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Healthcare in the US (AKA, what Feral does when he's bored on Saturday night)
Feral
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So there's a new Michael Moore movie coming out, this time about the sorry state of health care in America. And by "sorry state," I mean totally disfunctional. By now we've all heard the statistic that the number of uninsured Americans has broken 45 million and is still growing. Health care costs and insurance premiums are rising and a handful of states considering health care reform of their own.
So it's inevitable that we'll talk about healthcare again after the Michael Moore movie comes out, but the inevitable Sicko thread is probably going to have a low signal to noise ratio judging by Moore's popularity (or infamy, if you prefer). I'm hoping that by doing this now we can keep the thread a little more on-topic.
Before we start, some background! Y'all got your Trapper Keepers open? Pens and pencils to your notebooks, 'cuz we're gonna have a little Healthcare Reform 101!
First, the systems:
Privatized insurace - Pretty much what we have in the US, although see below about hybrid systems. Health insurance is provided for most citizens by private insurance companies, and many citizens work for companies who pay for all or part of the health insurance premiums for their employees.
Public-payer - The goverment is an insurance company. Maybe everybody qualifies (France, Germany), maybe only some retirees qualify (Medicare in the US).
Single-payer - A form of public-payer. The government is an insurance company and everybody qualifies. In some systems (France, Germany, Australia) you can have seperate, private insurance and still be covered under the government insurance policy. In a small minority of systems (South Africa comes to mind, and formerly France until a few years ago) if you have private insurance you don't get the public insurance.
Compulsory health coverage - Everybody must have health coverage. This does not necessarily imply that you have to get your coverage from the government - currently the state of California is looking at a system where if you do not get health insurance from your employer, and you do not qualify for state coverage, then you must either buy your own health insurance or you pay a tax penalty.
Socialized medicine = Some people throw around the the phrase "socialized medicine" to the point that the term has almost no meaning. Technically, though, this term refers to systems where hospitals are directly owned and controlled by the government and all doctors are government employees on a government salary. This is the system in Sweden and Finland. Canada and the UK have partially-socialized healthcare systems, where they have large-scale government-controlled hospital and doctor networks, but doctors have the option of going into private practice for themselves. (Technically, in Canada, this is illegal, but the government turns a blind eye.)
Hybrid systems - Almost every first-world country has some form of a hybrid system. France, Germany, Australia, and the uK, for instance have socialized hospital and doctor networks running alongside private hospitals and private doctors; citizens who can afford it can buy insurance from private carriers. Even the US is a hybrid system, since we've got Medicare (a public-payer) for the elderly and disabled and the Veteran's Administration (a socialized system) for military vets.
Other than a complete overhaul, what can we do?
Administration streamlining - Every reasonable study estimates that around one third of health care costs in the US go to administrative overhead. There are a lot of possible reasons why. One of the most frequently-cited reasons is the huge plurality of insurance companies - every insurance company has different documentation requirements and different forms, so one doctor might bill the same procedure several dozen different ways depending on who the insurance company is. Another possible reason is the lack of standardization of health care records, and the lack of interoperability of electronic medical records. If you want your records sent from one doctor to another, they still have to print them to a hard copy and mail or fax them over. In a world where I can download a fucking video game from Steam in 15 minutes to my computer, why can't we email medical records? It makes no sense.
A very high-profile case of a large healthcare system slashing administrative costs by going to standardized forms and electronic records is the Veteran's Administration. It's also one of the ways HMOs like Kaiser remain competitive - all their doctors access the same computer network.
Malpractice reform - You hear this a lot from the right wing of the political aisle. I'm skeptical. Malpractice costs represent anywhere from a half-percent to two percent of total healthcare costs in the US. A Congressional Budget Office report (Google cache link because the original site was down as of this post) found that malpractice reform would not have a significant effect on the economy or health care costs in either direction. Done incorrectly, though, bad malpractice reform could take patients' ability to seek reparations for medical errors and fuck it in the ass without lube.
That said, I do believe in some malpractice reform. Right now, if you have a problem with a small business, you don't just hit them with a lawsuit straight off the bat. You call the Better Business Bureau, your state Attorney General's office, and maybe the Federal Trade Commission. If you have a problem with your employer, you don't need to go straight to litigation, you can take it up with your state's Labor Commission. I'd like to see something similar for malpractice - a state-run board comprised of lawyers and doctors (in the wild, lawyers and doctors are vicious enemies who mark territory, track each other by the scent of their unique pheromones, and leap for the throat on sight) who take up patient advocacy allowing at least some issues to be resolved independently and out-of-court.
