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Read the rules in the OP before posting, please.In order to ensure that this thread continues to meet TL standards and follows the proper guidelines, we will be enforcing the rules in the OP more strictly. Be sure to give them a re-read to refresh your memory! The vast majority of you are contributing in a healthy way, keep it up! NOTE: When providing a source, explain why you feel it is relevant and what purpose it adds to the discussion if it's not obvious. Also take note that unsubstantiated tweets/posts meant only to rekindle old arguments can result in a mod action. |
On April 18 2016 10:04 puerk wrote:
you don't understand dog whistle? the literal translation is: white people are fine, but black and brown people drag down the us with their inferior culture
I find this ironic considering your counties problem with immigration recently. Dog whistle racism is a rather tame alternative to outright race baiting or provoking racial tensions like some politicians do in the country.
But regardless dog whistle racism is racism but without coming out and actualy saying racist things. building projects and section 8 houseing only causes more crime vs the Mexicans coming over the border are all rapists and drug dealers.
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On April 18 2016 12:05 IgnE wrote:Show nested quote +On April 18 2016 11:05 ticklishmusic wrote:On April 18 2016 10:48 Ghostcom wrote:On April 18 2016 10:06 ticklishmusic wrote:On April 18 2016 09:04 Ghostcom wrote:On April 18 2016 08:51 ticklishmusic wrote: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: 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."
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. 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. 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. 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. 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. 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. 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. 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. Yeah I'm pretty sure the demand for "legal consultant MDs" is inelastic.
It might actually go down under single payer b/c suing ppl might be harder. There are a lot of non practice jobs that MD's can take-- it's a degree that is actually pretty flexible, so if you reduce the benefits of being a practicing physician significantly some MD's will probably look at other career options.
It's kind of hard to discuss single payer in the US because it's such a vaguely defined proposal tbh
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Republican presidential hopeful Donald Trump again warned the GOP that if it doesn’t treat him fairly, it would face consequences at the nominating convention later this summer.
On Saturday, the real estate mogul called on party leaders to reform the way convention delegates are selected or face a “rough July” in Cleveland.
“The Republican National Committee, they’d better get going, because I’ll tell you what: You’re going to have a rough July at that convention,” Trump said during a campaign event in Syracuse, New York. “You’d better get going, and you’d better straighten out the system, because the people want their vote. The people want their vote, and they want to be represented properly.”
Trump has accused the RNC of setting up a “rigged” process after his rival Sen. Ted Cruz (R-Texas) swept delegates in Louisiana, Colorado and most recently Wyoming this weekend. In many cases, however, Trump’s campaign was simply out-organized by Cruz’s superior grassroots team, which has made the effort to show up to local and state party meetings where activists pick the actual delegates.
RNC Chairman Reince Priebus dismissed Trump’s comments as “hyperbole” in an interview on CNN’s “State of the Union,” further stating he should take his complaints to the state parties.
Source
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That's an interesting use of the term "grassroots."
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Here’s how big a favor the media is presently doing Mrs. Clinton — who, again, leads Senator Sanders by just 194 delegates:
False Delegate Counts, By Media Institution
(from most inaccurate delegate count to least inaccurate count)
CBS: 695 *
Politico: 672 *
NBC: 664 *
ABC: 244
Fox News: 244
RealClearPolitics: 244
CNN: 229
New York Times: 220
FiveThirtyEight: 206
* Network falsely includes super-delegates in delegate count, against the express demand of the Democratic National Committee.
So, as New York residents prepare to head to the polls on Tuesday, with many of them — particularly Sanders supporters — wondering how much of a difference their vote can really make, the answer is: a very, very great deal.
For as we’ve already seen over the past two weeks, delegate leads can evaporate far faster than the even the media intelligentsia can track. The actual delegate count is 1,299 to 1,105 today, but who knows what it’ll be by mid-week, if Sanders supporters ignore the mainstream media’s computational disabilities and turn out to vote?
Source
I saw this happen at my LD. Hillary almost lost another delegate too but enough Bernie people were late after looking for parking that they weren't counted for our delegate allocation. In what I'm sure is a totally unrelated occurrence none of the Bernie supporters reported receiving the information on time/location of the caucus from the party. Everyone there was informed either by the campaign or local Bernie groups. The state party didn't release delegate info to the district until just before the caucus when it would be practically impossible to contact them with the information.
