Darryl Issa's Idea for Replacing Obamacare

[AViking]

I grew up during the cold war. Socialism and Communism were bad words. We need to get people out of office who still believe that. Socialized medicine isn't perfect. However it's better than what we have in the states since it's simply too expensive to have our current system. You will bankrupt the USA if you do not reform healthcare. This is the first step.

Now if you are for healthcare providers pulling in huge sums of money, lawyers pulling in huge sums of money, and huge parts of America unable to get health insurance, going bankrupt from doctor bills, etc then we're not on the same page.

For those of you still scoffing at socialism. In the socialist hellhole that I live now (yes that was a joke) I pay more taxes. Depending on income in can be quite a pretty penny. However when you factor in everything you get for your taxes and not needing to spend these large sums of money on insurance premiums and deductibles I actually come out ahead here. It really isn't until you're making a TON of money that you start falling behind.

No doubt, if you make $500,000 a year it's better to have a $15,000 health insurance bill than pay an extra 5% on your taxes. However for the rest of us normal people making normal salaries it's far better to have a small bump in your taxes to get socialized medicine. Making $100,000 and paying an extra $5,000 in taxes to get healthcare for your family? Wonderful!

If has to be done correctly. Which it is in many countries. The USA is making some progress.

 

[Wardawg1001]

It does one thing. They can simply not pay the high prices that a medical provider provides. Once enough people use the ACA then it might be hard for providers to not service ACA customers.

I went to a specialist about 8 years ago and the doctor would not accept my insurance. I was using Blue Shield and they said that they would only pay them $60 for my office visit so they would demand cash. I had to pay $200 for a 15 minute visit. I had a HSA so I didn't care that much but this high priced healthcare needs to stop.

Another good example is that I got an MRI and they said my health insurance wouldn't cover it. They billed me $5000 for an MRI of my back. Six months later my insurance paid them and settled it for something like $1500. Of course the reality is that an MRI for the back only costs about $300 so they were still overcharging by about 500%.

You can't stop them from trying to overcharge unless you make big changes. Obamacare is at least a start. At some point you have to ask yourself why you are using expensive insurance to overpay your healthcare providers. The more people get on ACA the cheaper it will become. Hopefully in the near future we'll see that US healthcare costs drop significantly below the 17% of GDP we currently pay.

I'm fuzzy on many of the specifics of the ACA, but I don't recall hearing anything in it that would address this anecdote that you've given.

What part of the ACA would prevent doctors from erroneously claiming that your insurance will not cover a procedure that they do in fact cover?

Which part would stop them from incorrectly giving you a $5000 bill because they lied to you about the insurance coverage?

Which part would stop them from charging a 500% markup on a simple procedure?

What is the basis for your claim that insurance becomes cheaper as more and more people get on ACA healthcare plans?

 

[zinfamous]

I don't know how Darrell Issa got to be that rich if he's that dumb.

lots of insurance fraud, and other miscellaneous criminal activities.

http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_lizza

A real winner, this guy.

 

[rudder]

Funny that. People seem to be entirely willing to do so in most of the rest of the First World.

http://www.practicelink.com/magazine/vital-stats/physician-compensation-worldwide/

Most of the other first world nations subsidize physicians' education more heavily, I suspect.

Graduating from medical school with a $150,000 debt is a problem... and with careful thought it could be addressed. But still though, this is a good chunk of your life dedicated to learning a skill... one with great responsibility. I don't think doctors (not talking about Hollywood plastic surgeons) are overpaid at all... especially knowing how little (relatively speaking) family physicians earn. An a career that can be taken away in an instant.

People say Cuba has better healthcare than the U.S. Well it is true they spend a fraction of what Americans spend each year. Of course their doctors also don't get paid much more than anywhere else. I don't think that would fly in the U.S. And I think if someone were to go to Cuba and experience the healthcare system down there I bet they would say the U.S. is top notch. Lack of supplies, run down facilities, physician training, etc do effect Cuban healthcare. Sure it is free but not sure I would want to experience first hand.