Health spending accounts - Another suggestion you hear a lot from the right-wing. Basically, this is a tax shelter where you can have a certain percentage of your paycheck go (before taxes) into a special savings account that can then only be spent on health care. It's all the benefits of paying for your healthcare with cash and none of the drawbacks of an actual savings account. And it's an amazingly useful tax shelter for the wealthy and middle-aged! Did I mention that this idea is fucking stupid?
More doctors! (and nurses) - There's a shortage of health care professionals in this country, driven partially by a shortage of health care teachers. It's tough to get into med school and, surprisingly, tough to get into nursing school. Part of the reason they accept so few applicants is not because few people qualify, but because there isn't enough classroom space to take them all. See, if you want to teach future doctors, at most universities for most teaching positions, you have to be a doctor yourself - or have gone through comparable schooling. Ditto for nurses. But teachers don't make a comparable salary to their professional counterparts, so they don't get many health care program graduates who want to come back to teach. My suggestion? Mucho tax benefits for the teachers themselves. Also, give tax breaks to the universities who hire them as long as those universities also agree to let in more applicants. Make teaching a little more profitable, and more doctors/nurses will want to teach.
Some other terminology:
Provider - Any health care professional who directly helps patients. A "provider" can be a physician, a nurse, a physical therapist, or even a psychologist. Providers aren't necessarily people, either. A hospital can be a provider, as can an emergency room, or a diagnostic lab. Basically, whoever provides the care is a provider.
Payer - Whoever pays for the care. This is usually an insurance company, or it could be the government, and if you're really unlucky, it's you.
Note that there's no such thing as a "health insurance provider." In Healthcareland, a provider is always a patient-care provider, and an insurance company is usually a payer. (The exception to this are HMOs like Kaiser, where Kaiser is both the payer and the provider because they have doctors directly on salary.) So please don't use the phrase "health insurance provider," or I'll put a dunce cap on you and stick you in the corner with no food and no ice cream until bedtime.
So what does Feral think?
We need a multi-tiered approach. It doesn't have to be done all at once.
Step zero: Cut Bush's tax cuts on the wealthy. Sorry, we need a way to pay for this. Oh, and did I mention get the fuck out of Iraq? Yeah. Get the fuck out of Iraq.
Step one: mandate a national standardization of medical records and insurance paperwork. We're partway there - some billing procedures are standardized, but some are not. Give tax incentives to payers and providers that switch to a standardized, interoperable electronic medical record system.
Second, expand Medicare - not to everybody, but start by making it an opt-in, premium-driven system for the self-employed, the unemployed, and people with chronic health conditions who can't get on individual insurance. Put an income cap - it should be for the lower-income and lower-middle class. Expanding it to everybody all at once could be disastrous, we need to do this stepwise.
Third, compulsory health insurance. The uninsured are a drain on the economy - they utilize hospital resources and then have to be given breaks because they can't pay for them. If you can't pay for it, get on the newly expanded Medicare. If you don't want to be on Medicare and don't want to pay for insurance, fine, we'll tax you in preparation for the day that you show up at the emergency room with a broken arm and a $5000 medical bill that you have no way to pay.
Fourth, tax incentives for health care teachers and universities.
Fifth, stimulate the adoption of non-physician healthcare professionals like nurse practitioners and physician assistants through additional tax incentives and awareness campaigns. Many of the decisions a doctor makes in his daily practice can be done by somebody with less education. It doesn't take an MD to diagnose an ear infection and prescribe antibiotics. Many emergency rooms are hiring physician assistants for this very reason, but growth of the PA system is still relatively slow.
Sixth, tax subsidies for the healthcare industry. We already give subsidies to emergency rooms and we give grants to research hospitals, but we don't subsidize your run-of-the-mill neighborhood private practice, even though our private doctors are the frontline grunts for the entire healthcare industry. Further, it should be cheaper to get preventative and diagnostic care... but guess who's giving preventative care? Yeah, general practitioners in private practice.
Seventh, raise the retirement age. As people retire, they use more healthcare resources but rely more on Medicare and post-retirement employer benefits without giving anything back. The flipside to this is that retirees are getting healthier. I think the retirement age should be increased to 70.