I know in WA she could easily end up losing several delegates by the time we get to the national convention. Her delegates just aren't showing up.
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On April 18 2016 10:48 Ghostcom wrote:Show nested quote +On April 18 2016 10:06 ticklishmusic wrote:On April 18 2016 09:04 Ghostcom wrote:On April 18 2016 08:51 ticklishmusic wrote: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: 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."
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. 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. 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. 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. 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. 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. 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
Here's some Canadian stats for you:
http://www.theglobeandmail.com/life/health-and-fitness/health/how-much-are-canadian-doctors-paid/article7750697/
CAD $127,100 after taxes, USD $96,000 (as of today's conversion rate).
In Canada its a bit of a meme to get an IT/CS/Medical degree and then promptly go to the US to work.
http://www.lop.parl.gc.ca/content/lop/ResearchPublications/tips/tip5-e.htm
This is a bit old, but still true. The good news for us is, Canada is relatively easy to immigrate to if you have a degree.
My question would be, where exactly would American doctors go if they were to leave their country? They'll still be paid less in the EU and Canada in comparison to their old wages. Korea is famously pumping out more doctors than it knows what to do with, so I doubt the Americans would go there to compete. What other part of the world that is famous for its medicine would take them?
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Doesn't Japan face a shortage of doctors as well? I am not sure it is easy to migrate there even with that profession as background though. Needing to learn the language and writing system would probably limit things quite a bit. Google says the average national salary for Japanese doctors is ~$111105.
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On April 18 2016 10:06 ticklishmusic wrote:Show nested quote +On April 18 2016 09:04 Ghostcom wrote:On April 18 2016 08:51 ticklishmusic wrote: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: 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."
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. 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. 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. 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. Show nested quote +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. 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.
Comparing salaries between countries is a poor comparison because physicians in other developed countries have so many things paid for them by taxes (e.g. their family's healthcare). It's like trying to compare the salary of military personnel to civilians; its absolutely ridiculous.
Physicians don't actually need to take a pay cut if the healthcare system were to change because that money could come out of the ridiculous administrative costs (where basically all of it goes in the first place). Of course, that won't actually happen, but it could.
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.
The debt burden is actually quite high and that program is only for physicians that work at public hospitals and only if your debt is owed to the public.
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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.
Of course you can't just employ 200.000 doctors tomorrow. But to say "these people don't exist, so you can't hire more than we have" is just incredibly dishonest. Give out an incentive. Starting with subsidized loans (less debt after finishing study etc), or/and make it easier for foreign MDs to settle in the US.
It's just such a dumb argument, "well we can't get it right 100% on day one, so lets stick with some shitty compromise or even better, lets scrap it altogether". Waiting times won't go up either. Why would they? You still have the same amount of MDs, they don't just magically disappear. If what you're saying is that they would have more work then, because people who formerly couldn't afford it would go.. Well. That shows you how urgent the whole situation is in the first place.
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On April 18 2016 13:42 GreenHorizons wrote:Show nested quote +Here’s how big a favor the media is presently doing Mrs. Clinton — who, again, leads Senator Sanders by just 194 delegates:
False Delegate Counts, By Media Institution
(from most inaccurate delegate count to least inaccurate count)
CBS: 695 *
Politico: 672 *
NBC: 664 *
ABC: 244
Fox News: 244
RealClearPolitics: 244
CNN: 229
New York Times: 220
FiveThirtyEight: 206
* Network falsely includes super-delegates in delegate count, against the express demand of the Democratic National Committee.
So, as New York residents prepare to head to the polls on Tuesday, with many of them — particularly Sanders supporters — wondering how much of a difference their vote can really make, the answer is: a very, very great deal.
For as we’ve already seen over the past two weeks, delegate leads can evaporate far faster than the even the media intelligentsia can track. The actual delegate count is 1,299 to 1,105 today, but who knows what it’ll be by mid-week, if Sanders supporters ignore the mainstream media’s computational disabilities and turn out to vote?
SourceI saw this happen at my LD. Hillary almost lost another delegate too but enough Bernie people were late after looking for parking that they weren't counted for our delegate allocation. In what I'm sure is a totally unrelated occurrence none of the Bernie supporters reported receiving the information on time/location of the caucus from the party. Everyone there was informed either by the campaign or local Bernie groups. The state party didn't release delegate info to the district until just before the caucus when it would be practically impossible to contact them with the information. I know in WA she could easily end up losing several delegates by the time we get to the national convention. Her delegates just aren't showing up.