 

[Jhhnn]

Graduating from medical school with a $150,000 debt is a problem... and with careful thought it could be addressed. But still though, this is a good chunk of your life dedicated to learning a skill... one with great responsibility. I don't think doctors (not talking about Hollywood plastic surgeons) are overpaid at all... especially knowing how little (relatively speaking) family physicians earn. An a career that can be taken away in an instant.

People say Cuba has better healthcare than the U.S. Well it is true they spend a fraction of what Americans spend each year. Of course their doctors also don't get paid much more than anywhere else. I don't think that would fly in the U.S. And I think if someone were to go to Cuba and experience the healthcare system down there I bet they would say the U.S. is top notch. Lack of supplies, run down facilities, physician training, etc do effect Cuban healthcare. Sure it is free but not sure I would want to experience first hand.

Don't start up with spurious references to Cuba, OK?

I mean, I'm confident that Repub policy taken to the limit would reduce us to a third world society of a few very Rich & the rest very Poor, but we haven't yet arrived at a revolutionary threshold.

Part of the problem with American medicine is a dearth of physicians, leading to a lack of competition & artificially high prices along with limited access. That's why doctors can afford to turn away medicaid patients, & the why the high price of entry to the field creates a shortage in less populous & affluent areas. It cuts both ways at the same time.

It's just the way that the very "conservative" AMA wants it. Otherwise, it'd be different.

Physicians carry no greater responsibility that many other professionals, like structural & civil engineers, for example. It's just more personal, more one on one.

 

[Mr. Pedantic]

Don't start up with spurious references to Cuba, OK?

I mean, I'm confident that Repub policy taken to the limit would reduce us to a third world society of a few very Rich & the rest very Poor, but we haven't yet arrived at a revolutionary threshold.

Part of the problem with American medicine is a dearth of physicians, leading to a lack of competition & artificially high prices along with limited access. That's why doctors can afford to turn away medicaid patients, & the why the high price of entry to the field creates a shortage in less populous & affluent areas. It cuts both ways at the same time.

It's just the way that the very "conservative" AMA wants it. Otherwise, it'd be different.

Physicians carry no greater responsibility that many other professionals, like structural & civil engineers, for example. It's just more personal, more one on one.

The AMA has been very forthright about how much of a shortage there is going to be. The answer has always been, depending on the specialty, "a little" to "it'll be a catastrophe".

Do you guys seriously have to wait over a month for a doctor's appointment?

 

[Jhhnn]

The AMA has been very forthright about how much of a shortage there is going to be. The answer has always been, depending on the specialty, "a little" to "it'll be a catastrophe".

Do you guys seriously have to wait over a month for a doctor's appointment?

Hogwash. Only recently has the AMA acknowledged the possibility of a shortage. They've worked for decades to limit supply.

http://usatoday30.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

 

[Mr. Pedantic]

Hogwash. Only recently has the AMA acknowledged the possibility of a shortage. They've worked for decades to limit supply.

http://usatoday30.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

So...you think they were wrong on purpose?

 

[Jhhnn]

So...you think they were wrong on purpose?

I think they serve their own interests almost exclusively, regardless of the truth. A "surplus" of physicians isn't bad for the Country, just bad for practitioners.

 

[Mr. Pedantic]

I think they serve their own interests almost exclusively, regardless of the truth. A "surplus" of physicians isn't bad for the Country, just bad for practitioners.

So then why are they now saying there is a shortage? If we accept your premise, shouldn't it be in the AMA's interest to still maintain there is a surplus?

 

[Jhhnn]

So then why are they now saying there is a shortage? If we accept your premise, shouldn't it be in the AMA's interest to still maintain there is a surplus?

Nah. All they propose is a slight increase, a return to the previous level of 2.7/1000, if that. It was inadequate then, and it's still inadequate.

Public pressure only nudged 'em over a little bit. Their efforts are entirely to maintain their position, not to significantly alter the ratio or the profitability of it.

They like the system the way it is, where established members get to exploit shit eating workaholics of at least average intelligence to lockstep through the program, particularly internship & residency.

It follows the same pattern as abusive individuals having been abused as children.

