US Politics Mega-thread - Page 3627

On April 18 2016 06:39 m4ini wrote:


Never said "but europe can do it". What i did say is that "medical capacity" isn't an issue. At all. Not enough docs? Employ more. That's literally the smallest issue to solve.

Every single time i hear an american bitching about universal healthcare, i don't see them pointing out differences, but simply an extreme misconception of how it works in other countries.

Now don't take it personally, if you enjoy going bankrupt because you lost the lottery of health - or think it's fine that others do, i don't care. If you think that the health of people should be "a business" rather than an obligation to the country, fine too (and it's clearly fine for americans, see privatization of jails, or schools exploiting the living shit out of sportlers).

But please, have the balls to say it how it is, and don't make up reasons which are literally solved by getting more educated people. I'm not saying the european system would work in the US, it wouldn't. "Not enough doctors" has zero to do with it. Like, nothing.

On April 18 2016 07:30 cLutZ wrote:
Also, if you do 1:1 comparisons of Swedes in America, Germans, etc the QOL and healthcare outcomes are comparable or in America's favor.

As Milton Friedman once said, "That’s interesting, because in America, among Scandinavians, we have no poverty, either."

On April 18 2016 06:56 ticklishmusic wrote:


the US has approximately 900k physicians so thats a 1:300 ratio or so

the AMA is projecting that as boomer MD's retire we will have an estimated shortage of 50k primary care physicians by 2020 or so based on the current volume of care. we graduate about 18k MD's every year, and i'm not sure how many are retiring or going part time.

the US medical system sucks. you spend 4 years in undergrad, then you apply, less than 50% of people get in-- getting into med school here is such a pain in the ass that the average first year applies something like 3 times and is 26 years old. then you go to school for another 4 years, have a minimum of 2 years of residency. if you decide to specialize, it might easily be 10 years of graduate + postgrad education. in addition, each year of school is gonna cost something like 50k+, ad scholarship for med school is incredibly rare and while undergrad is going to be a bit better the average freshly minted MD is looking at half a mill in debt for a decade of education

now lets say we go universal. this is gonna have several impacts on physicians. first is lowered pay. second is that the new systems ans rules are gonna be a pain in the ass-- i know many physicians already hate the new HITECH rules and every time the ICD codes are refreshed a lot of physicians grumble. some already retire or cut hours b/c of these. under a new system many of them are gonna say fuck that and just quit. others are gonna find some other job b/c a MD can make a shitload in positions that dont require practice. so effectively you put a dent in the existing physician population. students thinking of medicine are gonna be turned off by the fact their salaries are gonna be cut by like 30-40% as well so basically RIP the physician pipeline

tossing out a couple more fun facts: the US has a much unhealthier population and is much more spread out so rural care is already pretty shitty. i havent even touched on the logistics of what happens to the insurance co's. or other potential effects.

so yeah the euro to US comparison sucks and hopefully i wont have to post on why that is again

On April 18 2016 07:33 Ghostcom wrote:
1) Why would the pay for a physician be lowered? A lot of the extra costs by having multiple payers is due to administration, not physician pay. There was an excellent article in TIME a couple of years ago about this exact issue.

2) I sincerely doubt physicians retire because ICD-codes are updated - and it's kind of a null-point, because that is going to happen regardless of whether or not you go universal healthcare or not.

3) Most MDs didn't become MDs to make money. If money was everything MDs would either not work in a practice/hospital but for the industry, or they would have taken another education. That is not to say that money doesn't matter - we all like to be compensated for long/shitty hours.

4) 10+ years of medical education is the norm for a specialist, regardless of country. What you are highlighting is that it is not only the US healthcare system that has issues, but also the US educational system.

EDIT:


Out of curiosity would you mind linking some data for this? I do think you are correct, I could just use this for a presentation I'm working on I think the explanation is extraneous to the healthcare system though.

EDIT2: The lack of doctors is going to be an issue in all healthcare systems due to retirement and the increasing age of the population. It's really not an argument against universal healthcare.

EDIT3; Don't get me wrong, I don't consider a universal healthcare system to be feasible in the current US political and social environment.

On April 18 2016 08:46 Falling wrote:
But doesn't the doctor shortage exist regardless of whether there is public healthcare or not? The only difference is the poor people aren't even bothering to try and use the system unless they are dying. The shortage still exists, but the system isn't being stress tested because people have given up (or never tried in the first place). All public healthcare does with doctor shortage is highlight the already existing people because people are actually trying and stress testing the system. The doctors were always needed, but the old system cuts the poor out before they even try.