Last, a further expansion of Medicare eligibility. Increase the maximum income cap stepwise every few years until it's feasible to remove the maximum income cap entirely, eventually converting it into a true universal single-payer system.
Discuss!
TL;DR: Fuck you, read the damn post. I could have been out getting drunk and snorting coke off a hooker's ass, but instead I wrote this because I love you guys so much. The least you can do is read it.
So it's inevitable that we'll talk about healthcare again after the Michael Moore movie comes out, but the inevitable Sicko thread is probably going to have a low signal to noise ratio judging by Moore's popularity (or infamy, if you prefer). I'm hoping that by doing this now we can keep the thread a little more on-topic.
Before we start, some background! Y'all got your Trapper Keepers open? Pens and pencils to your notebooks, 'cuz we're gonna have a little Healthcare Reform 101!
First, the systems:
Privatized insurace - Pretty much what we have in the US, although see below about hybrid systems. Health insurance is provided for most citizens by private insurance companies, and many citizens work for companies who pay for all or part of the health insurance premiums for their employees.
Public-payer - The goverment is an insurance company. Maybe everybody qualifies (France, Germany), maybe only some retirees qualify (Medicare in the US).
Single-payer - A form of public-payer. The government is an insurance company and everybody qualifies. In some systems (France, Germany, Australia) you can have seperate, private insurance and still be covered under the government insurance policy. In a small minority of systems (South Africa comes to mind, and formerly France until a few years ago) if you have private insurance you don't get the public insurance.
Compulsory health coverage - Everybody must have health coverage. This does not necessarily imply that you have to get your coverage from the government - currently the state of California is looking at a system where if you do not get health insurance from your employer, and you do not qualify for state coverage, then you must either buy your own health insurance or you pay a tax penalty.
Socialized medicine = Some people throw around the the phrase "socialized medicine" to the point that the term has almost no meaning. Technically, though, this term refers to systems where hospitals are directly owned and controlled by the government and all doctors are government employees on a government salary. This is the system in Sweden and Finland. Canada and the UK have partially-socialized healthcare systems, where they have large-scale government-controlled hospital and doctor networks, but doctors have the option of going into private practice for themselves. (Technically, in Canada, this is illegal, but the government turns a blind eye.)
Hybrid systems - Almost every first-world country has some form of a hybrid system. France, Germany, Australia, and the uK, for instance have socialized hospital and doctor networks running alongside private hospitals and private doctors; citizens who can afford it can buy insurance from private carriers. Even the US is a hybrid system, since we've got Medicare (a public-payer) for the elderly and disabled and the Veteran's Administration (a socialized system) for military vets.
Other than a complete overhaul, what can we do?
Administration streamlining - Every reasonable study estimates that around one third of health care costs in the US go to administrative overhead. There are a lot of possible reasons why. One of the most frequently-cited reasons is the huge plurality of insurance companies - every insurance company has different documentation requirements and different forms, so one doctor might bill the same procedure several dozen different ways depending on who the insurance company is. Another possible reason is the lack of standardization of health care records, and the lack of interoperability of electronic medical records. If you want your records sent from one doctor to another, they still have to print them to a hard copy and mail or fax them over. In a world where I can download a fucking video game from Steam in 15 minutes to my computer, why can't we email medical records? It makes no sense.
A very high-profile case of a large healthcare system slashing administrative costs by going to standardized forms and electronic records is the Veteran's Administration. It's also one of the ways HMOs like Kaiser remain competitive - all their doctors access the same computer network.
Malpractice reform - You hear this a lot from the right wing of the political aisle. I'm skeptical. Malpractice costs represent anywhere from a half-percent to two percent of total healthcare costs in the US. A Congressional Budget Office report (Google cache link because the original site was down as of this post) found that malpractice reform would not have a significant effect on the economy or health care costs in either direction. Done incorrectly, though, bad malpractice reform could take patients' ability to seek reparations for medical errors and fuck it in the ass without lube.
That said, I do believe in some malpractice reform. Right now, if you have a problem with a small business, you don't just hit them with a lawsuit straight off the bat. You call the Better Business Bureau, your state Attorney General's office, and maybe the Federal Trade Commission. If you have a problem with your employer, you don't need to go straight to litigation, you can take it up with your state's Labor Commission. I'd like to see something similar for malpractice - a state-run board comprised of lawyers and doctors (in the wild, lawyers and doctors are vicious enemies who mark territory, track each other by the scent of their unique pheromones, and leap for the throat on sight) who take up patient advocacy allowing at least some issues to be resolved independently and out-of-court.