 

[Mr. Pedantic]

Nah. All they propose is a slight increase, a return to the previous level of 2.7/1000, if that. It was inadequate then, and it's still inadequate.

Public pressure only nudged 'em over a little bit. Their efforts are entirely to maintain their position, not to significantly alter the ratio or the profitability of it.

They like the system the way it is, where established members get to exploit shit eating workaholics of at least average intelligence to lockstep through the program, particularly internship & residency.

It follows the same pattern as abusive individuals having been abused as children.

We have 2.7/1000, that's plenty. We could probably do with a few more, as burnout isn't exactly the best possible outcome, but it's adequate.

The main problem, as your link states, is that there are simply not enough generalists to meet demand. Healthcare in the US has always been skewed toward specialist care. This is simply untenable. Most people's problems can be managed by a generalist, who would generally provide equal or better care than a subspecialist, but because of various reasons people don't want to be generalists - they would rather be specialists.

The result is you have a relative shortage of generalists, people flock to specialists because there are shorter waiting times and insurance treats them differently to generalists, specialists get better paid, and more and more graduates go into specialist training. This results in more work for everyone because generalists decrease the overall required physician contact time, so instead of having a perfectly fine situation you have a shortage of all specialties, when it could have been solved by just getting more generalists.

 

[shady28]

So all this talking about barriers to becoming an MD in the US and how Europe has such good healthcare, I decided to look at what it takes in Europe vs the US.

Here's what I found.


http://www.wisegeek.org/in-what-country-is-it-easiest-to-become-a-doctor.htm

Europe :

"Medical school programs in Europe and Australia are pretty standardized: Medical students need to complete six years of undergraduate study, plus an internship. The exception is Germany, which requires completion of a five-year program."

From the same link and other sites, internships overseas tend to be 6months - 15 months.

That makes a total time of 6 to 7.5 years.


United States (multiple sources) :

4 years undergraduate education
4 years medical school
3-7 years residency (& fellowship)
-------
11 to 15 years total


Basically it takes double the time to become a doctor in the US as it does in Europe. And, the candidate has to pay for all of it, unlike in Europe.

Edit : takes 6 to 7.5 years, had 5 to 7.5 years

 

[Mr. Pedantic]

So all this talking about barriers to becoming an MD in the US and how Europe has such good healthcare, I decided to look at what it takes in Europe vs the US.

Here's what I found.


http://www.wisegeek.org/in-what-country-is-it-easiest-to-become-a-doctor.htm

Europe :

"Medical school programs in Europe and Australia are pretty standardized: Medical students need to complete six years of undergraduate study, plus an internship. The exception is Germany, which requires completion of a five-year program."

From the same link and other sites, internships overseas tend to be 6months - 15 months.

That makes a total time of 6 to 7.5 years.


United States (multiple sources) :

4 years undergraduate education
4 years medical school
3-7 years residency (& fellowship)
-------
11 to 15 years total


Basically it takes double the time to become a doctor in the US as it does in Europe. And, the candidate has to pay for all of it, unlike in Europe.

Edit : takes 6 to 7.5 years, had 5 to 7.5 years

None of the figures in the article count the residency training, which varies depending on specialty. The other thing is that many universities offer both an undergraduate and a postgraduate entry pathway: the undergraduate is what is described in the article, whereas the postgraduate is available for people who already have a tertiary qualification.

Take New Zealand as an example. We have both pathways, and I entered through the undergraduate pathway. I have a 1-year "pre-med" year, then 5 years of actual med school, then I graduate. But before I get a residency position I also have to spend 1-3+ years working as an house officer (what you'd call an intern, I guess), rotating between specialties - most people stay for 2-3, but it can be as short as 6 months and as long as 6-7 years for some I know. So the total time, from when I leave high school, is 8-9 years before I enter a training program.

Whereas if I entered through the postgrad pathway (and several people in our class did this), you have a 3 year Bachelors degree, +/- 1 year Masters/Honours, +/- 3-4 years PhD. So before you enter Med School, you may have already spent 7 years as a student. Add on the 5-6 years of med school, and 2-3 years of residency, which totals around 14 years for someone who did a PhD beforehand.

