By Laura Turner
SDN Staff Writer
Dr. David Sundwall was confirmed in January 2005 as Executive Director of the Utah State Department of Health. In this capacity he supervises a workforce of almost 1,000 employees and an annual budget of over $2.0 billion. He currently serves as Immediate Past President of the Association of State and Territorial Health Officers (ASTHO), serves on the Executive Committee of ASTHO and is Chair of the ASTHO Government Relations Committee.
Dr. Sundwall has extensive experience in federal government and national health policy, including:
- Administrator, Health Resources and Services Administration (HRSA), Public Health Service, U.S. Department of Health and Human Services (HHS) and Assistant Surgeon General in the Commissioned Corps of the U.S. Public Health Service under Reagan administration (1986-1988).
- Director, Health and Human Resources Staff (Majority), U.S. Senate Labor and Human Resources Committee (1981-1986).
He currently has academic appointments at the Uniformed Services University of the Health Sciences, Bethesda, Maryland; Georgetown University School of Medicine, Washington, DC; and the University of Utah School of Medicine. He is board certified in internal medicine and family practice. He is a volunteer primary care physician in a Utah public health clinic one-half day per week.
Dr. Sundwall recently took time out of his busy schedule to talk to the Student Doctor Network about health care policy.
David Sundwall, MD
What do you think are the greatest issues facing the U.S. healthcare system today?
“Cost” control, i.e. restraining the rate of growth of spending for health-care services. This is not unique to the U.S., but is a global challenge in that our capacity and technology have outstripped our ability to pay for them.
The U.S. is the only industrialized/Western nation without single-payer health care. Why do you think that is?
It is a historical fluke, in some respects, in that the passage of Medicare/Medicaid in 1965 was made possible by compromising to use existing private health insurance to administer the programs, even though paid for by federal (and federal/state ) taxes. The general skepticism of “government” has long been a significant factor in the various health policies we have enacted, and avoided.
What concerns do you have with the single-payer model?
Few, but we all need to acknowledge that if we eventually embrace a “ single payer” system it will likely result in delays, inconvenience, and frustration with coverage policies that will be based on the “public good,” not necessarily the best new technologies.
What impacts would you anticipate to physician income and quality of life if a single payer model were to be implemented?
There will likely be a more fair, i.e. “narrower” distribution of compensation among physicians, regardless of specialty. Primary care physicians would be paid more, sub-specialists less but still more. I do not necessarily think income is closely related to quality of life, but most strive for high incomes and associate this with “success”.
What do you think the best solution is for the U.S.?
Eventually we will have a single payer system, not because it is necessarily “the best” but because it will be more fair, and enable restraint of spending. It will be a difficult but necessary transition in that we are accustomed to getting what we perceive we need and want and when we want it. This is simply too expensive to sustain, so we must acknowledge that “he who pays the piper gets to call the tune,” and to the extent we pay for health care with public funds the “government” could and should determine what services are covered and at what level.
The health reform bills currently under discussion in the House and Senate all require that every U.S. citizen carry health insurance (“individual mandate”) – do you think this is a necessary element of any solution?
Short of a “single payer” system, this is an essential component of health reform. If it is not an entitlement, it should be required.
Proponents of nationalized health care often cite information that U.S. health care lags other industrialized countries, including the U.S. being 42nd in life expectancy and 41st in infant mortality. How do you respond to such criticisms?
When you compare health status of Americans with health insurance coverage with other countries we compare favorably (better than most aggregate data from other countries). This is pretty good evidence that having health insurance coverage is important to improve health. However, there are other important factors that are not necessarily related to coverage, e.g. economic status, race, access, etc.
What are the incentives a for-profit health care model to focus on preventative medicine and keeping people healthy versus having them consume as much care and incur as much cost as possible?
Not many – though there is little hard evidence that “preventive” health services pay off over time. We still don’t have consensus on what constitute best practices for preventive care and what will improve health status and reduce costs over time.
Critics claim that pharmaceutical and medical device companies make egregious profits. Do you agree or disagree, and what reforms, if any, would you like to see in this area?
In a free market economy, I believe there should be opportunities for medical device and drug companies to compete and charge what the market will bear. However, there may be justification for imposing regulatory restraints when “public” health insurance programs (financed with tax dollars) are purchasing such.
What solution would you propose address the criticism that overseas businesses have an advantage on costs because they don’t have to provide private health care?
I haven’t proposed a “solution,” but I believe our country’s ability to reduce health care expenditures will improve our ability to compete, whether it is accomplished by private or public-based health reforms.
What will be the impacts on physician income and quality of life of the proposed reforms?
See the answer I gave to the fourth question. “Quality of life” and income are not necessarily related. Physicians motivated primarily by income will be disappointed and possibly seek other ways to make a living. Those of us who value the rewards of patient care, service, and life-long learning of new biomedical science will still find being a doctor very rewarding.
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Good article, percy.
I’m in total agreement with Dr. Sundwall about healthcare’s biggest problem being the cost, and unfortunately as it stands, the proposed healthcare reform itself is simply too expensive. We’ve got some of the best medical schools, best hospitals, and best physicians in the world, but politics tend to often detract from a doctor’s single greatest concern – the well being of his or her patient. Until more emphasis is placed on controlling the overall cost of healthcare, I feel quality will come second.
“There will likely be a more fair, i.e. “narrower” distribution of compensation among physicians, regardless of specialty.”
How is it more fair for a neurosurgeon to be paid the same or slightly more than a primary care physician? The length of training, works hours, personal sacrifices and job stress of a neurosurgeon far exceed that of a PCP, thus they should be compensated more.
This article is poorly written grammatically-speaking. I couldn’t understand all of the questions asked. And, while most of us understand what the single-payer model is, the term needs to be defined. This article was written hastily and it shows.
Regarding primary care, we have heard over and over that there will be a terrifying shortage of these physicians in the near future. They at least need more compensation than they are getting currently.
Is health care a right? I don’t think so… Why do people think people think neurosurgeons “deserve” more pay? Neurosurgeons, FM docs, EM docs, Ortho, don’t “deserve” anything for the training. They “deserve” only what the market is willing to pay them, who cares if they are a PGY 1000 with 500 on both USMLES and in the top 0.1% of the nation. They deserve the market price. Looks like Obama’s about to nip the market right out of health care. Just a smattering of things to think about.
“Those of us who value the rewards of patient care, service, and life-long learning of new biomedical science will still find being a doctor very rewarding.”
This is what I hate! older physicians making younger or future physicians feel guilty! these guy shave NO clue what current physicians and future physicians are going through in terms of medical school (for some even residency) loans. For them to say this stuff makes me want to puke. These guys, who them selves made decent money with very little indebtedness, always throw this type of BS on our faces. I have a question for everybody here who is for a single payer system…if we go to socialized medicine will you pay my 150k+ loan?? think about these kinds of things before you start blaming every free minded person of being greedy. The truth is almost 99% of doctors and soon to be doctors want to treat and care for patients(they also want to learn and every thing else Dr.Sundwall mentioned). This is our ultimate goal, but why should we be punished for having such lofty goals? I’m not begging for some one to pay my loans off…all I am saying is that I should have my right to pay them off promptly if I want to. Unfortunately, with the kind of talk in this article, I feel really scared that maybe (god forbid) I wont be able to pay my loans off with ease.
P.S. I may sound a little angry, but really I’m just worried. Any words to soothe my worries from proponents of a “single-payer system” will be much respected and appreciated.
“sub-specialists less but still more.”
What does that even mean???? A single payer system will ruin this country. I think their still needs to be some oversight, but complete government take over will kill people.
Gotta love the balance of Student Doctor. Always looking at all sides and never only promoting a liberal approach to health care reform.
For anyone who interested in a free market solution to health care, check out Atul Gawande’s article in the New Yorker about accountable care organizations. It was so good Obama made it requried reading in the white house (although it didn’t change his opinions much).
Interesting,
Neurosurgeons don’t “deserve” more pay. It’s not their right to be paid more. I don’t agree with taking some of their pay, spreading the wealth, to give it to PCPs though.
Let’s face it, many students simply will not choose a more rigorous training path if they know they can make about the same with much less training. Just the other day a neurosurgeon was telling me that they don’t have as many applicants applying because of lifestyle considerations with our generation- not because they do not like neurosurgery. Clearly altruism is only part of the decision making process. Take away the money and we might be screwed one day if we need a neurosurgeon. I think this logic can be applied to other specialities. The above poster “Interesting” says that no one deserves anything- while that may be true, there needs to be incentive beyond altruism to ensure an adequate supply of highly skilled surgeons, specialists, etc.
Well, if physician’s pay will go down to the point where they can’t pay their student loan debt, I think they will have to make medical school more affordable or change the way doctors are educated so it’s not so long. How else will they attract people to become doctors? Yes, there are other professions that don’t pay well and yet people still go into it (social work comes to mind) but becoming a physician is long and hard. Something has to give.
Milton Friedman has got the rebuttal over here: http://www.hoover.org/publications/digest/3459466.html
Two simple observations are key to explaining both the high level of spending on medical care and the dissatisfaction with that spending. The first is that most payments to physicians or hospitals or other caregivers for medical care are made not by the patient but by a third party—an insurance company or employer or governmental body. The second is that nobody spends somebody else’s money as wisely or as frugally as he spends his own. These statements apply equally to other OECD countries. They do not by themselves explain why the United States spends so much more than other countries.
No third party is involved when we shop at a supermarket. We pay the supermarket clerk directly: the same for gasoline for our car, clothes for our back, and so on down the line. Why, by contrast, are most medical payments made by third parties?…
Enactment of Medicare and Medicaid provided a direct subsidy for medical care. The cost grew much more rapidly than originally estimated—as the cost of any handout invariably does. Legislation cannot repeal the nonlegislated law of demand and supply: the lower the price, the greater the quantity demanded; at a zero price, the quantity demanded becomes infinite. Some method of rationing must be substituted for price, which invariably means administrative rationing…
A cure requires reversing course, reprivatizing medical care by eliminating most third-party payment, and restoring the role of insurance to providing protection against major medical catastrophes.
The ideal way to do that would be to reverse past actions: repeal the tax exemption of employer-provided medical care; terminate Medicare and Medicaid; deregulate most insurance; and restrict the role of the government, preferably state and local rather than federal, to financing care for the hard cases. However, the vested interests that have grown up around the existing system, and the tyranny of the status quo, clearly make that solution not feasible politically. Yet it is worth stating the ideal as a guide to judging whether proposed incremental changes are in the right direction….