On April 18 2016 08:51 ticklishmusic wrote:


1. Insurers already have a medical loss ratio, so they have to spend 85%+ of premiums on care. The efficiencies that can be realized here are relatively small. Single payer's big cost savings would come from negotiating down price on basically every procedure. Less money in means less money for physicians.

2. Oh they do. All the new tech and paperwork and crap physicians have to do is a massive pain. Many small physicians with their own practices or that are part of small groups hate the admin work. They have to hire people to do it, or they have to do it themselves and it takes away from their time to practice. Either that or they go home and have to do it. HITECH and the electronic reqs were a particularly big hit-- had to pay for a bunch of crap software, etc.

3. I'm not saying MD's become MD's just to make money. However, financial incentive is gonna be part of it-- taking that argument to the opposite extreme, MD's aren't going to work for $1 y'know? Then let's say Joe MD makes 200K, he lives a lifestyle that matches his income-- million dollar house, a couple vacations a year, kids in private school, etc. He needs to keep that pay up, so if the gov. tells him he has to take a big paycut he says fuck it and goes to become a medical expert for some big law firm or something.

4. The debt burden is the problem and the physician pipeline in the US is awful due to that and a bunch of other reasons. The med ed system needs massive reform before we can even think of touching the healthcare system here, and it's an illustration of how inextricably convoluted and tangled the delivery of healthcare is to everything else. We can't simply slap down a model that works in a very different context like single payer or whatever.

Pennsylvania on Sunday became the 24th US state to legalize a comprehensive medical marijuana program.

The Democratic governor, Tom Wolf, signed the bill into law in the afternoon, surrounded by a jubilant crowd of supporters at the Capitol building in Harrisburg.

“Marijuana is medicine and it’s coming to Pennsylvania,” said Democratic state senator Daylin Leach, the bill’s cosponsor.

The bill’s drafters say it could take two years to write regulations and get retailers opened, but a provision allows parents to legally administer medical marijuana to their children before the bill takes effect in a month.

The bill sets standards for tracking plants, certifying physicians and licensing growers, dispensaries and physicians. Patients can take marijuana in pill, oil, vapor, ointment or liquid form, but will not be able to legally obtain marijuana to smoke or grow.

Senator Mike Vereb, a Republican, called on lawmakers to take on what he called “the No 1 killer in Pennsylvania” – opioid abuse.

On April 18 2016 07:30 cLutZ wrote:
Also, if you do 1:1 comparisons of Swedes in America, Germans, etc the QOL and healthcare outcomes are comparable or in America's favor.

As Milton Friedman once said, "That’s interesting, because in America, among Scandinavians, we have no poverty, either."



No, the "not enough doctors" complaint is very real. You could not simply hire more, because those people don't exist, instead you would have to hire people not currently considered doctors to do what doctors do.

On April 18 2016 09:04 Ghostcom wrote:


1. Physician pay is marginal when looking at a US hospital bill - yes less money in also means less money out, but when hospitals don't have to make a profit you don't need as much money in (and don't get me started on the "non-profit" hospitals - if ever there was something that was wrongfully labelled there you have it).

2. Physicians retiring due to ICD-code upgrades is going to happen regardless. ICD-codes update every decade more or less - regardless of healthcare system. It's a non-argument when discussing the viability of universal healthcare. Similarly, HITECH was going to happen regardless as well - if anything, making a universal healthcare system with a single payer would reduce the amount of administration considerably (I worked in a San Francisco hospital for a year and never figured out the entire process of billing people - the current system is insane).

3. I agree you are not going to be able to pay MDs 1 USD, but then again, that isn't needed either. In fact, I remain unconvinced that a major paycut is necessary.

4. I agree entirely.

On April 18 2016 09:39 Livelovedie wrote:
I can't really imagine the debt burden being that big of a deal for physician's. Under programs like the Public Service Loan Forgiveness program doctors at hospitals on an income based repayment plan only have to repay 10% of their income for 10 years to have their debt forgiven. Debt is a much bigger problem for people who are getting a master's in public health (like me for epidemiology) with an expected earnings of 65k a year or social workers making an average of 44k a year.

On April 18 2016 10:06 ticklishmusic wrote:
3. A major paycut will happen. See 2. Compare what physicians in other nations make and what US ones make. IIRC in the UK, a GP makes like 120K. In the US, it's 160K.