I'm not too familiar with the US system, but from what I understand students get matched to a training program straight from med school - they don't do any post-grad years doing rotations before entering a training program. So 4 years undergrad + 4 years med school makes 8 years.

It really isn't that much different. The only real difference is the financing IMO - my degree is about 70% subsidised by the New Zealand government, and I'll leave school with about $100,000 of (interest free, as long as I stay in New Zealand) debt. This seems a lot to my friends, most of whom graduated with around $30-40k (without having to work menial service jobs in between), but I understand that for you guys that's tiny. The interest-free student loan is the real kicker - without it, I would not have been able to go to Med school. I don't know whether I would even have been able to go to college.

 

[shady28]

None of the figures in the article count the residency training, which varies depending on specialty. The other thing is that many universities offer both an undergraduate and a postgraduate entry pathway: the undergraduate is what is described in the article, whereas the postgraduate is available for people who already have a tertiary qualification.

Take New Zealand as an example. We have both pathways, and I entered through the undergraduate pathway. I have a 1-year "pre-med" year, then 5 years of actual med school, then I graduate. But before I get a residency position I also have to spend 1-3+ years working as an house officer (what you'd call an intern, I guess), rotating between specialties - most people stay for 2-3, but it can be as short as 6 months and as long as 6-7 years for some I know. So the total time, from when I leave high school, is 8-9 years before I enter a training program.

Whereas if I entered through the postgrad pathway (and several people in our class did this), you have a 3 year Bachelors degree, +/- 1 year Masters/Honours, +/- 3-4 years PhD. So before you enter Med School, you may have already spent 7 years as a student. Add on the 5-6 years of med school, and 2-3 years of residency, which totals around 14 years for someone who did a PhD beforehand.

I'm not too familiar with the US system, but from what I understand students get matched to a training program straight from med school - they don't do any post-grad years doing rotations before entering a training program. So 4 years undergrad + 4 years med school makes 8 years.

It really isn't that much different. The only real difference is the financing IMO - my degree is about 70% subsidised by the New Zealand government, and I'll leave school with about $100,000 of (interest free, as long as I stay in New Zealand) debt. This seems a lot to my friends, most of whom graduated with around $30-40k (without having to work menial service jobs in between), but I understand that for you guys that's tiny. The interest-free student loan is the real kicker - without it, I would not have been able to go to Med school. I don't know whether I would even have been able to go to college.

Well New Zealand isn't exactly Europe.

For simplicity, the original article I linked to stated :

"In general, the toughest countries in which to become a doctor are the United States and Canada, since both of these countries require completion of an undergraduate degree first. "

From what you wrote, it sounds like New Zealand requires that undergrad degree, plus a masters. In other words, it sounds a lot like the USA.

That's not the way Europe works. Med school is the undergrad / degree program, taking from 5-7 years. So, right off the bat, you knock off 4 years from a US program.

Germany for example, noting that this is out of 'secondary education' aka 'High School':

"After at least six years of medical school, the students graduate with a final federal medical exam (Zweiter Abschnitt der ärztlichen Prüfung). Graduates receive the license to practice medicine and the professional title of physician (Arzt). The academic degree Doctor of Medicine (Dr. med., an equivalent to the MD)is awarded if the graduate has, in addition, successfully completed a scientific study and dissertation."

More information can be found here :

http://en.wikipedia.org/wiki/Medical_school#Germany

From what I gather, at 6 years you can practice medicine in Germany. You cannot start your own practice until you've completed additional residency to gain a specialization. But that does not appear to be required to practice medicine in say a hospital as a general practitioner.

" If physicians wish to open up a doctor's office, they are required to further complete residency in order to fulfill the federal requirements of becoming Facharzt (specialized in a certain field of medicine like internal medicine, surgery, pediatrics etc.)."

 

[Mr. Pedantic]

Well New Zealand isn't exactly Europe.

For simplicity, the original article I linked to stated :

"In general, the toughest countries in which to become a doctor are the United States and Canada, since both of these countries require completion of an undergraduate degree first. "

From what you wrote, it sounds like New Zealand requires that undergrad degree, plus a masters. In other words, it sounds a lot like the USA.