Medical savings accounts offer one way to resolve the growing financial and administrative problems of Medicare and Medicaid. It seems clear from private experience that a program along these lines would be less expensive and bureaucratic than the current system and more satisfactory to the participants…A more radical reform would, first, end both Medicare and Medicaid, at least for new entrants, and replace them by providing every family in the United States with catastrophic insurance (i.e., a major medical policy with a high deductible). Second, it would end tax exemption of employer-provided medical care. And, third, it would remove the restrictive regulations that are now imposed on medical insurance—hard to justify with universal catastrophic insurance.
Medical students amaze me with their incompetence and hypocrisy.
Has anyone among you run a business with 300 million customers? Please tell me your name and location. I would like to see you.
Do you really think that government is able to run a business with so many consumers? If yes, show me where and when our government accumulated that experience!!!!!
When was the last time you went to a Veteran Affairs Hospital? Did you enjoy that experience? BTW, these hospitals were built by our government and for our veterans!
Do you understand that selling Healthcare is not the same as selling Coca-Cola? It is a service CUSTOMIZED to each patient.
Ms. Turner emphasized credentials of Dr. Sundwall by pointing to the fact that he is running 1000 employees on an annual budget of $2 billion.
Would he by any chance volunteer to run our healthcare system with a “projected” trillion dollar budget and a SHORTAGE OF PHYSICIANS IN ALL SPECIALTIES!!!!!!!!!!!!!!
I think not. That is why he decided to live in Utah
The costs of Healthcare have been spiraling out of control for only 1 reason: supply vs. demand. The demand is there, it is stable, it is 300 million people worth. But the supply??????? You think it is possible to service such a large population with 750,000 physicians???? Of course the prices are high, b/c it is the only way to lower the demand for regular, routine care.
Double the number of physicians and the prices will be halved.
Triple the number of physicians and the prices will go down by 2/3.
The ONLY reason why all countries are experiencing budget deficits for Healthcare is b/c all countries LIMIT the number of people accepted to medical schools. The supply is kept down and obviously there is no pressure for physicians to lower their fees. If there was more competition in the medical sector, the costs would be affordable to everyone.
But then again, physicians’ income takes precedence to people’s access to healthcare.
Also, are we going to institute price controls on lawyer fees? Legal services are next to a necessity in the capitalist society. I would like to have a more regular, affordable access to a lawyer. Will Dr. Sundwall ask his Washington cronies to cap the lawyer fees so that legal services do not continue to spiral out of control???????
I don’t see where Dr Sundwall is recommending anything. He is just stating where things will eventually lead, like it or not. Seems like this guy is pretty conservative, works in Utah and worked for Reagan administration.
I don’t think bagging on the VA is an effective argument. The VA is monolithic, but they are ahead of the game for evidence based medicine and have been using electronic medical records since the 90s. Its about outcomes, not how pretty the facility looks.
I agree, medical malpractice needs to be capped to prevent over ordering of defensive testing that isn’t based on evidence.
Tony:
I was not talking only about medical malpractice fees. Stop fixating only on your own professional liability costs.
I am talking en-masse. MOST people would like to have an affordable access to a lawyer for civil litigation, for probate filings, for contract counsel. You name it.
Why doesn’t Washington force lawyers to lower their fees across all law sub-specialties? It REALLY is a necessity in US to have a regular access to a lawyer. This whole country works only through contracts. Why are ALL people in US not allowed affordable legal protection?
Or JUSTICE is not a right in US?
In Minnesota, where every major health insurer now offers high-deductible plans, nearly half a million enrollees, or 10 percent are now covered by such insurance.
That’s created an explosion in demand for price information – which used to be treated like industry secrets. Now, law requires clinics and hospitals to give an estimate whenever a patient asks for it.
Last year, overall medical spending in Minnesota grew at just 6 percent, the smallest increase in a decade, according to the Department of Health. At companies that switched to HSA-type plans, the slowdown was even more dramatic, with some reporting actual drops in medical spending.
For Jeff Palumbo of Grant, Minn., the epiphany came this year when he took his son in for ringworm. Palumbo had just switched to his employer’s high-deductible plan. Despite multiple phone calls to his clinic and his insurer to ask the price of a doctor visit, he kept getting the same maddening answer: It depends. Finally, someone told him it would cost at least $85. When Palumbo ended up getting billed $125 for the visit – “For seven minutes!” – he called to complain.
Next time, he said, he’ll go to a MinuteClinic. (It charges $59 for ringworm.) Despite the frustrations, Palumbo likes his control over spending. “It makes you ask more questions,” he said.
Increase supply of physicians and costs WILL go down!!!!!!!!
If there are not enough smart students to qualify for entrance to US medical schools, then import them from abroad.
The sad part of all this is that US education system both secondary and post-secondary has dumbed down the entire population.
In reality, we DO NOT have enough smart applicants to med schools.
We really don’t! Just like we don’t have enough qualified science Ph.D. applicants
MCAT average is 31-32 right now and that is pretty low. The exam is not difficult, but the sad part is that most applicants find it challenging.
The most disturbing aspect of US system is its poor education system. For that we have to blame our Marxist/Liberal tenured professors.
Also, regarding the so-called Allied Health Model. Before you allow a nurse or a physician assistant make medical judgments about your care, first take the time to visit NP or PA lectures. The instruction is dumbed down to the level of a typical high school curriculum. Nurses do have a powerful lobby in US, but their knowledge base is really inadequate to service a patient.
Instead of fractioning medical care to nurses, technicians and assistants, increase the number of physicians in the system so that a patient can have COMPLETE access to care from 1 person instead of getting a vertigo from exposure to 1000 under-trained substitutes.
Increase the supply of physicians to meet the demand by 300 million!
Um, OK.
MediaCurves.com just conducted a study exploring how effective two ads were in changing people’s opinions of the new health care plan. Results showed a decreased level of support for the current U.S. health care plan across all political parties after watching anti health care reform ad. More in-depth results can be seen at http://www.mediacurves.com/HealthCare/J7470-HealthCare/Index.cfm. Thanks.
Ben
I cant believe some people would vote for this… this would mean sacrificing the quality of medical care and the technology. What would happen to those that have the money to afford better health care than that proposed by the government? what would happen to the people that have cancer and need better technology and specialists to survive? I think that the actual shortage of physicians in our country is big enough for the government to risk loosing those who are aspiring to become physicians.
Here is what is going to happen:
1. US converts to the single-payer system.
2. 300 million people will have to stand in long lines to get low-quality care from tired and over-burdened 750,000 physicians.
3. Canadians will look at their feet and will go:
“Look at ALL those CUSTOMERS! Let’s convert our healthcare system to a private one so that we could service all those disgruntled Americans.”
4. Canada exits recession
But seriously, watch this 20-minute documentary about Canadian single-payer healthcare system. 2 guys went out with a HIDDEN CAMERA in order to record how service was delivered in Canadian hospitals and clinics. This is not your SICKO with biased editing. This is real-life, streaming video.
You witness the entire process of getting triaged, the waits, the evaluation by a NURSE, inability to even sign up for a doctor, etc.
Watch this documentary and then tell me if you are willing to have this system in US.
http://radioviceonline.com/canada-health-care-documentary-better-than-michael-moores/
Also, read this journal article from American Journal of Physicians and Surgeons about how Canadian healthcare system really works.
http://www.jpands.org/vol14no2/kurisko.pdf
Also, do ANY of you understand that all those ill Canadians who cannot get immediate treatment have to quit their jobs because they are not in health to continue working.
They have to quit and go on welfare. Honest, hard-working people have to abandon their career tracks and incomes in order to wait for YEARS before they get relief. In US, they would have gotten their care immediately.
There is only one problem with US healthcare: NOT ENOUGH PHYSICIANS. Everything else is fine and can get much better. RELEASE MORE PHYSICIANS INTO THE SYSTEM and COSTS WILL GO DOWN! Relax the licensure!
BTW, the REASON why administrative costs for Medicare are so low is b/c Medicare REJECTS MOST CLAIMS. They just trash them.
Efficiency through a trash basket.
http://tinyurl.com/lq6fna
Its easy for the people on capitol hill to propose these changes when they are getting the best healthcare that money can buy.
Ironic isnt it?
Few things infuriate me more than people (old doctors and crackhead mothers alike) who think that being a doctor is only about “helping people.” Yes, there’s that component, but there are a lot of careers where you can help people. I’d certainly hope that a neurosurgeon would be better compensated for his hard work, intelligence, and sacrifice than a babysitter, even if both of them are full of warm, fuzzy feelings at the end of the day.
Quote from Atlas Shrugged:
“Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the priviledge of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything–except the desires of the doctors. Men considered only the “welfare” of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only “to serve.”…I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind–yet what is it that they expect to depend on, when they lie on an operating table under my hands?”
I am in complete agreement with this statement and the way healthcare reform is being approached. For those who have not read this book, I highly recommend it. It philosophically demolishes the argument others make for any, and I mean “any”, form of socialism, whatsoever.
As far as I’m concerned, less government involvement with healthcare and tighter competition will bring down costs much more rapidly than the burdensome, overregulating, bureaucratic lawyers in congress (who certainly love suing the pants off doctors) creating laws that only create greater inefficiencies in the system in the name of “good intentions.”
haha I think you hit that point right on the money Emily!
Yes Emily! US is all about creating martyrs out of its citizens.
Bend over and be grateful.
MAKE MORE DOCTORS NOT MORE REGULATIONS!!!
DWIGHT! YES! THANK YOU FOR QUOTING AYN RAND!
RON PAUL FOR PRESIDENT!
AUDIT THE FEDERAL RESERVE!
DOWN WITH THE BUREAUCRATS!
WATCH THIS DOCUMENTARY http://tinyurl.com/lq6fna
READ THIS ARTICLE http://www.jpands.org/vol14no2/kurisko.pdf
DOWN WITH OBAMACARE!
OBAMA WAS SO UNCONCERNED ABOUT HIS FAMILY’S INCOME THAT HIS WIFE CONTINUED TO WORK IN A CORPORATE LAW FIRM IN ORDER TO BRING HOME 200k A YEAR.
BUT THEN HE GIVES SPEECHES TO COLLEGE GRADUATES ABOUT DOING PUBLIC SECTOR WORK! TELL THIS TO YOUR WIFE, YOU HYPOCRITE! TELL HER TO WORK FOR PENNIES ON A DOLLAR!
IF YOU OBAMA ARE SO CONCERNED ABOUT HEALTH OF AMERICANS, WHY ARE OUR TROOPS STILL IN IRAQ HAVING THEIR BRAINS AND LEGS BLOWN OFF?
TRY BUSH FOR TREASON AND IMPEACH OBAMA. WE NEED A NEW PRESIDENT.