As I am outstanding, I am not too deep into this topic, but in the German media, most of the time there are numbers like 1100 for Bernie, 1700 for Hillary. With the note, that over 500 of the 700 "super-delegates" (non voted delegates, "honorable party members") will vote for Hillary. Here it is stated as a fact, that this gonna happen and these super-delegates will vote for her.
On April 18 2016 21:26 m4ini wrote:Show nested quote +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.
Of course you can't just employ 200.000 doctors tomorrow. But to say "these people don't exist, so you can't hire more than we have" is just incredibly dishonest. Give out an incentive. Starting with subsidized loans (less debt after finishing study etc), to make it easier for foreign MDs to settle in the US. It's just such a dumb argument, "well we can't get it right 100% on day one, so lets stick with some shitty compromise or even better, lets scrap it altogether". Waiting times won't go up either. Why would they? You still have the same amount of MDs, they don't just magically disappear. If what you're saying is that they would have more work then, because people who formerly couldn't afford it would go.. Well. That shows you how urgent the whole situation is in the first place.
Education is free in Germany, you could hire doctors from here. But we have problems with doctors of our own, as we have enough, but not enough outside of the cities. In the end, I see it standing and falling with the payment you have to do in the U.S. for education.
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Cayman Islands24199 Posts
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Education is free in Germany, you could hire doctors from here. But we have problems with doctors of our own, as we have enough, but not enough outside of the cities. In the end, I see it standing and falling with the payment you have to do in the U.S. for education.
Well you have to pay back Bafög (basically 50% subsidizing and 50% an interest-less loan from the state for people who otherwise wouldn't be able to afford to study, to pay for living costs. So if you get, lets say, 11.000 euros through bafoeg, you need to pay 5500 back, with the option to drop iirc 15-25% off of it, if you finish fast/with top grades).
The reason why there's not enough outside cities is simply because many people don't really like to live in a small village (i was born near Cologne/Essen, moved to a 3000 souls village in south wales in the UK - and i have trouble adjusting).
I agree with your conclusion though.
The average German visits the doc 10 times a year, US 4 times
Just to explain this: the 10 times a year include people with chronic treatments. People with organ transplants, cancer treatment etc (40% of visits are due to chronical conditions) - stuff that many people in the US can't/couldn't afford. So it's rather misleading. I couldn't find a statistic on "first contacts" (Erstkontakt) though.
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I think the shortage of physicians will become a major problem globally sooner or later. The current generation (so called millennials) will be the first to average between 90 - 100! years life expactancy, which is insane.
So a major overhaul of the system (educational and healthcare as a whole) is the only way out of this mess.
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On April 18 2016 21:42 thePunGun wrote:
I think the shortage of physicians will become a major problem globally sooner or later. The current generation (so called millennials) will be the first to average between 90 - 100! years life expactancy, which is insane.
So a major overhaul of the system (educational and healthcare as a whole) is the only way out of this mess.
The first way out of this mess is to have people learn how to automedicate to some extent.
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Cayman Islands24199 Posts
hello? the md shortage is due to cartel behavior
and on a related matter, obama signaling that market concentration is something his and the next administration would look at. i've been sayin this for a while
https://promarket.org/the-white-house-acknowledges-the-u-s-has-a-concentration-problem-president-obama-launches-new-pro-competition-initiative/
Another troubling trend is that the gap between the most successful firms and the median firm has grew tremendously over the last two decades. The table below, showing the returns on invested capital for public non-financial firms, demonstrates the effect of concentration: firms at the 90th percentile are seeing returns on investments that are “more than five times the median.” Twenty five years ago that figure was closer to two.
the above si really a key driver for m&a activity and while it does promote efficiency theoretically to have the more effective firms win out, it may lead to higher concentration. there's also a lot of high tech industries having very high returns and these guys tend to have either natural or legal monopolies
obama's nominee garland is really good on this issue, casting into doubt the value of a far leftist on the court as opposed to an intellectual advocate for a nuanced position that may persuade other members of the court.
http://www.antitrustupdateblog.com/blog/merrick-garland-efficiencies/#.VvHUcvokBTQ.twitter
edit: here's krugman on the situation
http://www.nytimes.com/2016/04/18/opinion/robber-baron-recessions.html
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You guys keep changing the argument. Single payer is literally making the government pay for healthcare. I point out that it has problems X, Y and Z, you guys point out X, Y and Z can be fixed by A, B and C which are all viable solutions but all fall outside the scope of single payer. That just goes to show how convoluted our health system is and how much change would be necessary to make single payer work in the US.