Health spending accounts - Another suggestion you hear a lot from the right-wing. Basically, this is a tax shelter where you can have a certain percentage of your paycheck go (before taxes) into a special savings account that can then only be spent on health care. It's all the benefits of paying for your healthcare with cash and none of the drawbacks of an actual savings account. And it's an amazingly useful tax shelter for the wealthy and middle-aged! Did I mention that this idea is fucking stupid?
More doctors! (and nurses) - There's a shortage of health care professionals in this country, driven partially by a shortage of health care teachers. It's tough to get into med school and, surprisingly, tough to get into nursing school. Part of the reason they accept so few applicants is not because few people qualify, but because there isn't enough classroom space to take them all. See, if you want to teach future doctors, at most universities for most teaching positions, you have to be a doctor yourself - or have gone through comparable schooling. Ditto for nurses. But teachers don't make a comparable salary to their professional counterparts, so they don't get many health care program graduates who want to come back to teach. My suggestion? Mucho tax benefits for the teachers themselves. Also, give tax breaks to the universities who hire them as long as those universities also agree to let in more applicants. Make teaching a little more profitable, and more doctors/nurses will want to teach.
Some other terminology:
Provider - Any health care professional who directly helps patients. A "provider" can be a physician, a nurse, a physical therapist, or even a psychologist. Providers aren't necessarily people, either. A hospital can be a provider, as can an emergency room, or a diagnostic lab. Basically, whoever provides the care is a provider.
Payer - Whoever pays for the care. This is usually an insurance company, or it could be the government, and if you're really unlucky, it's you.
Note that there's no such thing as a "health insurance provider." In Healthcareland, a provider is always a patient-care provider, and an insurance company is usually a payer. (The exception to this are HMOs like Kaiser, where Kaiser is both the payer and the provider because they have doctors directly on salary.) So please don't use the phrase "health insurance provider," or I'll put a dunce cap on you and stick you in the corner with no food and no ice cream until bedtime.
So what does Feral think?
We need a multi-tiered approach. It doesn't have to be done all at once.
Step zero: Cut Bush's tax cuts on the wealthy. Sorry, we need a way to pay for this. Oh, and did I mention get the fuck out of Iraq? Yeah. Get the fuck out of Iraq.
Step one: mandate a national standardization of medical records and insurance paperwork. We're partway there - some billing procedures are standardized, but some are not. Give tax incentives to payers and providers that switch to a standardized, interoperable electronic medical record system.
Second, expand Medicare - not to everybody, but start by making it an opt-in, premium-driven system for the self-employed, the unemployed, and people with chronic health conditions who can't get on individual insurance. Put an income cap - it should be for the lower-income and lower-middle class. Expanding it to everybody all at once could be disastrous, we need to do this stepwise.
Third, compulsory health insurance. The uninsured are a drain on the economy - they utilize hospital resources and then have to be given breaks because they can't pay for them. If you can't pay for it, get on the newly expanded Medicare. If you don't want to be on Medicare and don't want to pay for insurance, fine, we'll tax you in preparation for the day that you show up at the emergency room with a broken arm and a $5000 medical bill that you have no way to pay.
Fourth, tax incentives for health care teachers and universities.
Fifth, stimulate the adoption of non-physician healthcare professionals like nurse practitioners and physician assistants through additional tax incentives and awareness campaigns. Many of the decisions a doctor makes in his daily practice can be done by somebody with less education. It doesn't take an MD to diagnose an ear infection and prescribe antibiotics. Many emergency rooms are hiring physician assistants for this very reason, but growth of the PA system is still relatively slow.
Sixth, tax subsidies for the healthcare industry. We already give subsidies to emergency rooms and we give grants to research hospitals, but we don't subsidize your run-of-the-mill neighborhood private practice, even though our private doctors are the frontline grunts for the entire healthcare industry. Further, it should be cheaper to get preventative and diagnostic care... but guess who's giving preventative care? Yeah, general practitioners in private practice.
Seventh, raise the retirement age. As people retire, they use more healthcare resources but rely more on Medicare and post-retirement employer benefits without giving anything back. The flipside to this is that retirees are getting healthier. I think the retirement age should be increased to 70.
Last, a further expansion of Medicare eligibility. Increase the maximum income cap stepwise every few years until it's feasible to remove the maximum income cap entirely, eventually converting it into a true universal single-payer system.