I totally do not agree with this doctor responce at all!!! Why should medical doctors be sacrificed in this process??? on average a medical doctors go through over 12 years of studying and training without any compensation! why should doctors which are the weakest individual in this system be sacrificed? This is totally not fair. No one said quality of life means financial stability but compensation needs to be fair according amount of training and hardwork! If a surgeon will go over 16 years of training then its just fair to say the least he/she needs to be financially satisfied or the quality of medical practice will go down very poorly!
If you don’t like where its headed, organize and even unionize. Doctors are a very selfish and competitive bunch and current docs often don’t belong to professional associations. If docs worked together, they could actually do something about this. Instead they work to protect their individual turf and subsequently are easily played by government and insurance companies.
I think the responses to this article demonstrate one of the main reasons why health care in this country sucks – self-important, greedy doctors. I doubt this crowd will respond to evidence, but see the AMA’s website for research showing the minor influence of debt on specialty choice. Most of you would also benefit by reading the actual article and the actual proposed health care reform legislation instead of trotting out your paranoid, ideologically-driven delusions about the loss of quality (relative to what?) and bureaucratic nightmare government intervention will bring (because private health insurance companies are so benevolent and well-run). Dr. Sundwall never said neurosurgeons would make the same as primary care doctors, he said the range of salaries between specialists and generalists would narrow. And anyone who quotes Ayn Rand, well, for anything, especially health care-related topics should have their sanity checked. If all you want is a great salary and a lot of prestige go work on Wall Street. Oh yeah, they almost tanked the entire world economy. OK then find some other profession where you can afford a pottery barn-furnished McMansion on the green, a beamer, and a membership to some swanky country club where you, surrounded by your equally vacuous and one-dimensional peers, can gloat about all the letters behind your name.
SUNNY:
Did you read my comments? I am pretty sure you didn’t.
What part of “Reduce Costs by Training More Doctors” did you not understand?
Check your vision, because it is AFU.
With such inability to pay attention to details, you should be expelled from medical school.
Please tell me the name of your institution so that I could talk to your Dean about your stupidity.
Please tell me, how do you expect to service 300 million people with 750,000 doctors????? Please give me your answer, I am waiting!
MA is a state with the highest per capita population of physicians and a single-payer system. Pick up a phone RIGHT NOW and try to schedule an appointment in Boston for a physical exam. You will be lucky to see a 1ST YEAR RESIDENT AFTER 3-6 MONTHS. THAT’S EMPIRICAL EVIDENCE FOR YOU.
SERIOUSLY, take out the Yellow Pages and dial medical practices around MA to schedule an appointment. Instead of sitting of front of NY Times and New Yorker websites, imagining how single-payer system is going to give people FAST, HIGH-QUALITY ACCESS to care.
REGARDING MAYO CLINIC AND ITS WONDERFUL COST-SAVING STRATEGIES: check the details!
1. They don’t let ambulances go to their ER because of its cost-inefficiency and thus “outsource” poor patients to other hospitals. Other hospitals lose money and Mayo clinic stays on budget. Did Atul Gawanade mention this to you in his article? Oh yes, you would have to spend more than a day at a hospital to really see how its operations work.
2. MAYO is a world-renowned medical institution. They have SAUDIS buy MEDICAL FLOORS to get access to care. Frequent cash payments FROM foreigners are subsidizing the hospital’s budget. There is only a handful of world-class medical centers in US. What rich foreigner is going to subsidize regular US clinics? Please give me their names and phone numbers. I am waiting.
CHECK OUT THE COMMENTS AT THE BOTTOM OF THIS SLATE ARTICLE TO SEE HOW MAYO CLINIC IS ABLE TO STAY ON BUDGET; SCROLL DOWN TO READ THE LAST COMMENT
http://www.slate.com/id/2223474/
ALSO, people who work hard and have talent deserve to live well! That is why people come to the United States, to have their work honestly rewarded by the market.
If you have a problem with a capitalist society, then move to Cuba. THEY subsidize their “FREE” healthcare by allowing foreigners to operate hotels on their beaches. Now that the world is in a recession and few are willing to travel, we’ll see how much longer that utopian system will last.
FROM SLATE MAGAZINE:
http://www.slate.com/id/2223474/
I am a physician and I went to medical school in Ohio and did some of my training in Cleveland. In the late 90’s and early part of 2000, there was quite a bit of bad publicity for the Cleveland Clinic as its ER was closed about twice as often than surrounding hospitals (University Hospitals affiliated with Case University, and Metro Health Medical Center, the county hospital). Anyone who knows anything about the financing of medical care knows that the ER is a money loser. The reason for the closings was that the hospital was full. Now the ER doesn’t close in the sense that nobody can go there, but the ambulances will get diverted to another hospital. Also the Cleveland Clinic gets not-for profit status for revenue purposes (no property taxes) but only about 2% of its operating revenue is for charity care. Factor in that while I was there, and I’m sure it still happens now, some sultans from the middle east, and people from all over the world come and not only pay cash for services (at God only knows what rate) and in some cases pay for entire floors of the hospital for their entourage (yes this occurred while I was there), one can see on the surface how the Cleveland Clinic is so “efficient.” It should be noted that all major teaching hospitals (The Cleveland Clinic has its own satellite medical school) have salaried physicians who do not get paid fee for service, but not all of them have the global wealthy come to pay their bills or close the ER so frequently to make them appear so “efficient.”
– Canexican
DOWN WITH OBAMACARE!
OBAMA WAS SO UNCONCERNED ABOUT HIS FAMILY’S INCOME THAT HIS WIFE CONTINUED TO WORK IN A CORPORATE LAW FIRM IN ORDER TO BRING HOME 200k A YEAR.
BUT THEN HE GIVES SPEECHES TO COLLEGE GRADUATES ABOUT DOING PUBLIC SECTOR WORK! TELL THIS TO YOUR WIFE, YOU HYPOCRITE! TELL HER TO WORK FOR PENNIES ON A DOLLAR!
IF YOU OBAMA ARE SO CONCERNED ABOUT HEALTH OF AMERICANS, WHY ARE OUR TROOPS STILL IN IRAQ HAVING THEIR BRAINS AND LEGS BLOWN OFF?
TRY BUSH FOR TREASON AND IMPEACH OBAMA. WE NEED A NEW PRESIDENT.
I wanted to point out that Universal Healthcare does NOT necessarily imply single-payer. There are many Western/industrialized nations that do NOT have single-payer systems but DO have UHC. Germany is one example. Switzerland is another.
In response to Suzie, there is much more to the cost of healthcare besides physician salaries.
This is OBAMACARE for you:
MA is a state with the highest per capita population of physicians and a MANDATORY insurance system. Pick up a phone RIGHT NOW and try to schedule an appointment in Boston for a physical exam. You will be lucky to see a 1ST YEAR RESIDENT AFTER 3-6 MONTHS. THAT’S EMPIRICAL EVIDENCE FOR YOU.
SERIOUSLY, take out the Yellow Pages and dial medical practices around MA to schedule an appointment. Instead of sitting of front of NY Times and New Yorker websites, imagining how single-payer system is going to give people FAST, HIGH-QUALITY ACCESS to care.
RATIONING OF CARE STARTS WITH RATIONING OF PHYSICIAN SLOTS!
ALLOW MORE PEOPLE TO MED SCHOOLS, IMPORT FOREIGN DOCS, DO SOMETHING!
GET MORE DOCTORS INTO THE SYSTEM.
WHY DOES A DERM EXAM COST $150????????????
WHO IS NUTS ENOUGH TO PAY THIS PRICE TAG????????
DOUBLE THE NUMBER OF PHYSICIANS AND PRICES WILL BE CUT BY HALF! DOUBLE THE NUMBER OF PHYSICIANS AND TWICE AS MANY PEOPLE WILL BE ABLE TO SEE THE DOCTORS AT ANY MOMENT.
UNIVERSAL COVERAGE MUST MEAN UNIVERSAL COVERAGE. THERE SHOULD BE ENOUGH DOCTORS FOR ALL PATIENTS. WHAT GOOD IS A PIECE OF PAPER THAT SAYS YOU ARE INSURED IF THERE IS NO PHYSICIAN AVAILABLE TO SERVICE YOU.
THINK!!!!!!!!!!
EVERYBODY!
WATCH THIS DOCUMENTARY http://tinyurl.com/lq6fna
AND
READ THIS ARTICLE http://www.jpands.org/vol14no2/kurisko.pdf
Dr. Sundwall is a bureaucrat!!!!!!!!!!!!!!
Check out his biography on wikipedia!!!!!!!!!!!
While I understand people’s concern with the proposed health care plan (I’m a future doctor myself), I think a lot of people are overreacting. The truth is that something needs to be done about health care costs; they are not sustainable. Yes, this means will mean sacrifices, but we will still be able to pay off our loans, and we will still be compensated well, and everything will be okay. If it turns out to be a single-payer system, then there will be less overhead and less paperwork, and people will pay less for health insurance. Those are all positives. I realize that the reform will probably hurt health care because people won’t always be able to get what they want when they want it, and the shortage of doctors will become even more of a problem. The reform is by no means perfect, but its not going to be as devastating as some are making it out to be.
CHRIS:
THIS IS NOT ABOUT YOU!!!!!! THIS IS NOT ABOUT YOU!!!! YOU SELFISH PRICK!!!!
PEOPLE CANNOT FIND DOCTORS TO SERVICE THEM!!!!!!!! DO YOU UNDERSTAND THIS??????
DO YOU KNOW THAT 1/3 OF US CITIZENS IS ABOUT TO RETIRE!!!!!!!!!
MOST OF THEM HAVE NO MONEY; THEY LOST EVERYTHING IN THE STOCK MARKET!!!!!!!
WHO WILL SERVICE THESE 100 MILLION POOR PEOPLE??????????
DO YOU HAVE ENOUGH PHYSICIANS UNDER YOUR SKIRT TO SERVICE THE DEMAND?????
HONESTLY, I WOULD REALLY LIKE TO KNOW YOUR MEDICAL SCHOOLS? I WOULD DELICENSE YOU ALL IN A SECOND FOR YOUR STUPIDITY.
IF YOU CANNOT DO SIMPLE ALGEBRA, YOU SHOULD NOT BE IN MEDICAL SCHOOL.
One big problem arises from the 1974 ERISA law, which grants tax benefits to employers for providing health care, while not allowing similar incentives for individuals. This results in the illogical coupling between employment and health insurance. As such, government removed the market incentive for health insurance companies to cater to the actual health-care consumer. As a greater amount of government and corporate money has been used to pay medical bills, costs have risen artificially out of the range of most individuals.
