm unaware of anything that looks at all of the co-morbidities associated with that (DM, HTN, and so on) and deals with cost from that perspective.

Yes they do smoke more, but their smoking-related disease rate isn't all that different from ours if memory serves.

 

[nimbus]

If we went to Medicare universal coverage right now at current Medicare rates, 95% of physicians would have to take a pay cut. I'm FP, Medicare reimburses about 70% of what private insurance does in my area.

For anesthesia Medicare pays <30% of most commercial payors.