Discuss!
TL;DR: Fuck you, read the damn post. I could have been out getting drunk and snorting coke off a hooker's ass, but instead I wrote this because I love you guys so much. The least you can do is read it.
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
the "no true scotch man" fallacy.
the "no true scotch man" fallacy.
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The idea of having lesser educated professionals to deal with common illnesses sounds like a good plan, but I wonder if they would be able to diagnose more serious illnesses with symptoms simmilar to colds/the flu/ear infections. Do you think that if PAs became more popular that they would open up a type of healhcare targeted at the poor that would insure them for visits to offices mostly staffed by PAs instead of doctors?
A PA degree is basically a Master's degree.
Honestly, if a disease looks like an ear infection but is something else, most of the time it's going to be treated like an ear infection anyway. An ear infection probably isn't a good example; let's say lung cancer vs bronchitis. If somebody comes into a doctor's office with a cough and wheezing and shortness of breath, the doctor isn't going to rush them straight to imaging just in case it's lung cancer. He's probably going to treat it like a flu or bronchitis (depending on what it looks/sounds like) first. Only if the patient comes back complaining that the treatment isn't working will he look at more exotic possibilities.
I don't think that a lack of education is an issue in and of itself; I think a lack of face-time with patients is more of an issue. A PA who's able to sit down with a patient for 30 minutes and take a good family history and look at all the possible symptoms is going to have a better chance of finding leads on those exotic disorders than an MD who can only sit with the patient for 10.
But I'll admit to being a little bit biased in favor of PAs, because one of my best friends is one.
the "no true scotch man" fallacy.
I've had nothing but awesome experiences with nurse practitioners and PAs. Feral's suggestion to use them in a larger capacity is an excellent idea.
Warframe: TheBaconDwarf
Expansion of coverage is important, but it's not the only issue. I don't know how things are with Medicare, but there are assloads of folks on Medicaid (gov't health coverage for poor people) who don't go to the doctor; instead, they wait until their condition becomes serious and then go to the ER. This drives up costs and results in poorer health for those patients. We need to not only make sure that everyone is covered, but also to be certain that everyone has a doctor they will go to who properly manages their care.
I'm all for individual states sharing the burden of health costs but what I know of Medicaid in California (MediCAL) is a huge bureaucratic clusterfuck.
the "no true scotch man" fallacy.
I'm inclined to agree, because people are afraid to go to the doctor for fear of high cost of procedures or medication, that Medicaid may not cover. Thus, you have a nation that is trained not to get anything done until it's serious.
So yeah, we have another example of the importance of prevention and maintenance. Maybe if coverage is increased, they can convince more people to go for those sorts of things. But again, the money has to come from somewhere and I see too few people stepping up the to plate wanting a tax increase. Consider money is tight for lots of people now, gas prices are rising, and so on and so forth... come election time the mantra of increased taxes isn't going to sit well.
Warframe: TheBaconDwarf
It's the same in South Carolina. At least 20% of our population is on Medicaid at any time. Curiously enough, though, we have some of the most advanced electronic medical records systems in the country.
OK, I should preface this with the disclaimer that I am drunk and just snorted coke off a hooker's ass. From my conversations with doctors, doctors don't get paid enough for the trouble they need to go through to get a license and that is why there is a shortage of doctors. I see the numbers from my own insurance statements and I've heard medicare etc. pay pennies on the dollar. Socialize medicine = less doctors. Private medicine = more people who can't afford doctors. Utopia is such a bitch to concoct. My solution is to have the basic stuff of national health taken care of by the nation: immunizations, clean water, emergency care. Let a private system take care of the stuff that isn't that big a deal in the grand scheme of things (although it might be a big deal for you). Presumably a smart polis can jigger the fulcum as necessary. One hopes.
― Marcus Aurelius
Path of Exile: themightypuck
Also, I think that part of the problem could also be improved by separating doctors who will work primarily in labs (i.e. technicians) and those who work with patients.
Since the government doesn't really crack down on them in the US, they can bilk us to offset when a government abroad cracks down on them. Brazil recently forced Merck into a compulsary license for an AIDS drug undercutting their offer.
However, given how stringent the requirements are for FDA approval and the amount of time required, I don't know of any easy solution to the problem.
I'll be fine, just give me a minute, a man's got a limit, I can't get a life if my heart's not in it.