Full 1,000-page text of proposed US Healthcare Bill.
Link to Congress: http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.3200:
Read all 1,000 pages of regulations, instead of “summaries” by Dr. Sundwall. You are about to live them.
Link to Obama’s Healthcare Plan
http://www.govtrack.us/congress/billtext.xpd?bill=h111-3200
It is VERY VERY BIG FILE!!!!!!!!!!!!!!! 1,000 pages.
better start reading up, or if you break these regulations, the government will have your license!
FROM THE BILL:
PG 272 SEC. 1145- TREATMENT OF CERTAIN CANCER HOSPITALS – Cancer patients – welcome to rationing!
Page 280 Sec 1151- The Govt will penalize hospitals for what Govt deems “preventable re-admissions.”
Pg 298 Lines 9-11- Doctors, treat a patient during initial admission that results in a readmission? Govt will penalize you.
Pg 317 L 13-20- OMG!! PROHIBITION on ownership/investment. Govt tells Drs. what/how much they can own.
Pg 317-318 lines 21-25,1-3: PROHIBITION on expansion- Govt is mandating hospitals cannot expand.
pg 321 2-13: Hospitals have opportunity to apply for exception BUT community input required. Can you say ACORN?!!
Pg335 Lines 16-25, Pg 336-339 – Govt mandates establishment of outcome based measures. HC the way they want. Rationing.
Pg 341 Lines 3-9: Govt has authority to disqualify Medicare Adv Plans, HMOs, etc. Forcing people into Govt plan
Pg 354 Sec 1177 – Govt will RESTRICT enrollment of Special needs people! WTF.
Future colleagues, if you re-admit someone to a hospital, the government will decide if re-admission should be compensated. Since the ultimate goal is to control costs, it is to the advantage of the government to refuse as many re-admissions as possible.
Basically, just as Medicare/Medicaid processes the claims by trashing them, so it will be done again.
From the bill:
(1) IN GENERAL- With respect to payment for discharges from an applicable hospital (as defined in paragraph (5)(C)) occurring during a fiscal year beginning on or after October 1, 2011, in order to account for excess readmissions in the hospital, the Secretary shall reduce the payments that would otherwise be made to such hospital under subsection (d) (or section 1814(b)(3), as the case may be) for such a discharge by an amount equal to the product of–
`(A) the base operating DRG payment amount (as defined in paragraph (2)) for the discharge; and
`(B) the adjustment factor (described in paragraph (3)(A)) for the hospital for the fiscal year.
Imaging services are to be cut by 1/2
from the bill:
SEC. 1147. PAYMENT FOR IMAGING SERVICES.
ADJUSTMENT IN TECHNICAL COMPONENT DISCOUNT ON SINGLE-SESSION IMAGING INVOLVING CONSECUTIVE BODY PARTS- The Secretary shall INCREASE THE REDUCTION in expenditures attributable to the multiple procedure payment reduction applicable to the technical component for imaging under the final rule published by the Secretary in the Federal Register on November 21, 2005 (part 405 of title 42, Code of Federal Regulations) FROM 25 PERCENT TO 50 PERCENT.’.
SEC. 1147. PAYMENT FOR IMAGING SERVICES.
(a) Adjustment in Practice Expense to Reflect Higher Presumed Utilization- Section 1848 of the Social Security Act (42 U.S.C. 1395w) is amended–
(1) in subsection (b)(4)–
(A) in subparagraph (B), by striking `subparagraph (A)’ and inserting `this paragraph’; and
(B) by adding at the end the following new subparagraph:
`(C) ADJUSTMENT IN PRACTICE EXPENSE TO REFLECT HIGHER PRESUMED UTILIZATION- In computing the number of practice expense relative value units under subsection (c)(2)(C)(ii) with respect to advanced diagnostic imaging services (as defined in section 1834(e)(1)(B)), the Secretary shall adjust such number of units so it reflects a 75 percent (rather than 50 percent) presumed rate of utilization of imaging equipment.’; and
(2) in subsection (c)(2)(B)(v)(II), by inserting `AND OTHER PROVISIONS’ after `OPD PAYMENT CAP’.
(b) Adjustment in Technical Component `discount’ on Single-session Imaging to Consecutive Body Parts- Section 1848(b)(4) of such Act is further amended by adding at the end the following new subparagraph:
`(D) ADJUSTMENT IN TECHNICAL COMPONENT DISCOUNT ON SINGLE-SESSION IMAGING INVOLVING CONSECUTIVE BODY PARTS- The Secretary shall increase the reduction in expenditures attributable to the multiple procedure payment reduction applicable to the technical component for imaging under the final rule published by the Secretary in the Federal Register on November 21, 2005 (part 405 of title 42, Code of Federal Regulations) from 25 percent to 50 percent.’.
(c) Effective Date- Except as otherwise provided, this section, and the amendments made by this section, shall apply to services furnished on or after January 1, 2011.
VOTE AGAINST HR 3200!!!!!!!!!!!!!!!
VOTE AGAINST America’s Affordable Health Choices Act of 2009!!!!!!!!!!
CALL YOU CONGRESSMAN BEFORE IT IS TOO LATE!!!!!!!!
UNIVERSAL COVERAGE ON PAPER IS NOT UNIVERSAL COVERAGE IN REAL LIFE!!!!!
SOVIET UNION LAW SAID THAT EVERYONE DESERVED HOUSING, BUT THERE WERE NOT ENOUGH BUILDINGS!!!!!!!!!!
Suzie – take your meds and step away from the computer.
I can’t Tony, meds are too expensive
Can’t afford them on a student budget.
Claude Castonguay: Father of Canadian Healthcare System claims that it is ruined
http://tinyurl.com/koso5g
http://canadafreepress.com/index.php/article/12397
One such man is Claude Castonguay of Canada, a man that championed national healthcare for his country when that nation first began to explore the concept. It was full speed ahead as far as Castonguay was concerned. He too thought it an emergency.
In fact, he became known ever after as the “father of Quebec medicare” for his efforts. The Canadian government agreed with him and the plan was entered into with back slaps and hearty congratulations all around.
Yet, four decades later, it was Castonguay that declared that the Canadian healthcare system was in “crisis.” Things weren’t as rosy as he first thought they might be.
“We thought we could resolve the system’s problems by rationing services or injecting massive amounts of new money into it,” says Castonguay. But now he prescribes a radical overhaul: “We are proposing to give a greater role to the private sector so that people can exercise freedom of choice.”
Castonguay advocates contracting out services to the private sector, going so far as suggesting that public hospitals rent space during off-hours to entrepreneurial doctors. He supports co-pays for patients who want to see physicians. Castonguay, the man who championed public health insurance in Canada, now urges for the legalization of private health insurance.
Why is this? Didn’t the Canadians find the perfect solution, the “fair” one for all citizens? If you think bureaucratized, government systems are the way to go, ask yourself if this woman is “worth” saving?
Sick with ovarian cancer, Sylvia de Vires, an Ontario woman afflicted with a 13-inch, fluid-filled tumor weighing 40 pounds, was unable to get timely care in Canada. She crossed the American border to Pontiac, Mich., where a surgeon removed the tumor, estimating she could not have lived longer than a few weeks more.
The Canadian government pays for U.S. medical care in some circumstances, but it declined to do so in de Vires’ case for a bureaucratically perfect, but inhumane, reason: She hadn’t properly filled out a form. At death’s door, de Vires should have done her paperwork better.
Or ask yourself if government has the capacity to address problems when they inevitably occur?
The Ministry of Health declared that British patients should get ER care within four hours. The result? At some hospitals, seriously ill patients are kept in ambulances for hours so as not to run afoul of the regulation; at other hospitals, patients are admitted to inappropriate wards.
CHART OF US HEALTHCARE
http://urbangrounds.com/2009/07/23/house-health-plan-hr-3200/
Suzie… Seriously if your so adamant about your views… DO SOMETHING ABOUT IT! What good would ranting on a SDN forum on a subjective article do???
Oh and by the way, you want to know what medical school I go to.. NYU
Let me know if you want to meet me personally so I can do some nice algebra problems for you.
Suzie, what do you think you are accomplishing by this ranting? I agree with Tony, take a walk or something… you’re not convincing anyone because you sound so irrational. We’re all passionate about something but not everyone will agree with you and they have that right. Move on. Let people who have open minds actually debate the topic rather than continuing to personally attack those who disagree.
Oh and I love Suzie’s remark about the MCAT entrance exam’s and how low they were… tsk tsk Suzie.. well how did you score and where did you end up… if its anything short of Ivy League I would say your arguments hold no validity. Honestly, I feel your a huge hypocrite that finds pleasure out of making others feel bad.
Just my two cents…and probably everyone else’s as well.
“I think the responses to this article demonstrate one of the main reasons why health care in this country sucks – self-important, greedy doctors.”
Here we go again with the accusations. How am I greedy really? Read my first comment for this article. I am not sure if you are a proponent for the president’s health reforms or not but these clauses will have a significant effect on the plan I came up with before I decided to choose medicine as my career. You may somehow not be taking a huge medical school loan, but I happen to be one of those who are. Therefore, one of my top concerns (along with patient care, and having a satisfying career of learning) is the repayment of these loans.
Yea, and what school do you attend Suzie? You conveniently left that out of your last post.
And I second worried.. financial concerns about the career you are going into are very justified. The fact is medical school and residencies do not teach you how to run a business nor how to make money in order to pay off your debt and live a comfortable life. In fact, they frown upon the subject, relating such topics to students who go into the field for the “wrong reasons”.
The reality is once you finish residency and all your schooling, you have to pay off your student loans, open up a practice and pay the rent, pay your employees, pay your malpractice insurance, etc – being a physician is business just like anything else, so financial questions concerning the field should NOT be coupled with “Greedy Doctors”.
Mike
Nah I got accepted to BU I didn’t go.. to many people like you there. Come down to the city and see if you can handle the real world.
I haven’t posted on here before but wanted to address this post by Suzie:
“Double the number of physicians and the prices will be halved.
Triple the number of physicians and the prices will go down by 2/3.
The ONLY reason why all countries are experiencing budget deficits for Healthcare is b/c all countries LIMIT the number of people accepted to medical schools. The supply is kept down and obviously there is no pressure for physicians to lower their fees. If there was more competition in the medical sector, the costs would be affordable to everyone.”
I’m a resident in Canada and I’ve been reading extensively about cost issues in health care recently, and what you are saying here does not make sense logically. Less physicians is clearly not the cause of higher costs in other countries. Most western nations have even worse shortages of physicians than the US, but much LOWER costs. In fact the US gov spends double the amount per person than the next closest country and you STILL needs private insurance anyway, resulting in nearly 4 TIMES the cost per person than the next most costly nation.