That's not the way Europe works. Med school is the undergrad / degree program, taking from 5-7 years. So, right off the bat, you knock off 4 years from a US program.

Germany for example, noting that this is out of 'secondary education' aka 'High School':

"After at least six years of medical school, the students graduate with a final federal medical exam (Zweiter Abschnitt der ärztlichen Prüfung). Graduates receive the license to practice medicine and the professional title of physician (Arzt). The academic degree Doctor of Medicine (Dr. med., an equivalent to the MD)is awarded if the graduate has, in addition, successfully completed a scientific study and dissertation."

More information can be found here :

http://en.wikipedia.org/wiki/Medical_school#Germany

From what I gather, at 6 years you can practice medicine in Germany. You cannot start your own practice until you've completed additional residency to gain a specialization. But that does not appear to be required to practice medicine in say a hospital as a general practitioner.

" If physicians wish to open up a doctor's office, they are required to further complete residency in order to fulfill the federal requirements of becoming Facharzt (specialized in a certain field of medicine like internal medicine, surgery, pediatrics etc.)."

Are you sure you read what I wrote?

 

[shady28]

Are you sure you read what I wrote?

Yes I did and I thought it overly complex. What the is done in each individual year of training is irrelevant; how long before you get your medical license and can practice medicine? It wasn't clear from your post, but appeared to be about 8 years.



http://en.wikipedia.org/wiki/Medical_school



Iceland : 7 years
Medical school in Iceland takes 6 years to complete. Students receive a cand.med. degree upon graduation. Following this, Icelandic regulations require 12 months of clinical internship before granting a full medical license.[46]


Ireland : 7 years
For Programmes that are six years in length, entry is based on secondary school qualifications. ...After graduation with the degrees of BM BS (Bachelor of Medicine and Bachelor of Surgery) or MB BCh BAO (Medicinae Baccalaureus, Baccalaureus in Chirurgia, Baccalaureus in Arte Obstetricia), a doctor is required to spend one year as an intern under supervision before full registration is permitted.


Italy : 6 1/2 years
Medical school lasts 6 years (12 semesters). ...After graduating, new doctors must complete a three-month, unpaid, supervised tirocinio post-lauream ("post-degree placement") consisting of two months in their university hospital (one month in a medical service and one in a surgical service) as well as one month shadowing a general practitioner.

Norway : 8 years
Medical education in Norway begins with a six- to six-and-a-half-year undergraduate university program. ... the Norwegian Registration Authority for Health Personnel (Statens autorisasjonskontor for helsepersonell) requires a minimum of 18 months of internship (turnustjeneste) before granting a medical license.

Denmark : 7 years
The duration of basic medical education is six years and the course leads to the degree of Candidate of Medicine. Students are given the degree Doctor of Medicine (M.D.) after swearing the Hippocratic Oath upon graduation.[44]
Medical school is usually followed by a year residency called clinical basic education (Danish: Klinisk basisuddannelse or just KBU) which upon completion grants the right to practices medicine without supervision.

Again, in the USA, 11-15 years.

 

[Mr. Pedantic]

Yes I did and I thought it overly complex. What the is done in each individual year of training is irrelevant; how long before you get your medical license and can practice medicine? It wasn't clear from your post, but appeared to be about 8 years.

It wasn't really a question. It was a hint that you probably should read it again.

http://en.wikipedia.org/wiki/Medical_school

.
.
.

Again, in the USA, 9 years.

https://en.wikipedia.org/wiki/Internship_(medicine)#United_States

FTFY.

 

[SirStev0]

Tort reform, per se, isn't the way to go.

The medical profession, unlike other professions, lacks standards. It would seem they are just 'practicing'.

Accounting is a good example. We have standards for auditing and preparing financial statements. If you follow those, you're fine. Anyone can bring a lawsuit for any reason but if you've followed the standards you should be OK. Moreover, if you 'over' audit the client, thus driving up fees unnecessarily, you'll get in trouble.