There are a few ways in which just general reform of the system can effect improvement in this arena.
First, more prevention leads to fewer people needing expensive drugs. Here's a list of the top ten selling drugs in the US by dollar sales and their major uses:
Zocor - Cholesterol
Nexium - Acid reflux
Prevacid - Acid reflux
Advair Diskus - Asthma
Plavix - Acute coronary syndrome and thrombolytics (stroke)
Zoloft - Psych
Erythropoietin - Anemia from diabetes or cancer
Enbrel - Anti-inflammatory (rheumatoid arthritis)
Norvasc - High blood pressure
Two are cholesterol drugs, two more are cardiovascular drugs, one is partially used in diabetes. The need for these drugs would be diminished (though admittedly far from eliminated) if people took better care of their bodies, and a step in that direction is for better access to preventative care.
I'd also like to see fuck-you-in-the-ass taxes leveed on the tobacco industry, considering that smoking is responsible for around 30% of cancers, not to mention cardiovascular disease, and the funds funneled back into healthcare. Better insurance coverage for smoking cessation would be nice, too. But again, I'm heavily biased against the tobacco industry. If I could drain the plasma from tobacco CEOs vascular systems and make Factor VIII out of it for hemophiliacs, I would.
Also, a single-payer system would have far greater power to negotiate drug prices and buy them in bulk, reducing consumer costs.
That said, I'm a little hesitant to attack pharma marketing. I would like to see a ban placed on direct-to-consumer marketing for prescription drugs, and tighter controls placed on the bribes *cough* er, incentives, they give to physicians. But I don't think that these measures alone would reduce prices.
I also know that physicians are more interested in prescribing drugs based on how well they think they work, not necessarily how much they cost. I'm not necessarily attacking this practice, I'm just wondering if it makes much sense, economically. Sure, if a physician knows that, say, Zoloft is a better drug than generic Prozac, he'll prefer to prescribe Zoloft because it's in the best interest of his patient. But what if the patient would have done just fine on generic Prozac? I'm wondering if there's an ethical and reasonable way to promote greater use of off-patent generics instead of on-patent brand names, or even if such a change is desirable.
A lot of countries give pharma companies incentives for developing drugs for undertreated and exotic diseases. I don't know how the US compares against other countries in this regard, but I think it's a great idea.
the "no true scotch man" fallacy.
So one of my friends works as a drug representative for a major pharmaceutical company. And let's just say, it's a bloated industry.
One example: Many doctors won't even meet with him unless he provides a full meal for them. He is constantly having to give perks to said doctors to keep them talking to him, let alone to look at his company's products.
Warframe: TheBaconDwarf
August 25 - Pfizer, pizza
August 27 - Merck, burritos
September 1 - Forest Labs, deli sandwiches
etc.
the "no true scotch man" fallacy.
And that's because people want to make money rather than save lives. This is why we have bad doctors.
Sorry, it's offtopic, but I'm really adamant about doctors who get into the field for the wrong reasons.
http://fantasy.premierleague.com/my-leagues/
The join code for the CLASSIC league: 214755-65927
The join code for the HEAD-TO-HEAD league: 5294-3346
You aren't really going to change that any time soon, so lets focus on what is fixable.
Wow. That's actually quite amusing.
I also get a kick out of having a huge stack of Vioxx post-it notes. Although, to be honest, they don't stick for shit. Coincidence?
Warframe: TheBaconDwarf
Sadly, that's not the case. It's pretty well documented that the AMA restricts access to benefit themselves, maintaining an artificial shortage of doctors as a means to keep their skills at a premium. In fact, there's several problems that would be remediated by reining in the AMA, such as malpractice insurance rates.
Fencingsax, while malpractice insurance rates are high, it's not because of lawsuits despite what the AMA and the insurance industry claim. It's actually because of them. The AMA refuses to take a hardline stance on doctors that commit malpractice, even after studies have shown that malpractice is mainly caused by a small number of bad actors. And the insurance companies raised rates in order to recoup losses on the stock market when the tech bubble burst - insurance rates have risen across the board, and insurance companies have resorted to hardline tactics to cut "risky" policyowners, such as cancelling the policies of homeowners that submitted claims.
I should have been clearer, but I was aware that most malpractices were caused by relatively few. The rest of the stuff I did not.