The other reason your theory is wrong is just look at the numbers of national systems worldwide. Most modern nations do not pay according to market demand, but according to fixed federal fee schedules. Therefore increase in supply has absolutely zero effect on reducing costs, rather the opposite is true. This is well-known and in fact supply restrictions are precisely how national systems LIMIT cost. Whether you agree or not with that philosophy of care (personally I don’t) is not the point, the fact is that is what they do to limit cost, and it does work.
The only 1st world nation your idea would theoretically work for is the US where the market determines costs, however as I pointed out reality shows it is not working because despite more doctors per person in US than many places, care is massively more expensive. Its possible that increasing the supply in a US private system might reduce costs, but increasing supply in a national system will not.
To clarify: Switching to a national system will initially drop costs because of the nature of such a system, but after the initial equilibrium is reached, adding supply only increases costs.
Suzie please don’t take this to mean I think socialism is best or that our system is better or anything like that, because I do not. There are flaws in EVERY system. I just wanted to point out that your economic theory is based on a false premise and is immediately contradicted by real-world examples. While national care will certainly be interpreted as lower quality by some people, it is better than no care at all which is where you are currently going. In 1980 8% of personal bankruptcies where for healtcare costs, now its over 65%. Continue that system and….well I think you can connect the dots. Obama specifically may not have the best system, but its clear that some kind of national system likely the only way to continue to have some kind of guarantee to care in the future.
To anyone:
To those who want to eliminate money from the specialty choice equation, I think that is foolish to think its not a factor. As nice as it would be if everyone was Jesus, the fact is everyone is not and in the real world what you will get (obviously with some exceptions) is the most driven most skilled people in the highest paying positions. FACT: if you pay surgeons less, you will end up with worse surgeons. To be fair I don’t think the author of the article is wanting to equalize GP and neurosurgeon salaries, I think its more like he wants their salaries to be 5 times more, instead of 10 times more. I’m not a right-winger or anything like that, but I can see what’s plainly in front of me in daily life, which is that if you pay somebody more, you will get a better performer more often than not.
To those who believe tort reform is the answer: A recent study by Health Affairs showed that only 0.5% of insurance expenditures were for tort payouts, with another 0.5% spent defending them. Defensive medical tests/spending cannot be estimated accurately but they suggest 5-9%. This simply does not account for the multi-fold higher costs in the US compared to other industrialized nations.
I hear what you’re saying Suzie but you are essentially just repeating your original point again and again. Its a moot point however, because while what you say about the costs of supply and demand is true, national systems do not work on supply and demand, but they do limit cost. So we know for a FACT that there are several ways to limit costs, and that a national system IS one of them.
Your comparison between medical care and McDonalds is factually untrue, and somewhat odd. Should I draw insight into how you view medical care from this analogy? To the point though, there are more medical clinics in new york than mcdonalds in the entire world. My good colleague, Mcdonalds is cheap because it serves crap, not because of its size.
If you don’t believe the US has enough doctors, than I guess you need to answer the question of how does Canada and Europe, with less doctors/person, give routine care to all its citizens? I can get an appointment with my GP usually the same day, worse case the same week. This systems is not perfect, I can list you a fistful of things I would change without hardly having to think twice. But it does deliver universal effective primary care. Presumably the US could as well.
I have to disagree with the person that says we should double or triple the physician supply to reduce their fees and save money.
It won’t work because there is a point of no return. The supply and demand curve of economics works well but does not account for the human side of things all the time.
If the supply of doctors go up and the prices go down then students that were interested in medicine will find another field that pays better. Where is one proof for this? Simple, when the economy is bad people start to look for better paying jobs or go back to school. Medical school inrolment goes up. It goes up because people want more secure higher paying jobs. So as soon as pay goes down so will the number of doctors.
This has happened in the US. The Primary care salaries went down and now everyone wants to be a specialist.
My solution:
Tax every luxury item and every dollar spent on luxury.
For example:
If the famous host of american idol makes 15 million a year while doctors and supreme court judges make about 1/70th of that we know where the american priority is. They would rather support luxury and entertainment than their own health needs.
So, I say for every dollar spent on luxury and entertainment we should be taxed 5-10%.
what is a luxury item?
We can start with DVD’s, Movies tickets, music downloads, Fatty foods, snack foods etc.
Every penny should go into healhcare.
We would no longer have a problem. We would have an unlimited supply of money for healthcare.
So, go ahead eat at McDonalds or go buy those 150 dollar concert tickets. Just pay the piper.
What a moron. It sounds like this guy is Obama’s mouthpiece…..stating that he worked for the Reagan administration is supposed to give this guy some credibility from the other side of the isle??? Almost everything this guy said is poppycock. Yes, there will still be those who want to pursue medicine as a career, and yes there are other things in life to judge success by other than financial rewards; however, monetary compensation is always a factor in the decision making process when thinking about career. We will lose many of the best and brightest to business/engineering/whatever has more income potential that would otherwise choose medicine if this guy gets his way. Don’t we have a physician shortage already??? What this guy espouses will only exacerbate that problem, which will make it even harder to provide access to those who need it most.
Suzie, just curious, if you feel the US educational system can’t produce students smart enough to get into med school, why are you studying to be a doctor in the US? Wouldn’t you want to go to the country where you received your superior education to gain that stellar 35 MCAT score? After all, there actually are medical school professors who are products of the US educational system, right? How could they possibly teach you to be a smart, competent doctor?! (Sorry, had to go there.)
I apologize if I am repeating someone’s comment. There are too many to read and agree with. The current view that the medical system is in need of an overhaul is absolutely correct. There is a growing cost of providing medical care, and the current system cannot support that cost. The answer may be forcing individuals to carry medical insurance. It may be government insurance with higher taxes. It may be something else. The argument on how to pay for medical care for every American is lacking in two categories.
First, It almost always centers on insurance. That is different than care. Insurance is gambling. It is a game where some people get everything they paid for and it was worth every cent while others get screwed. In medical insurance, people die. People die because the focus is on money. Whatever the system is, the point must be to provide medical care to everyone. This means building a system of strict government oversight to regulate both the insurance system and how care is delivered. It does not mean running it. American capitalism is a powerful force if it has well defined boundaries that protect the individuals. To fix the healthcare system, there needs to be a comprehensive system of oversight; insurance companies will compete within the system which will breed cheaper models to offer to the people while maintaining the highest level of health care in the world. It is no surprise that America is the leader in medical technology. It is a direct outcome of competing private industries. They are strictly regulated, and the insurance system should be handled likewise. Government run healthcare systems…think DMV.
Second, the problem with the healthcare system must be tackled holistically, or it will collapse. The system is in the process of failing, but it is failing as a whole. If we reform one part and not the others, it will simply fail immediately. Take a pick. There is the legal system that encourages lawyers to sue doctors and hospital egregious amounts of money for legitimate mistakes. Take a second to read how John Edwards made his money. The high cost of malpractice insurance is reflected in the high pay doctors receive. I wouldn’t mind making less, if that system was reformed because in the end, I would still take home the same amount. The loan system for medical students could be reformed. Offer the lowest possible interest rate to competing banks and see how low they will buy. Government offers 6% ? There are banks that will take 6.25%. Subsidize the interest as part of the healthcare reform. This allows government intervention to fix a problem while not letting government control the institute Use the capitalist system to offer better deals to up and coming doctors. Here again, I would not mind making less if I knew I wouldn’t be over a quarter of million in debt. This would come full circle and cut the bottom line in the health care system. In fact, there are countless industries that make up the healthcare system that have nothing to do with hospitals directly. They are swimming in the profit gleaned by taking advantage of the high level of government imposed standards inside the hospital. Regulate that. Fix the problem as a whole. And for the love of God do not say people will just have to get used to something being subpar to expectations. The reality of capitalism is that money should be able to buy better healthcare. Do not punish those who have the resources to afford the best and fastest care by taking their money and giving it to the less well off with nothing to show. There is a way to reform the healthcare system so that the quality of life and the average life expectancy will increase, but we as Americans should get used to the fact that people who earn more and work harder will live more comfortably and live longer. This should not be a sore point; it should be a reason to be proud of a system that defends the opportunity to rise to success and reap the rewards of labor.
Suzie,
The entertainment industry will NEVER die out. Sex, Drugs (ETOH), Rock and Roll. It’s what people want.
Can you imagine how much money we would make if we tax every dollar spent on Porn dvd, strip clubs, movies?
That alone would take care of healthcare.
Now add to that things like disney land tickets, concert tickets, taxing bad food choices and now you will have a surplus for life.
People don’t change much. What are they going to do sit at home and look at the wall. People want to be entertained.
Interesting enough so do dogs.
I will. How do I get it to the president?
As a medical student from Utah I am ashamed to have such a man running our state health department. Cost is obviously a huge concern in health care but does this man really believe that putting the fed gov in charge will HELP that? When have they been known to cut costs or run anything efficiently? Everyone acts like we have two choices- socialized medicine or “unsustainable” rises in cost. There are so many excellent free market reform ideas out there that are never addressed (Rep. Paul Ryan’s proposal for instance). Get the government out of health care, don’t put them in charge. Decreasing burdensome regulations is the first step to reduce costs. Tort reform anyone? And what about the most important question of all- freedom? Trust me, when the government decides what your medical care should be you are a slave to them.
Those who voted for this man will suffer the consequences. He is spending so much money and looking to destroy the medical profession. No one will want to go to medical school. If he gets his way, the time and effort to become a doctor will be wasted.
Chris,
If lawyers run the country why would they want to shoot themselves in the foot? Have you noticed that Obama said nothing about controlling cost by prohibiting lawyers from suing doctors.
But he is quick to cut payment to doctors in order to control costs.
I believe it is important for people to get healthcare. But I don’t think they should penalize the ones giving it in order to get it.
I have an idea. The next time someone has a life threatening medical problem instead of calling 911 or going to the ER, they should call Tiger woods.
See what he says.
How is it that the rest of the westernized world is wrong on healthcare and we’re right?
How is it that we have millions of the middle class that can’t afford insurance, and end-up going bankrupt after a single accident or major illness?
I keep seeing people attempting to apply widget-based profit models onto healthcare. In the long-run it doesn’t work; it’s like trying to make fire department for-profit.
For suzie,
We do pay higher taxes, but its more like about 30%. But we don’t need that information for this topic because what we’re really interested in is what our system actually costs us. Higher taxes does not mean higher health expenditure. I don’t need to convince anyone of that, the factual numbers are available. For better or for worse, our health care costs us 3-4x less than yours costs you.
