Universal Healthcare

[Canadiens1131]

Originally posted by anitram


Don't you think that this would simply lead to overcrowding because how many doctors in their right mind would work in an inner city ER for half the money when they can work in a posh clinic out in the suburbs, half the hours at twice the pay? You may not mind "more room" at public clinics, but I just don't see how that would be the reasonable end result.

Government regulation and incentives. The problem right now, at least in Quebec, is kind of the opposite - doctors have to head off to middle-of-nowhere towns to practice for several years before they even have a chance at a position in a clinic in an urban area.

In fact, we just about already have a two-tiered system in Canada. I can think of at least five private clinics within walking distance of my downtown apartment, to be honest.

Like anything else, private clinics will be regulated.

[anitram]

Originally posted by Canadiens1160

In fact, we just about already have a two-tiered system in Canada. I can think of at least five private clinics within walking distance of my downtown apartment, to be honest.

That's true in Quebec because of Chaoulli, but it isn't like that in Ontario (and presumably the rest of the country). I wouldn't know where to find a private clinic even if I wanted one. Quebec litigates every bloody thing under the sky.

[BonoIsMyMuse]

Originally posted by onebloodonelife
I think that in theory, universal healthcare is a good idea, but I don't trust the U.S. government to implement it correctly.

That's how I feel, too. I currently have no health care, and it's always something I worry about. I can go to a free clinic on campus right now, but once I graduate next month, I'm on my own. My university isn't offering me any benefits to serve as an adjunct, though I'll be doing the same work I did when I was a unionized grad student, which is frustrating (both the lack of benefits and no longer having union representation). Part of me feels like this is wrong, but part of me doubts the government could institute a universal health care program that's really fairfor all.

As to the debate between inner-city ERs and private clinics, I think it's sort of like schools. There are teachers who teach in urban public school districts, and there are teachers who teach at private or religious schools. The quality of education between public and private schools is certainly debatable, but students aren't being turned away from schools anywhere because there aren't teachers to help them.

[Liesje]

Originally posted by BonoIsMyMuse

As to the debate between inner-city ERs and private clinics, I think it's sort of like schools. There are teachers who teach in urban public school districts, and there are teachers who teach at private or religious schools. The quality of education between public and private schools is certainly debatable, but students aren't being turned away from schools anywhere because there aren't teachers to help them.

Except public school teachers, even at inner-city schools, often make twice as much or more than private school teachers. I'm guessing the opposite is true for doctors?

My main beef with American health care at the moment is not so much the quality of insurance (the main benefit of my job is my health coverage, it's worth taking a salary half of what I could be making), but that you have to spend hours on the phone fighting with people just to actually GET the services and coverage you're supposed to be getting. The expectations for the patient are unreal! For example, over Christmas I had a bacterial infection on my head that turned into a sinus infection and periorbital cellulitis in my eyes. I knew what it was and how to treat it b/c I've had it all before. I logged onto my health insurance account and read ALL of the fine print on how to proceed. It said that I could go to an urgent care facility for a $15 co-pay (mind you, that's ONLY what you pay up front, it ended up costing me another $60), but only after I either got permission from my primary care doctor (PCP - HMOs will NOT give you any coverage if you go to any doctor but your PCP), or tried to call her for at least 48 hours. Um, doesn't calling your doctor for 48 hours over Christmas defeat the purpose of seeking URGENT care!? I thought that was ridiculous, but I called her office anyway and luckily the recording said "this is permission to seek urgent care, we are closed for Christmas." So I went to urgent care and waited forever just to see some guy younger than me not even look at my head and say "yes you need a broad spectrum antibiotic" after 30 seconds. Duh. And that was just a simple infection. I can't imagine getting the coverage IM PAYING FOR if I ever needed a surgery or had an issue that was hard to diagnose (well, my foot ordeal was like that but I don't even want to think about it).

[INDY500]

Michael Moore will have all the answers in his new documentary "Sicko."

[yolland]

Originally posted by randhail
It's also why so many med students opt to specialize rather than doing primary care.

This article from today's New York Times reminded me of this thread.

In Massachusetts, Universal Coverage Strains Primary Care
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In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role. Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the state’s new law requiring residents to have health insurance. Since last year, when the landmark law took effect, about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage. Many are now searching for doctors and scheduling appointments for long-deferred care.
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Dr. Patricia A. Sereno, state president of the American Academy of Family Physicians, said an influx of the newly insured to her practice in Malden, just north of Boston, had stretched her daily caseload to as many as 22 to 25 patients, from 18 to 20 a year ago. To fit them in, Dr. Sereno limits the number of 45-minute physicals she schedules each day, thereby doubling the wait for an exam to three months. “It’s a recipe for disaster,” Dr. Sereno said. “It’s great that people have access to health care, but now we’ve got to find a way to give them access to preventive services. The point of this legislation was not to get people episodic care.”

