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Sad that we live in a society that condones such corrupt and greedy healthcare system
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US health care the worst while spending the most
- Thread starter uncgriff
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- Politics
superrific
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1. Spend more money. But that's what you're trying to avoid, because American voters have made clear that they don't want to spend more so that other people can get health care (in some cases, not even to get much better insurance but that's a different story).
2. Fix the cost drivers on the physician side. Make med school free or close to free. Set up programs where a full undergrad degree is not needed to start med school.
3. Here's the thing. The Baumol effect predicts that public service goods will become increasingly more expensive, because they are basically not amenable to productivity improvements in the same way that, say, manufacturing is. We can invest in health care technology that improves diagnoses, makes doctors more efficient, etc. -- but at the end of the day, people still need to be seen by a physician. And a physician can only see X patients per hour. I've not seen X lower than four. For my wife, it used to be 2 and is now 3. You can't build an assembly line and layoff half the assembly line to cut costs. You can't outsource to sweatshops.
So in a sense, we're stuck with services that appear to grow more expensive over time, but that's in part in comparison to other things. We spend more of our GDP on health care than we used to, but that's in part because we spend less money on things that have gotten cheaper. We spend way less on computer hardware than we used to; much less on TVs; etc.
And a rich country should be able to afford that. The best way to finance universal health care is taxes on upper incomes. We already saw that a bit with Obamacare. Unfortunately, we have the GOP to block that.
4. Sometimes problems aren't solvable. Let's assume that you're right, and we can't get to comprehensive universal coverage without hitting doctor pay. Well, that probably means that we can't get to universal coverage, because our system with lower doctor compensation would quickly become a worse system. It would be like the UK system which, as you might have noticed, is doing pretty crappy right now. And one of the reasons it's crappy is that they have been losing doctors to the US for a long time. Fully half of my dad's residents were physicians from England or Ireland who did their education abroad, and were coming to the U.S. to make money.
SnoopRob
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That's a very complicated question, but there are a few simple answers that explain a good portion of it (at a high level)...
- We spend a lot on care to solve medical issues once they occur but we do really poorly on preventative care
- Americans expect to be able to do things that significantly harm their health (especially processed foods and lack of exercise) and then expect medicine to save/treat them
- We focus a good bit on creating and utilizing the latest/greatest in care to treat problems in new and better ways
- We privatize the expense of expense of creating both new medical professionals and medical solutions which leads to those professionals/solutions being profit-driven once a part of patient care
What we've created is a system that is likely the best in the world at driving innovation and addressing some of the most difficult medical problems, but also creates high costs across the board while systematically ignoring or not addressing the main drivers of ill health in our nation (which is in many ways outside of the medical field altogether).
There are definitely problems with the system.
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BC/BS has an enourmous share of the Market in NC At one point I think it was 80% of the private market Thats not real healthy I think in Pamlico it may be the ONLY insurer offering an individual coverage
superrific
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Well, that's fine to package taxes and other measures into a policy idea. Just don't say that universal health care will be cheaper in the aggregate, because by your own admission, that's not true. And does it even matter that much? The government would end up spending more money, but it will be cheaper for everyone. Health insurance has gotten per-capita cheaper than it was (when you adjust for quality of insurance coverage) after Obamacare. That should be the selling point: it will be cheaper per person, even if it's more expensive overall because more people are getting more care.
The "problem" I was referring to was the problem of providing universal care for less expenditure. That problem won't be solved by slashing physician reimbursements. In the short-term it might do something but we would be creating a worse system overall. Low pay brought down the quality of our school teachers. We don't want it to do the same for physicians.
If you want to define the problem as "providing universal care," that's doable. Let's not lie about what would be required, though. BTW I'm not saying that physician reimbursement is perfect. Far from it. There are reforms that could be enacted to make the system a bit more rational. But I just don't think there's a lot of room to continue cutting physician compensation in the aggregate while maintaining quality.
Look, I'm married to a psychiatrist so I admit that have some skin in the game on this issue But my views here predate meeting my wife. They also postdate Obamacare. I learned a few things from Obamacare. I think everyone learned some things from Obamacare. I happen to think that Obamacare was a great start. It was never intended to be the end point, and I don't think it will be. But it will take some time. Obamacare itself was decades in the making.
I just don't think the choice should be "doctors making slightly less" or "the system we have now." We could have a system in which doctors don't have to take a pay cut. We'd have to find that money somewhere else. There are lots of places to find it. There's a LOT of potential government revenue (and cost savings) that goes untapped. That's the political challenge. Saying that we don't need to do that because universal care pays for itself is not helpful to that cause, I think.