I’m not sure why you’re having trouble understanding the cost situation in national systems. In private systems yes, adding physicians would reduce costs. In national systems no, because the gov sets the rates, supply and demand rules do not exist. More physicians does not mean lower rates, it just means more physicians charging the same rates. If the country gets saturated with physicians, than physician income might go down because they see less patients, but no costs to the government will go up.
Socialized health care wouldn’t be as cheap to run if those countries didn’t receive deep discounts on drugs and devices researched and manufactured in the US while Americans pay the full retail price and pick up the tab for the research funding. Do those countries perform much in the way of research? It seems like all the journal articles I read come from the US or Asia, with an occasional article from Europe. From Wikipedia…”However, the U.S. is the leader in medical innovation, with three times higher per-capita spending than Europe and producing more new pharmaceuticals, medical devices, and affiliated biotechnology than any other country.” I’d think with all the money left over from those cost-effective socialized health care budgets, Europe would have cured cancer by now. Are they waiting for the evil-greedy-capitalist American companies to do it for them?
On a different note, has anyone heard about this? http://www.thisisstaffordshire.co.uk/news/Forced-plead-cancer-treatment/article-1203688-detail/article.html
Poor woman. The government is playing God with her.
Elephant in the room: the health care industry is for making people healthy. It’s amusing to watch all of the intellectual acrobatics that suzie and others here will perform in order to make the debate about levels of bureaucracy and doctors’ salaries. Anyone that can honestly say “physicians’ income takes precedence to people’s access to healthcare” with a straight face (suzie, July 27th, 2009 at 9:50 am) needs to get their head examined, and I hope to God that you’re not one of the 46 million Americans who can’t afford it. The debate is about which system offers better health outcomes, and our current profit-driven system doesn’t hold a candle to one based on medical need.
OK, I’ve had enough of this nonsense. Suzie doesn’t have a clue about the healthcare industry. SDN should delete her uneducated ranting / spamming.
So here is a question for all of you.
Is healthcare a right?
Many argue that it is but before you say yes, let me point out some basic concepts.
People who say healthcare is a right usually make the argument that if you get sick you can’t take care of your family and may go broke trying to pay the medical bills or worse you may die.
I say you are right about all of the above.
However, there are many other factors in life that can land you in the same exact spot.
For example:
If you can’t afford to buy food you will die.
If you can’t afford to pay you heating bill you may freeze to death.
If you eat too many hamburgers you can die from an MI.
AND the list continues.
So ask yourself this question before answering the first question.
Should food, heat, electricity, transportation, clothing be covered? Is it a right too?
And Suzie you have way too much time on your hands. Have you counted how many post you’ve put on here?
Quote: Lucid Says:
July 29th, 2009 at 10:04 pm
Anyone that can honestly say “physicians’ income takes precedence to people’s access to healthcare” with a straight face (suzie, July 27th, 2009 at 9:50 am) needs to get their head examined,
____
So how do you propose ensuring that the best and brightest American citizens aspire to become physicians? An engineering degree only takes 5 years, and a business degree takes 4-6. Even a Ph.D. can take as little as 8. Kids won’t grow up wanting to be doctors if they get paid a school teacher’s salary in exchange for being on call, working 80 hours a week and paying a ridiculous amount of money in malpractice insurance and student loans while also dealing with blood-borne pathogens and the other risks of caring for sick people. Is cheap health care actually better if you end up with doctors who have a heart of gold but who aren’t the brightest crayons in the box?
Socialized health care wouldn’t be as cheap to run if those countries didn’t receive deep discounts on drugs and devices researched and manufactured in the US while Americans pay the full retail price and pick up the tab for the research funding. Do those countries perform much in the way of research? It seems like all the journal articles I read come from the US or Asia, with an occasional article from Europe. From Wikipedia…”However, the U.S. is the leader in medical innovation, with three times higher per-capita spending than Europe and producing more new pharmaceuticals, medical devices, and affiliated biotechnology than any other country.” I’d think with all the money left over from those cost-effective socialized health care budgets, Europe would have cured cancer by now. Are they waiting for the evil-greedy-capitalist American companies to do it for them?
___
I’m re-posting a previous post a made that I don’t think posted correctly because I added a hyperlink. Sorry if this ends up posting twice.
Suzie,
You really need to find a better way to spend you vacation. I like the beach myself.
JS and David make competing arguments that are interesting and makes one wonder where to draw the lines?
So, let’s look at a few things we deem should be for the collective good:
fire departments
police departments
water and sewer
libraries
transportation (streets, trains, etc)
K-12 education
But then we say that somethings can be for profit, but are heavily regulated:
telephone
electrical
gas
healthcare
Now the food and heat argument isn’t a good one because we have food stamps and low income programs for gas and heating – there’s already a saftey net there. If a homeless person freezes to death in america, it’s most likely because they’re mentally ill. Which gets back to healthcare again.
I imagine we’d be having a similar arguments if the government proposed setting up libraries today, rather than back in the days of Ben Franklin. Imagine trying to create government funded libraries – publishers and authors would lobby it down in a second – the argument would be that it’s government sponsored copyright theft. However, today publishers love libraries because it’s a big source of sales, rather than a source of copyright theft. What I’m getting at is that there are many benefits to having libraries and a short-sighted pursuit of profit would have prevented this important resource which today benefits all Americans regardless of income.
I think, lawmaker should go to the root cause of problem. The real problem with expensive heal care in the US is that few people are abusing the system. Few people are unethically law sue to doctors (greedy attorneys are provoking) resulting heavy charges for all. Lawmakers should come up with two options to the citizens (two tier of system). Let individual decide which is suitable for him/her.
1. Current system. Person can sue Physician (Current Higher rate of health care)
2. Person can’t sue Physician. He/she can complain to authority for medical malpractice. If Physician proves guilty, his/her license suspend for time or permanently revoke. (This system will have much lower cost. I am sure, it will have 40% lower cost.)
Tony,
Good point about food stamps and homeless shelters. However, we have medicaid as well.
So the conclusion is that we do help those who can’t or unable but should everyone be entitled to healthcare and why should someone who works hard and makes more money be forced to pay for it?
I realize that those who make more most likely had more chances to get to the point of making more. (most of them anyway)
The two main points of healtcare reform appear to be controlling cost and insuring everyone. They want to control cost in multiple ways and one of them is going to be reducing physician pay. Obama does not want to go after lawyer because he is one.
I say stop picking on the very people who are going to treat you when you are sick. Go after all the other reasons why healthcare is so expensive. Like, pharmaceuticals, Medical device companies, Big insurance, Private hospitals, those who abuse the system. Also, find better ways to tax for healthcare. I believe one of my other posts above addressed that.
I’m not against comprehensive healthcare for all. I’m against screwing the guys who are going to be delivering that care.
At the end of the day doctors do make a good living. But they put in the time to get there. More than most other professions.
Suzie,
That’s a good idea. We can insure ourselves against fatal snake bites, pianos falling on our head, giant fish eating us, getting hit by an asteroid and off course burning ourselves with McDonalds coffee.
But personally I want to get insurance for a drop in salary. In fact I want to get very extravagant. The policy would say that if my salary dropped below 5 million a year (not that I make anywhere near that) I would be covered for at least 60% of that for life.
I guess if the argument is that we shouldn’t take care of the 35 million without healthcare so that a few specialists can continue to make millions, it’s an argument that isn’t going to get much sympathy from the public or congress.
I’m not saying that is OK, that’s just the fact. That’s exactly what Dr Sundwall is saying, more or less “it sucks, but that’s what we can expect.” Complain as much as you want, but he’s telling the truth.
Realistically, I don’t see doctor income changing at all, but if it does, it’s going to be the fertility specialists and GI specialists feeling it, basically those specialities that get paid a lot for doing something that’s actually pretty simple. Putting a fiberoptic scope up a butt could be done by anyone with minimal training. (Yeah, I know GI docs will have 1000s of reasons why that’s not true). Some specialties will always be paid more because they’re very technical and complex, such as neurosurgery.
Medical malpractice reform and pharmaceutical price caps aren’t going to make much of a dent realistically. Cutting physician incomes isn’t going to do anything either — physician income is a teenie fraction of the overall cost. It’s kind of a nonstarter to even be arguing about it. Indeed, it’s practically a smokescreen for the real issues.
The discussion should really be about the high cost of high-tech healthcare for babyboomers; it’s freekin expensive. All these great (and expensive) things we can do today that weren’t available 10 or 20 years ago are breaking the collective bank. The only way to cover it is to get all the healthy folk to pay into a system.
Along those lines we should really be arguing about what system is the best system to get all the healthy folk to pay for those with illnesses. Is it single-payor, is it mandated coverage, is it co-ops?
Well Tony,
I can’t say I disagree with most of what you say. Doctor salaries are not the reason healthcare costs are going up. In fact I believe they are only about 10% of the total cost of healthcare. Don’t quote me on that I may off a little.
Your last statement is about the healthy people putting in for the rest in the main issue.
Will it be all the relatively healthy people or just those making more than $250.
They way I see it everybody used luxury items. See, the things we take as normal everyday products are luxury in many other places. Things like Music and movie DVD, expensive dinners, concert tickets, even porn.
So, I say tax the luxury and pay for healthcare.
The current discussions about mandatory coverage and healthcare co-ops are most interesting and can solve a lot of issues without getting the government all that involved.
Hopefully we can all agree that we should get rid of Medicaid – that’s actually a good example of a government program gone wrong. I suggest putting that money directly into paying for basic healthcare plans for those who fall within a certain % of the poverty line.
As a medical student, I would like to see two things addressed when this health care reform occurs to protect ME. Listen, I want to be a healthcare provider for the rewarding patient-care experiences as well, but I want my interests protected. I’m human, and am going to be going through YEARS of training and debt to SERVE people. I feel I’m entitled.
(a) Address the problem of malpractice insurance costs. If doctor’s salaries in the subspecialties (neurosurgery, orthopedics being of chief concern) are going to be lowered, then their malpractice costs simply can’t remain the same.
(b) If the gov’t wants to take over healthcare, then at least partially take over my loans for medical school. It seems unfair to our generation of new doctors that we are going to be paying the highest medical school prices and making the lowest salaries.
They need not only address these problems because of ME. Not only because I am selfish and want a nice car and home. They need to because if they don’t then gradually less and less people are going to be compelled to go into specialties and medicine and general, and that would cause shortages that would create other uglier problems. Forget ever getting an MRI when you need it, and that kidney transplant that will save your life if you get it before the end of the month. The government doesn’t have enough to ration out to the entire population.