I think in the future it's possible to get more people in medicine, but even if we started today we likely wouldn't see the impact for like 10 years at a minimum.
Comparing salaries between countries is a poor comparison because physicians in other developed countries have so many things paid for them by taxes (e.g. their family's healthcare). It's like trying to compare the salary of military personnel to civilians; its absolutely ridiculous.
Physicians don't actually need to take a pay cut if the healthcare system were to change because that money could come out of the ridiculous administrative costs (where basically all of it goes in the first place). Of course, that won't actually happen, but it could.
Medical loss ratios mandate insurers spend 85% of premiums on care. Admin fees come out of the rest, and whatever is left is profit. CMS admin fees per patient are about the same as private insurers; studies have shown costs to actually be higher so that's hardly going to be a source of savings. Again, you could posit that a Medicare for all service would be better run, but that's no guarantee. People want to boogeyman the big bad insurers, but truth is they have some of the shittiest profit margins in the health industry. True cost reduction is going to impact organizations who deliver care, so the health systems, the physicians and the medical device manufacturers and suppliers.
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The US and China are leading a push to bring the Paris climate accord into force much faster than even the most optimistic projections – aided by a typographical glitch in the text of the agreement.
More than 150 governments, including 40 heads of state, are expected at a symbolic signing ceremony for the agreement at the United Nations on 22 April, which is Earth Day.
It’s the largest one-day signing of any international agreement, according to the UN.
But leaders will really be looking to see which countries go beyond mere ceremony and legally join the agreement, which would bind them to the promises made in Paris last December to keep warming below the agreed target of 2C.
So far, the US, China, Canada and a host of other countries have promised to join this year - boosting the hopes of bringing the Paris deal into force before the initial target date of 2020 – possibly as early as 2016 or 2017, according to officials and analysts.
That is well before the timeline originally envisaged at Paris. Environment ministers attending the World Bank spring meetings this week said the faster pace indicated serious commitment to dealing with the global challenge.
The accelerated timeline would have one obvious advantage for Barack Obama. The standard withdrawal clause on any such agreement would force a future Republican president to wait four years before quitting Paris, according to legal experts.
An earlier start date could also turbo-charge the agreement, providing momentum for deeper emissions cuts.
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You guys keep changing the argument. Single payer is literally making the government pay for healthcare. I point out that it has problems X, Y and Z, you guys point out X, Y and Z can be fixed by A, B and C which are all viable solutions but all fall outside the scope of single payer. That just goes to show how convoluted our health system is and how much change would be necessary to make single payer work in the US.
So better stick with status quo?
Oh, as a sidenote: solutions A, B and C, while "out of scope of single payer", are all better solutions for the existing systems too. Especially in regards to education.
The only two things we agree on is that your health (and education) system is "convoluted", and that change won't happen overnight. But no "solution" would do that. It always literally boils down to either "takes too long to implement" or "too much hassle".
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Only 6 percent of people say they have a great deal of confidence in the press, about the same level of trust Americans have in Congress, according to a new survey released on Sunday.
The study mirrors past reports that found the public’s trust in mass media has reached historic lows, according to data gathered by the Media Insight Project, a partnership between The Associated Press-NORC Center for Public Affairs Research and the American Press Institute. The report found faith in the press was just slightly higher than the 4 percent of people who said they trusted Congress.
Alongside the dire findings, the report found respondents valued accuracy above all else, with 85 percent of people saying it was extremely important to avoid errors in coverage. Timeliness and clarity followed closely, with 76 percent and 72 percent respectively saying those attributes were imperative among media sources.
“Over the last two decades, research shows the public has grown increasingly skeptical of the news industry,” the report reads. “The study reaffirms that consumers do value broad concepts of trust like fairness, balance, accuracy, and completeness. At least two-thirds of Americans cite each of these four general principles as very important to them.”
Ironically, despite news organizations’ ongoing battle to master social media platforms, that trust doesn’t extend to the likes of Facebook and Twitter. The report found just 12 percent of people trust media delivered via Mark Zuckerberg’s evolving juggernaut, even though 87 percent of people get news from Facebook.
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Predictions for today's immigration ruling? I think it's gonna go 4-4.
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EPT