Whether there is a national shortage of primary care providers is a matter of considerable debate. Some researchers contend the United States has too many doctors, driving overutilization of the system. But there is little dispute that the general practice of medicine is under strain at a time when there is bipartisan consensus that better prevention and chronic disease management would not only improve health but also help control costs. With its population aging, the country will need 40% more primary care doctors by 2020, according to the American College of Physicians, which represents 125,000 internists, and the 94,000-member American Academy of Family Physicians. Community health centers, bolstered by increases in federal financing during the Bush years, are having particular difficulty finding doctors.
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Studies show that the number of medical school graduates in the United States entering family medicine training programs, or residencies, has dropped by 50% since 1997. A decade-long decline gave way this year to a slight increase in numbers, perhaps because demand is driving up salaries. There have been slight increases in the number of doctors training in internal medicine, which focuses on the nonsurgical treatment of adults. But the share of those residents who then establish a general practice has plummeted, to 24% in 2006 from 54% in 1998, according to the American College of Physicians.
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A. Bruce Steinwald, the accountability office’s director of health care, concluded there was not a current nationwide shortage. But Mr. Steinwald urged the overhaul of a fee-for-service reimbursement system that he said undervalued primary care while rewarding expensive procedure-based medicine. His report noted that the Medicare reimbursement for a half-hour primary care visit in Boston is $103.42; for a colonoscopy requiring roughly the same time, a gastroenterologist would receive $449.44.
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“It is a fundamental truth—which we are learning the hard way in Massachusetts—that comprehensive health care reform cannot work without appropriate access to primary care physicians and providers,” Dr. Bruce Auerbach, the president-elect of the Massachusetts Medical Society, told Congress in February.
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The need to pay off medical school debt, which averages $120,000 at public schools and $160,000 at private schools, is cited as a major reason that graduates gravitate to higher-paying specialties and hospitalist jobs. Primary care doctors typically fall at the bottom of the medical income scale, with average salaries in the range of $160,000 to $175,000 (compared with $410,000 for orthopedic surgeons and $380,000 for radiologists). In rural Massachusetts, where reimbursement rates are relatively low, some physicians are earning as little as $70,000 after 20 years of practice.

[anitram]

I got the feeling that randhail was implying that med students in the US don't want to deal with the hassle of insurance companies and that drives them to specialize. Which doesn't make too much sense to me given that we have a severe family physician shortage in Canada, where doctors don't have to deal with insurance companies.

I think the more honest answer is that there is much more $ and prestige in specializing and that the gap has only widened in the last couple of decades, which drives med students in that direction (let's not forget $100K loans). It's sort of why law students go into corporate law rather than legal aid, but then again for all of our faults, at least we seem a bit more honest about the desire to see a payoff than the med students I know. They want the same thing but for some reason choose to couch it in more palatable terms in public.

[yolland]

Are the salary gaps between primary care doctors and specialists in Canada similar to ours then?

[indra]

Originally posted by anitram
They want the same thing but for some reason choose to couch it in more palatable terms in public.

That's because everyone hates lawyers (even when they need one) where doctors are looked at more positively. If you want to earn a lot and don't care what people think of you, you become a lawyer; if you want to earn a lot but do care what people think of you, you become a doctor.

[financeguy]

Originally posted by anitram
It's sort of why law students go into corporate law rather than legal aid, but then again for all of our faults, at least we seem a bit more honest about the desire to see a payoff than the med students I know. They want the same thing but for some reason choose to couch it in more palatable terms in public.

To me, those kinds of calculations and priorities are ultimately a function of a society's overall value system, rather than of the value systems of doctors (or even lawyers!)

It's only in the US and countries heavily influenced by US neo-liberal fanatically free market values (including for example Ireland. We have the second highest paid medical consultants in the world, after the US) that high salaries are viewed as the be all and end all of a career, or that a gifted doctor (or for that matter a gifted lawyer) feels ashamed if they don't earn 300k a year.

In Germany, for example, well qualified doctors don't earn particularly huge salaries. Granted, they earn more than the average industrial wage, but not a huge multiple of it.

I actually hope that if the current recession leads to any positive results, it will lead to a rejection of neo-liberal free market fanaticism and a return to a more balanced society, especially in countries with embarassingly huge income disparities such as the US.

(Who'da thunk it , me, financeguy, the uber-capitalist of FYM, 'coming out' as a social democrat. )

[financeguy]

Originally posted by anitram


Don't you think that this would simply lead to overcrowding because how many doctors in their right mind would work in an inner city ER for half the money when they can work in a posh clinic out in the suburbs, half the hours at twice the pay? You may not mind "more room" at public clinics, but I just don't see how that would be the reasonable end result.

Yep. That's the basic logic that the 'privatise healthcare' brigade ignore.