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We need more-lots more-Physicians
We don't need Physicians getting of Med School with big debt . For starters it means planning to be a Physicans is something way under represented by students that are not from monied families-so we miss out on potential Docs. Secondly for those that go into debt they almost "have to " go into some high paying speciality -so we limit the number of GPs etc
Supply and Demand is a real bitch and we need to get a better grip When I was young man "reading film" was a low paying job for an MD Now with all the imaging technology it has become very high paying . Dermatolgy is now very well paid-it was not that way 30 years ago As Super pointed out Psychiatry pay is now pretty good-not the case 30 yrs ago-maybe even 10. A dozen years ago my father had Heart surgery at UNC-the State Hospital. There was 1 freaking Heart surgeon ( I think Duke would suck up any that were good) . Hospitals now have pretty well paid "hospitalists"superimposed on top of every ones Attending Physician-I guess part of it is to manage insurance limits-potential law suits???
There are tons of issues unresolved in planning Med school expansion . Demand was WAY unpredicted by those planning the number of Med School slots 20 years ago-Folks with good insurance go and see an Orthopaedic surgeon when their finger hurts How many older folks do you know today that get a new knee or Hip? ( A lot the month they become eligible for Medicare ) Medicaid expansion means lots of folks go to various types Docs that never did.
We need lots more doctors
And of course we need lots more Doctors in places that are economically depressed-which geographically is the majority of the country-think Red Counties
We don't need Physicians getting of Med School with big debt . For starters it means planning to be a Physicans is something way under represented by students that are not from monied families-so we miss out on potential Docs. Secondly for those that go into debt they almost "have to " go into some high paying speciality -so we limit the number of GPs etc
Supply and Demand is a real bitch and we need to get a better grip When I was young man "reading film" was a low paying job for an MD Now with all the imaging technology it has become very high paying . Dermatolgy is now very well paid-it was not that way 30 years ago As Super pointed out Psychiatry pay is now pretty good-not the case 30 yrs ago-maybe even 10. A dozen years ago my father had Heart surgery at UNC-the State Hospital. There was 1 freaking Heart surgeon ( I think Duke would suck up any that were good) . Hospitals now have pretty well paid "hospitalists"superimposed on top of every ones Attending Physician-I guess part of it is to manage insurance limits-potential law suits???
There are tons of issues unresolved in planning Med school expansion . Demand was WAY unpredicted by those planning the number of Med School slots 20 years ago-Folks with good insurance go and see an Orthopaedic surgeon when their finger hurts How many older folks do you know today that get a new knee or Hip? ( A lot the month they become eligible for Medicare ) Medicaid expansion means lots of folks go to various types Docs that never did.
We need lots more doctors
And of course we need lots more Doctors in places that are economically depressed-which geographically is the majority of the country-think Red Counties
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Yes. I am all for state med schools to offer graduated scolarships/free rides to those willing to practice ss a GP in Sampson Co. or equivilent for x years. Then if they want to go back to school and specialize, same deal. After x years they can move wherever they want free of debt. Northern Exposure kind of deal.
superrific
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There are federal programs like this, which is how Muslims end up moving to rural white areas in BFE.
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There not many programs that pay your tuition as you go. There are some that will pay off your debt if you work in undeserved areas..by then the many obstacles to Med School have shunned away potential students who are skeeered of the debt
superrific
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That's right. It's debt forgiveness.
Awinisawin
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Just how much do physicians earn — and why?
New research by Stanford health economist Maria Polyakova takes an in-depth look at how — and how much — physicians are paid in the United States.
haroldminer
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Most drugs aren’t advertised
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However, new research by Stanford health economist Maria Polyakova and colleagues — using unique data on physician income — shows that physicians’ personal earnings account for only 8.6 percent of national health-care spending.Just how much do physicians earn — and why?
New research by Stanford health economist Maria Polyakova takes an in-depth look at how — and how much — physicians are paid in the United States.siepr.stanford.edu
This is worth noting-But the rest of the article is what counts
Our results teach how policy drives the most consequential long-run outcomes in this labor market and provide a clear agenda for the future,” they write. “To analyze the long-run welfare impacts of healthcare policies, including those we investigate, we need evidence on the distribution of health impacts and thus social returns to physician ability in different specialties."
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On an Optimistic note I am a geriatric patient-so me and Medicare go to a lot of doctors/specialists. I help out with grandkids and regulary go to a good size Pediatrics outpatient clinic
I am very impressed , amazed , at the efficiency of the operations I go to. But is very expensive to maximize Physican encounters with high numbers of patients. Financial (insurance ) experts. Techs, Nurse, PAS to do tons of screening , discussions with patients-follow up exams.
And at the UNC Health Care outfits I go to there is also the HQs shop with bunches of eager beaver MBAs doing whatever they do to make the world a better place (lol )
But that is all expensive to hire all those folks and build facilities big enough to give them space to work . But man the places I go to give really good care with Tidy wait times
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How much doctors make is less relevant than how much health insurers make for their shareholders, and how much they spend other than direct payment of medical costs. Take out the costs insurance companies add to our health care expenditures, and use the collective dollars we (and our employers) all pay in health care premiums to pay for it.
superrific
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This is not true. Physician salaries are a bigger cost driver than insurance company profits or overhead. The latter is important and certainly adds to cost, but physician salaries are a big difference in our system versus Europe.