I resent that. I think people who go into healthcare mostly do so because of a need to help people. However, the US healthcare system chews these people up and fucks them up the ass. If you can't help sick people because they can't afford the medicine they have to take or some surgery..if the old people you take care of rot away in their beds because there is not enough staff..when you have to cut in half the amount of painkillers for a patient in chronic pain because of the insurance company..well, good luck keeping your goodwill and not becoming a bitter fuckhead.
There are two reasons people go into healthcare, just like there are two reasons people go into law. Unfortunately, the people with the more altruistic reason have it much, much harder for a variety of reasons.
Massive oversimplification. I'm pretty certain that there are a lot of doctors who got into it because they were interested in the field, or because they were good at it, and that to me is a perfectly good reason to choose a career. Maybe I could have got the qualifications for a nurse if I wasn't studying someone else the last few years, and then I could very well have saved a few lives by now. Am I evil because I chose something I enjoyed and was good at instead? Besides, there are a fair few careers that pay as well as/ better than medicine if you are good enough. Doctors aren't divided into the greedy and the saints.
And yes, of course I was oversimplifying, because there can also be any combination of motives.
This isn't true. The Canada Health Act states that it is illegal for a doctor or health care professional to charge directly to the patient for a service that is covered. But it isn't illegal to charge for something that isn't covered. For instance, I get "supplementary" insurance coverage from my university, which I use to pay for eye exams and trips to the dentist. But when it comes to general health-care stuff, you usually don't pay at all. Just the other day, I went to see my General Practitioner. I just waited around until he had a free moment, when in, he fixed me up, and I just walked out. Didn't have to fill out any forms or pay anything. It's like that way when someone has to go to the hospital, too, as long as you have your Care Card.
Definitely a superior system, in my opinion.
Did I say anything about people being evil if they don't want to save lives? No.
Did I imply that doctors who aren't in their field to help people are in the field for the wrong reason? Yes.
http://fantasy.premierleague.com/my-leagues/
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Everybody wants to get paid more. According to the US Department of Labor, the average primary care physician gets paid $137k-$156k per year and it goes north from there for specialists. That seems pretty respectable to me. Would I like to see doctors make more money? Sure. I want to be one someday, so if God came down the day after I get into med school and said "Thou shalt pay physicians a million dollars per year!" I'd be dancing in the street... but for purely selfish reasons. I don't think that a vast increase in the average salary of physicians is going to attract the type of people we want to be physicians. If the issue with the physician shortage is a largely economic one, I'd like to start by seeing what we can do to reduce malpractice insurance premiums.
I don't support socialized medicine.
From time to time if the AMA predicts a doctor surplus, they'll make recommendations to medical schools to limit the number of applicants accepted. The last time this happened was the late 90s. Now that there's a shortage of physicians (and all healthcare practitioners, basically) they and the American Association of Medical Colleges are calling for an increase in enrollment, and the schools are having trouble keeping up.
Of course, part of the reason he have a practitioner shortage right now is because the AMA and AAMC throttled back enrollment a little too hard in the 90s, so your point as some validity.
Actually, I do, on occasion. I don't smoke every day, I don't smoke when I'm anxious, and I don't have nicotine cravings. So if a pack of cigarettes is $6 instead of $4, it doesn't really affect me, because I only buy a pack every three or four months. Partly because I don't have an "addictive personality" at all, partly because when I start to have nicotine cravings I have the common bloody sense to quit for a while so I don't end up an addict.
As for whether or not they already levee fuck-you-in-the-ass taxes, the current federal tax rate on a pack of cigarettes is $0.39, and the average state tax rate is $0.84. Right now, if you smoke a pack a day, you're spending about $20-30 per week depending on your favored brand and where you live. A two week box of Nicoderm costs around $50. A month's worth of generic Zyban is $100 before insurance. Both of these products are recommended for use in the context of a formal smoking cessation program which will also involve seeing a doctor, thereby incurring more expense. In other words, it costs as much or more in the short term to keep smoking as to quit if you're a pack-a-day smoker. Consequently, if you're looking at a month-to-month outlook, quitting right now doesn't necessarily make economic sense. I'd like to see smoking become more expensive than quitting, and the easiest way to do that is to increase taxes combined with improved access to physicians.