On April 18 2016 10:06 ticklishmusic wrote:


Not to be mean, but usually the ones who do that are shit physicians who couldn't find a job (and jobs are hella plentiful, so you have to be a special kind of bad to not get one). There are obviously some interested in doing it b/c they're civic minded, but from a financial angle a decent physician would probably just get a job at a hospital and just make money there.

On April 18 2016 10:06 ticklishmusic wrote:


1. Physician pay will go down. It is impossible for healthcare costs to be reduced and somehow have physicians come out unaffected. Single payer does not include nationalizing the actual providers of care, only the payor. If you're saying to nationalize hospitals a la NHS in Britain, then sure, but then the problem is you're dealing with the HCA's and Community Health Systems of the world. These are public companies collectively worth hundreds of billions of dollars and figuring out how to deal with them in this fashion is a whole 'nother can of worms. Complete integration under the federal umbrella has much more of an impact but also requires a lot more to change, not that single payor isn't enough already. Also consider the impact on the health insurance companies.

2. Doctors are retiring. The average physician career has been inching downwards due to multiple reasons. Yes ICD codes change; the point is that every time the government shakes up healthcare it pushes physicians out. This may not be a huge amount, but its a dangerous acceleration of the trend. Would admin be reduced? Possibly in the end. However, it would be another painful transition for physicians and who knows how ugly a federal billings unit would be. Physicians hate dealing with the CMS as it is, and it's hard to see why this would change.

3. A major paycut will happen. See 2. Compare what physicians in other nations make and what US ones make. IIRC in the UK, a GP makes like 120K. In the US, it's 160K.



Not to be mean, but usually the ones who do that are shit physicians who couldn't find a job (and jobs are hella plentiful, so you have to be a special kind of bad to not get one). There are obviously some interested in doing it b/c they're civic minded, but from a financial angle a decent physician would probably just get a job at a hospital and just make money there.

On April 18 2016 10:48 Ghostcom wrote:


1. I remain unconvinced. I realize neither of us have presented a better argument than "yes it will" "no it won't" - but I can't seem to find the TIME article again

2. Doctors are retiring because they, just like the rest of the population, are getting old. Doctors are retiring because it is an incredibly tough and taxing job (try and imagine being surrounded by death, misery, and pain every day of your life - and then add the incredibly shitty hours on top). That the ICD codes (i.e. what numbers you put on your diagnosis which is mostly done by the secretary anyway) changes is not going to be the straw that breaks the camels back. That your money come from another source (again, usually handled by the secretary) isn't going to break your back either.

3. UK physicians and US physicians don't require the same level of insurance. I could double my pay (if not triple) by going to the US. However, the insurance would set me back at least 75% of that. And then I would also have to get a health-insurance for myself and pay for my future kids daycare and school - and that's just mentioning the biggest posts.

On April 18 2016 11:05 ticklishmusic wrote:


1. A quick google turns up results that show a small (10-20%) to larger (30-50%) decrease in physician pay, so while an impact on the lower end would probably be a grit-teeth-and-bear-it type scenario, one on the higher end is gonna suck.

2. Physicians in small/ private practice bear a lot of the burden of coding and charting. In a hospital or health system setting you have entire departments to take care of it. Sure people are retiring b/c they're old/burnt out-- adding additional admin and regulatory burden is going to push people out faster and that's something we can't risk given how shitty our physician supply is.

3. That's because in the UK the physicians are employed by the government except for smaller private practice. Again, that's a fully nationalized healthcare system, not single payer. The US is also a much more litigious society.

I'm not 100% sure of the procedure to get board certified in the US for foreign doctors, but IIRC it can be quite difficult and you need a hospital to sponsor you, etc.

On April 18 2016 11:35 Slaughter wrote:
If Bernie got all he wanted then MDs wouldn't have any debt. I think newer docs would take a pay cut to be debt free.

Its true though that there needs to be a lot of reform before any real attempt at what bernie proposes should come to pass.I think Bernie at least understands this, which is why he is trying to start a "revolution" so that major reforms and overalls can take place. The problem is how sustainable/big is his movement (not nearly enough). You would have to overall higher and lower ed, healthcare and its many associated industries, and a horde of over things because what he wants is a country that is structured a lot differently then what it needs to be for his stuff to work. Otherwise you just have a couple of pure socialist programs in the midst of a system that isn't designed to support them.