I don’t consider myself a republican because of many of their social policies, but when it comes to economy they have the right ideas. The solution is not to put control of the system in government hands! It is to re-examine the way in which we control costs. It is possible to do this without the beaurocratic two-headed monster of the American government. The solution lies within the costs being set by pharmaceutical and medical device companies. Regulation by government without government takeover. Obama, take advice from what you are doing on Wall st. You can regulate the free market from your oval office!
The following is a copy of the letter I have just sent to the entire United States Senate, The President and some public media:
It is possible to revise healthcare in the United States without totally changing its infrastructure and entirely rewriting policies. Over the past few months we have gained, first hand, insight into the effects of government deregulation of a large industry: the housing market. The lesson taught from the housing market crash is basic – you cannot deregulate something once it is regulated. Simply put: a national healthcare plan is something we cannot reverse once it has taken effect. When thinking about such deregulation my mind becomes filled with all too vivid memories of government bail-out dollars and government corporation control. The current system of care is not without its faults with regard to spending. The inefficiencies can be corrected, the access of care can be increased across a significantly greater income spectrum, and the quality of care can be improved. A modification of the current system of healthcare is the best approach to the healthcare crisis of the United States.
The analysis of the healthcare financial arena which includes, but is not limited to, spending, inefficiency, reimbursements, and profits is a complicated machine whose understanding is limited by many factors including investigator bias, lack of clinical knowledge by many investigators, and the lack of a systems based practice that promotes monetary efficiency by healthcare professionals. One thing is certain, however, the cost of care is increasing. Several major factors have contributed to this increase.
PROBLEM: Innovations and breakthroughs require research, and research requires time, manpower, and money. The new wonder drug or the fast noninvasive tests that roll out of the current capitalistic system and enhance the quality of care in this country cost money to develop. Pharmaceutical companies and technology companies need to recover these losses in the form of profit. A government run health care plan where compensations and ultimately profits of these corporations are dictated by the government will ultimately halt or significantly slow the innovations in medicine, most of which have come from the private sector. It would then become the government’s responsibility to finance and promote such advances since many of these corporations would then have little incentive to do so. There is a solution, however, to diminish the cost generated in this aspect of healthcare.
SOLUTION: By applying Nash’s theory of equilibrium, if all pharmaceutical and technology companies were restricted from spending the billions of dollars they currently utilize for marketing purposes, the profit distributions of these companies would not alter significantly from their current percentages, and corporations would lose less money in the form of advertising. These products would, as a result, cost less – enhancing the delivery of care. Moreover, clinicians would make selections on products based on data and not which product was more effectively marketed toward them.
PROBLEM: People are living longer due to enhanced medical care, increased nutritional awareness, and engaging in safe practices, amongst a number of other things. As a result, however, people live significantly longer with chronic conditions that debilitate their victims over time, after long periods of pharmacotherapy, a number of procedures, and significant pain and suffering. It is the diabetic with coronary artery disease, as an example, that costs the system money-not the person hit by a bus. Also, as a result of the enhancement of age, there is an increasing population of the elderly which is disparate to the ratios of the past. Medicare has enough difficulty paying for the elderly with these debilitating conditions.
SOLUTION: Compliant patients with regular follow up should pay relatively lower premiums compared to that of noncompliant patients with poor follow-up. The basis for this is that the practice of preventive medicine decreases the overall cost of their care, which rises exponentially with age. There is another benefit to this measure-it rewards people for living healthier lives.
PROBLEM: Another and more easily controllable factor contributing to the rising cost of increased healthcare is malpractice. Doctors practice defensive medicine. As a result, they order excessive tests and procedures to rule out what is very unlikely, though it has a very small possibility. Increased numbers of tests, unnecessary admissions, and needless prolongation of a hospital admission raises the costs of a hospital stay, increasing the reimbursements paid by insurance companies, which in turn amplifies insurance premiums, and, as a result, healthcare becomes inaccessible to a tremendous number of families.
SOLUTION: The auto insurance industry utilizes a system of full and partial tort options when insuring a vehicle. Tort refers to the victim’s ability to sue for pain and suffering. Individuals with partial tort pay less in premiums, but sacrifice the ability to sue for pain and suffering in more minor situations. Individuals can choose health insurance plans based on their desires and the amount of money they have available to pay their premiums. This addresses the issue of lowering malpractice limits, but allowing it to remain the choice of the individual-not the government.
On its surface, a national healthcare plan is a wonderful idea. The thought of each and every American being able to go to the doctor provides a vibrant image of a healthy United States. This notion is furthered by all the remarks made about how great the national healthcare plans of other first world countries are-promoting the “grass is greener on the other side of the fence” mentality. The reality of the situation is that national healthcare results in rationing of care, restriction of care in certain conditions, and waiting for necessary visits, tests, or procedures. A ninety five year old woman with inoperable and incurable lung carcinoma with a prognosis of three months survival will not receive the millions of dollars in care required to extend her life one additional month. In the few scenarios where examples of national healthcare at work are seemingly effective, the populations are small and there are few socioeconomic and ethnic barriers to care. The foundations of the current system of care can be enhanced and the availability of care can be broadened significantly. Many small steps can ultimately lead to a giant leap forward for all Americans, but a blind giant leap can throw us over the edge.
CNN Money has a series of people talking about primary care. Several PA’s and NP’s speak out.
A couple boldly say that they have more knowledge that Primary care MD’s.
WOW. I guess they forgot who trained them in the first place.
Fine, then I want 3 months of paid vacation like Sweden or I’ll mave there and our gov can eat the $130,000 that I owe.
Everyone will get paid based on half the education and training besides the actual doctor that the patient is paying to see. Fair?
This guy probably lives in a large house and sent his kids to good schools and can retire without worry after working hard his whole life. Well good for him!
Healthcare has to be state by state. So when one state screws up, people move to another one that works better. Keeps some degree of “fairness” around but maintains competition among states for medical providers.
Docs need to oppose a mandatory public option because that in itself is communist/socialist (wherever you want to throw it on that end of the spectrum). You can think you’ll lose, or actually keep working at it to make sure it doesn’t happen. Participate in your state PACs. Screw the AMA which cowers in political image.
For suzie:
I’m not sure what you’re arguing by posting the tax numbers. You were the one who said our tax was 50%, I told you it was closer to 30% and your numbers support that. Also understand that for each higher increment, its not the entire amount that gets taxed at the new rate, its just the portion within each subsequent bracket. I have never even heard of VAT, so not sure what you mean there.
Again consider what we’re talking about. You argue like many Americans, trying to imply that if a system is not perfect, its not better than the American system. But this is about what is better, not what is perfect because nothing is perfect.
The debt argument is a road that dose not support your point of view. If debt is so important, you should be even MORE favorable to the Canadians system because Americans have a much higher per capita debt than Canadians. Also nearly every modern nation has large debts, with the US having one of the highest. So this is actually another argument AGAINST the American system. But what’s really absent here, is any direct connection between debt and the medical system. Suzie it simply makes no sense to criticize the economics of a system based on an indirect attribute (debt) and ignore the most direct attribute (it is factually cheaper). That wouldn’t make sense even IF Canada had a larger debt/capita than the US. Like if I owe $10 and you owe $100 and I criticize your economic decision to go to walmart while I go to bloomingdales, saying that you are making a bad cost choice because you debt is higher. Your debt has absolutely nothing to do with it, you are still in fact doing the better economic action by shopping at walmart.
For Emily
“Socialized health care wouldn’t be as cheap to run if those countries didn’t receive deep discounts on drugs and devices researched and manufactured in the US while Americans pay the full retail price and pick up the tab for the research funding. Do those countries perform much in the way of research? It seems like all the journal articles I read come from the US or Asia, with an occasional article from Europe. From Wikipedia…”However, the U.S. is the leader in medical innovation, with three times higher per-capita spending than Europe and producing more new pharmaceuticals, medical devices, and affiliated biotechnology than any other country.” I’d think with all the money left over from those cost-effective socialized health care budgets, Europe would have cured cancer by now. Are they waiting for the evil-greedy-capitalist American companies to do it for them?”
Emily think that through for a moment. The costs of research and production don’t disappear just by getting a new customer (foreign governments). You fail to understand that same thing so many Americans do, that the costs are not borne directly on the foreign consumer, but on the government. Canada, nor any European nation can force the pharm companies to sell for cheap, they still have to buy machines and drugs for whatever rate they can negotiate. So those costs are still in the system, and DESPITE that, the systems are still much cheaper.
Of course, there is a certain element of savings that socialist governments get, which is simply that they CAN bargain for better prices, just like the market was meant to work. If US consumers had a means of using the market to their favor in this way, they could similarly benefit. The pharm companies have the world’s highest profit margins, and its partly due to the legal limits on bargaining from American drug distributors. This is anti-capitalist, anti-market policy that hurts the economy, and any even remotely conservative person should in theory be against it.
You also suffer another typical American syndrome, of being unable to separate politics from the economic issue. Its not about anyone being greedy or anyone being evil or anything like that, its simply about one system being cheaper than another. Maybe your antagonistic culture makes you automatically think in conflict-based tones, but it may have very little if anything to do with it. An entity that is allowed to bargain, and holds a massive bulk-contract for the drugs, will according to the laws of the market, typically get lower prices.
To Worried!:
“I’m not begging for some one to pay my loans off…all I am saying is that I should have my right to pay them off promptly if I want to.”
This argument always irks me. Why should doctors be entitled to paying off their loans any more “promptly” than anybody else? Doctors are not the only people who graduate heavily in debt. But they are among only a few professions who get compensation that allows them to pay off such a huge debt in 10 years. It took me 8 years to pay off my undergraduate loans for a Civil Engineering degree. And I am still paying off my law school loans 7 years after graduation (family law/child advocacy). A friend of mine is a PHD candidate in English/Writing who is a professor at a smaller college. In total when she is “paid off” it will have taken her over 20 years to pay off all the loans she has taken out to pay for her education. (She runs reading/writing workshops for low-income, at-risk girls on her own time as well).
My point is that other people choose fields/careers that help others and also graduate in debt. Perhaps the actual $ number is not as high but usually the corresponding compensation puts people in other careers at more of a disadvantage financially than doctors who cry about not being able to pay off their loans quickly.
In your last post Suzie, you successfully make the case that you need a much cheaper medical system. And where have you seen one? So then….connect the dots.
Another important point you do not recognize is that, for example, Canadian physicians make as much as American ones when you factor in insurance, malpractice, overhead, etc, and sometimes even when you don’t. It seems your primary objection to a national system is fear of loss of income, but this may be unsubstantiated.