Smoking is responsible for 300,000-400,000 new cancer cases per year in the US and around 440,000 deaths. These aren't quick and clean deaths either - no death ever is, but deaths from smoking are often long and protracted affairs involving numerous expense attempts to combat cancer or long periods of time on cardiovascular drugs. To compare, breast cancer causes around 500,000 deaths per year, and through 2005 AIDS caused a cumulative 525,000 deaths. If smoking were an infectious disease, people would be driving around with magnetic ribbons on their bumpers that said "Support smoking cessation!" If we treated nicotine addiction like the health issue it is, if I told somebody that my mother smoked a pack a day (she doesn't thank god), they'd react with an concerned "Oh, no! Are you okay? This must be hard for you!" as though I told them that my mom had cancer. I can't find recent statistics for the number of deaths per year caused by methamphetamine abuse, but in 1996 it was estimated to be 700. Not 700 thousand, just 700. Yet we've got politicians calling methamphetamine an epidemic, but no politician would dare to call nicotine addiction an epidemic, even though the public safety risk appears to be thousands-fold greater for nicotine than for meth.
But we wrap tobacco use up in the rubric of personal choice, due largely to the propaganda of the tobacco industry. I'm not suggesting we ban it, I'm saying that we're nowhere near making it economically impractical to smoke rather than to quit. And that's all I'm going to say on the matter, because I don't want to derail my own thread into a discussion on smoking on page 2... so if you want to get the last word in at me, have at it.
the "no true scotch man" fallacy.
The thing with the medical schools is that the AMA acts as gatekeeper - there are laws on the books that say that for a doctor to be licensed, he or she must have a sheepskin from an AMA-accredited school. By deciding which schools are accredited, and the fact that revocation of that accreditation is a deathblow to a medical school, the AMA has full control over how many seats are available. As for their push to increase enrollment - if the shortage gets bad enough, lawmakers might rethink those laws about accreditation.
Heck, he's let me walk out with bags of freebies before when we were trying new drugs just so I could find out if X worked better than Y before plunking down money on the copay. Of course he holds the cholestoral and good drugs back for his poor and elderly patients. His theory is if they're going to buy him lunch, fine he'll enjoy it. If they're going to give him drugs, fine he'll use them. But if they expect him to go with a second or third best choice because he got a steak one day, they're crazy.
As for doctor pay, don't forget that they come out of medschool owing about 200k. My friend is a pharmacist and she's in debt 90k, and most of that came at the end.
and Micheal Moore is funny. The only person who could make an antiAmerican movie about the one thing Canadians are happy to say is a Canadian attribute just to set themselves apart from US and even they think the movie sucked because it ignored the problems in the Canadian medical system.
At 24, working 40 hours a week, my company "offers" health and dental care, but at rates so high there is no way in fuck I can even think about coming close to affording it. Basically I would have to completely eliminate rent from my bills somehow to afford it.
And believe me, I'd love to have my knee looked at(hurt it hiking), and my teeth fixed (I've got some nasty cavities, that have turned to pretty much rotted out teeth). But it's not going to happen.
You should look into catastrophic insurance for your body and shoulda sucked it up and paid the $75 for a dental visit. Heck, getting my 4 wisdom teeth yanked 3 years ago cost all of $350 and that included a half hour of overtime for the oral surgeon and gaspasser.
As for your knee, pay the $80 for your general practitioners visit. He'll probably say tendon blah blah and prescribe some prescription strength ibuprofin for the swelling. He may ask for an MRI but explain that your uninsured and you'd rather start with what it probably is rather than checking out everything it possibly could be.
If it continues to be a problem you're screwed in that you'll have to take out a signature loan with the MRI provider to do the scans so your doctor can see what it is that's wrong and figure out the next step. One of my friends in college a few years ago had back problems and no insurance, he was freaking out. Went to the doctor when it became a life altering amount of pain, a quick physical and a signature for a $3000 loan later it was diagnosed as something weird with a muscle, a shot and little time and he as fine.
Again, I'll say this, look into catistrophic health insurance. It costs less than my cable bill does and covers the big problems. A simple 0% credit card can carry the incidentals and prescriptions if you're just impossibly broke right now and can't pay cash.
As for dental I'll just say what I've read from a few places, anything expensive enough to be a real problem in your mouth is going to be so bad as to need a doctor of medicine and not a dentist. Your dental doesn't get you much more than a couple of checkups and a cavity or two filled a year. If your jaw is smashed in you're going to be seeing a plastic surgeon or something and getting everything fixed with him, that'd be regular health insurance. That's the explanation I've read and it made sense.
You may find it makes more sense to get dental and health insurance to cover every cold and sniffle you get, but as you see, you have to pay for that.