Suzie, what is your point? You appear to be making yet another argument against the American system you want to keep. Medical tourism is evidence for what is wrong with your system, not what is right with it. Where exactly are you going with this?
Suzie makes a good point that no one is really talking about….decreased access after insuring “everyone,” even though everyone will not be insured under any current bill being proposed. Every other practicing physician I know says they will NOT accept any new type of plan that has anything to do with the government.
They may provide “coverage” for millions more, but in the end it will only be an “accomplishment” that idiots like the guy interviewed in this article will be able to add to their “list of accomplishments,” but provide no realized benefit. What good is “covering” millions more, if you decrease access to healthcare for even more. The people who have this new coverage, will be forced to flock to the yet fewer numbers of providers who are willing to accept their new insurance plan which will drastically increase wait times, overburden those providers, etc. There is currently a physician shortage, but the relative shortage after this reform will be exponentially greater because of the fact that there are so many physicians who will not accept any of these new plans.
What good is coverage if you can’t use it?
I just happened to see this site and the responses. I am just a businessman and have no great knowledge about this area. However, i have lived and worked in many countries. I can tell you this….every single ex-pat that I have known in business, NO MATTER THE COUNTRY, buys health care insurance. Having a medical policy with the provision of health treatment in the US is preferred. Thes policies are expensive but it goes to show the thinking of experienced people—-the last place you want to be treated is in a country with socialized medicine.
Suzie, you have no idea how much I know about the issue, my intelligence, where I get my information, or even where I stand on this, but it’s interesting that you’re so certain so as to relegate me to my undergraduate “cubicle”.
I was commenting on your abilities to engage in discussion on this forum, which clearly you are not very capable at. Generally, being able to have a mature, clear, and reasoned presentation is key to convincing others – something you seem to want to accomplish here.
I’m actually very well versed in much of the text you’ve smattered about here, as I have a masters degree in health policy, I have traveled to countries with socialized healthcare, and there’s much that I disagree with in what has been presented by the committees thus far. Unfortunately it does look like the plan will not meaningfully decrease health care costs nor will it improve quality of care; and hospitals and physicians will bear the brunt of the effort to contain costs.
But apparently you do not value any sort of respectful conversation and will continue to barrage this posting with things you’ve cut and pasted, without being able to critically read and respond to others, which is unfortunate for this board. Good luck having to deal with people in the real world without any regard for socially mature behavior, I’m sure it won’t affect your test taking abilities (or your ability to google things written by others), but it will affect your social and professional progress.
off to the cubicle!
I’m not a huge fan of his answer about Dr compensation in the new system. Basically he’s saying, “Those of us who like to work hard and not get paid very much will still be happy. The rest may want to find something else to do.” Very discouraging for those of us nearing 10 years of medical training and under a mountain of debt.
830,000 Canadian are currently waiting to be admitted.. so waiting period can be one minute or three hours. Last time I went to the ER for emergency birth-control pill (before it went over the counter), I waited over 4 hours and paid $900 for the visit and the pill.
And suzie, you need to calm down. Capitalizing all those words will give you high blood pressure. How do you propose to increase the number of physicians without losing quality? And we already import a large number of physicians, how do you think its politically smart to steal developing country’s newly trained doctors away from people who really need them?
Before you completely discount Obama’s plan, do you really think that your proposal will be effective? How many people will support you either way? If you can’t do the president’s job, why are you arguing and complaining as you are. Honestly, Obama’s plan will be the stepping stone for better improvements for the future, and I think we all need to admit that better system is needed. Without this stepping stone, we won’t get anywhere better in the future. You can forget about quality care and more physician output.
To conclude, you have great ideas, but too idealistic and very single minded.
New system needed….don’t see you offering any proposals at all…..just empty rhetoric as Obama does. Do you ever notice that he hasn’t actually proposed any specifics….just broad parameters under which he would like to see something done. Here’s what I think should be done, lest you reply that I’m not willing to propose anything myself:
1) There needs to be some provision made that would allow Americans to do a couple of things;
a) Allow people to purchase catastrophic coverage to cover major medical expenses. This would be relatively inexpensive coverage that is similar to high deductible health plans available in some states today. For example, I checked on a HDHP for my family recently and with a $5k deductible, coverage for a family of 5 was around $225/mth, but could be less if govt. regulations didn’t limit these types of plans.
b) Improve health savings accounts so that people are incentivized to save for their healthcare expenses by expanding the pre-tax breaks that are currently given, and loosening the withdrawal requirements upon retirement age so that the account could serve 2 purposes…..have an account that someone could contribute pre-tax dollars to each month that will grow like an IRA/401k etc to cover medical expenses up to the deductible on their HDHP, and upon retirement/medicare age be able to use that account to help subsidize their retirement
c) Get people to use these HSA’s to pay for their primary care instead of relying on their insurance “co-pay”. Since they would be able to withdraw money from the HSA for medical expenses (via a check tied to the account or a debit card), they would see the amount of money that they are spending (their money), and therefore be able to take a more active role in their healthcare and how much they access it. If someone stays very healthy, then they may not use their HSA but once/yr for a PCP checkup, thus their HSA would grow even more in value. People who actually pay for their healthcare, take a a more active role in it.
d)Take some of the 1+ TRILLION that Obama is trying to spend on his current overhaul proposals and help provide subsidies to “bridge” coverage so that while people are building up their HSA, they can have back up coverage.
2) People who are below “some” level of income be offered subsidies to purchase private insurance, be it through refundable tax credits, vouchers, whatever. Obviously the income level is debatable. Currently, these people are eligible to be covered under Medicaid. If you can use the Medicaid money to help people get private insurance instead, they will actually increase their access to care because more and more physicians are opting out of Medicaid all together.
3) FIX the Medicare trust fund. This is actually the ONLY place where I think raising taxes may have to be employed. I think that there is no getting around the fact that the baby boomer generation is the largest group of the population. We may have to raise medicare payroll taxes to help fix the medicare trust fund. The boomers paid into the trust fund their entire lives, so they deserve to be able to use medicare when they need it.
I have more but I have no more time for now. I AM completely discounting Obama’s plan because you can’t trust anything he says. As an independent who voted for him, I am truly disgusted at myself for being sucked in to his “feel good” propaganda web. The man has no substance, only empty rhetoric. We would all be served better if he used his talents in Hollywood.
“1. “sub-specialists less but still more.”
What does that even mean???? A single payer system will ruin this country. I think their still needs to be some oversight, but complete government take over will kill people.”
I think he means that instead of being paid 3-5 times as much, maybe they’d “only” be paid 1.5-2 times as much.
“When was the last time you went to a Veteran Affairs Hospital? Did you enjoy that experience? BTW, these hospitals were built by our government and for our veterans!”
Yes, indeed. I suggest you research the VHA before you slam it: http://money.cnn.com/magazines/fortune/fortune_archive/2006/05/15/8376846/
Woops, should clarify that all primary care average earnings in 2004 was $161.8k, while the average specialist was around 300k, though invasive cardiology was closer to 3x at $427.8k. So yeah the 3-5x was an overstatement. But I do think that was the gist of what he was saying. Specialists would still be paid significantly more, but not by the same margin.
Suzie and Jimmy
It is refreshing to see someone has actually taken the time to know the facts about HR3200 before sounding like they do. Another topic you have missed it Obamacare states that in order to curb costs, the govenment (with the bill) will penalize hospitals and doctors who admit people with the same disorder more than once. This means the hundreds of thousands who suffer kidney failure, diabetes, sickle cell anemia, asthma, epilepsy, or neurological disorders like Guillian Barre Syndrome will be able to be admitted one time for these disorders then it is up to them to foot the bill. And by the way, it was quoted that there will be no death panals, but just what do you think limiting Medicare further will do? Most elderly can’t afford all of their medications as it is and you propose to cancel it all together? The program that should be disbanded is Medicaid. It primarily provides care for people on welfare. It also supports the illegal aliens as that is the only program they can get into without a social security number.
I have been without health insurance for over a year because of GBS and have not been able to continue my rehab because I don’t qualify for Medicaid. I was informed by the intake person that the reason I don’t qualify is they tend to provide it for minorities only.
What a time not to be a minority-can’t even get the medication my daughter needs for her epilepsy.
But Canada’s form of health insurance isn’t the answer either. I started my 32 year career of nursing in NY state and I remember the number of Canadian nurses who came across the border to work because to be more cost efficient their local governments closed the hospitals they had been working in.
Dear Melanie:
Very few people on this site will understand your post, b/c this is a STUDENT site.
Almost no one who posted responses to the column has had any EXPERIENCE practicing medicine and has no knowledge of the regulatory environment that is suffocating American medicine today.
The older physicians will not participate in opposing HR3200: they made their money in better days and have enough savings to retire from the field entirely.
Most MD students are smart and ambitious, but are terribly misinformed and undereducated. They do not understand what kind of transformation this country is undergoing right now.
Obama is bankrupting the country. We are about to become a Banana Republic.
Ok ok ok time out-
I just want to say this and then move on….I AM NOT WORKING FOR LESS MONEY WHEN I AM DONE RESIDENCY AS COMPARED TO TODAYS PAYOUT RATES!!!
Why won’t anyone just say it? I do not feel as doctors we should be embarrassed about talking money….No it doesn’t make you look bad.
There is no reason why i can’t be a great doctor and be compensated for it at the same time. I see it as incentive to perform better. If you just cap me off and say well here is what you get regardless of your performance or ability i might just say ok well i’m leaving today at noon, bite me.
Sorry but i didn’t go through this much schooling and hard work to be told what to do now.
Oh yeah single payer insurance is a bad thing, not really for what i said above that was mindless ranting and foot stomping. It is bad because ultimately the people suffer. Waiting for care and specialized testing, higher tax rates, and ultimately the need for supplemental insurance (wow won’t that make you feel stupid).
Please America get over your sense of entitlement
The insurance companies make 2-4%??? That is unacceptable in America! These EVIL companies are profiting off of sick people. They should be running revenue-neutral charities to help all Americans! How dare they make a profit in this country….
The U.S. is the only [b]industrialized/Western[/b] nation without single-payer health care. Why do you think that is?
Since when did the word industrialized and Western become synonymous?
What about the countries in Asia that are also industrialized?
Isn’t Susie a medical student at Ross?
Oh, I forgot they don’t call them medical students more like bottom-feeders…reliably picking up the scraps that US MDs and DOs leave behind.
Honestly, I just don’t understand when any MD would say these things. Oh right, he’s old and already rich! Didn’t have 150K in student loans, didn’t see strigent admissions processes like today, didn’t sacrifice what current students have to today. This is retarded, there will be no neuro/spinal/cardiac surgeons in the future.