Physicians OTOH have no such standards. Therefore you not only have defensive medicine but other sorts of motivations for unnecessary and redundant procedures. What if the patient keeps pushing for other test etc., test that are unnecessary? Well, if his/her insurance covers it the physician is only motivated to provide it. The New England Journal of Medicine (with the AMA IIRC) did a study looking at health care provided to different patients who were as identical as possible. They found that for the same type of patient with the same medical condition that treatment varied by as much as 6 figures (hundreds of thousands of $'s). They then examined these differences in treatment and concluded that there was no valid reason for them.

Professional standards would fix this.

This is the solution to escalating medical costs pushed by some members of the HC industry and no one is listening to them, at all.

Fern

I don't think you know what the term "defensive medicine" means.
It is medical jargon for Cover-your-ass medicine. When granny comes in for the millionth time with belly pain and you don't CT scan her and 2 months later she dies of colon cancer you ass is liable.
Hence they basically hang CT scanners over the doors of ER's.

Medicine does have professional standard recommendations.. lots of them. They are called Best-Practice protocols and there are a LOT of them.

The problem is that there is may only be one or two right ways to do accounting.. Medicine still very much remains an art as much as a science.

We continue to pump out shitty (pharm backed) research that rarely conclusively finds one set way to properly do things. So getting a consensus is just never going to happen.

We also have a huge issue that, frankly, one treatment does not work for two people the same way. It is why there are so many options.
We aren't simple little machines that can be analyzed and engineered. There will never, ever, be a miracle magic bullet. There is frankly just too fucking much variation.
Even on very very very basic levels they are seeing that, for instance, there is massive variation in the protein structure of beta receptors. Everyone has them, but everyone is slightly different.. may very well account for the fact that one person has very different effects from taking lopressor than another person.



Can I also say that comparing Medicine to Accounting might be one of the most completely ridiculous pulled-out-of-your-ass bullshit I have ever read. I had to go back and read your post again just to make sure you weren't trying to be ironic or trolling.

 

[SirStev0]

The AMA has been very forthright about how much of a shortage there is going to be. The answer has always been, depending on the specialty, "a little" to "it'll be a catastrophe".

Do you guys seriously have to wait over a month for a doctor's appointment?

Our subsidized clinic has a 6+ month waiting period and our private docs have like 1-3 month waiting (but you have to have insurance).

We are also a surgical subspecialty, but we are apparently one of the "quicker" places to get into for that specialty.

 

[SirStev0]

Nah. All they propose is a slight increase, a return to the previous level of 2.7/1000, if that. It was inadequate then, and it's still inadequate.

Public pressure only nudged 'em over a little bit. Their efforts are entirely to maintain their position, not to significantly alter the ratio or the profitability of it.

They like the system the way it is, where established members get to exploit shit eating workaholics of at least average intelligence to lockstep through the program, particularly internship & residency.

It follows the same pattern as abusive individuals having been abused as children.

The AMA's argument for all of this is that they would be required to lower their standard's to drastically increase the number of medical students.

This has already significantly happened across the nation... It used to be if you couldn't cut it you could go to a Caribbean school and come in as a FMG (foreign med grad). However, in the last 5 years, "For-Profit" schools have popped up in the USA (after considerably lobbying and money thrown at the AMA) that have standards of "Can you pay/take on $80,000+ a year tuition".

There are also the Residency issues. A vast majority of the issue is Hospitals don't want to take on the cost and risk of residents unless the gov't is going to pay them and they can abuse us for free labor.

With duty hour changes, we have gone from 120+ a week solely slave labor to 80h/week wage slaves. That is 40 hours of lost coverage... and they still have to provide the educational standards necessary.

Aside from the very rough inner cities.. most residencies have fairly stringent educational requirements. And we get inspected. Frequently.

 

[shadow9d9]

ZOMG! The Liberal party has just identified their true agenda - socialism. Sorry, fuck you and never!

It is the Republican's own plan, straight from the Heritage Foundation.. please shut the fuck up.

 

[AViking]

Regarding the time it takes to become a doctor: I have doctors in my family in both parts of the world.

Keep in mind that a "high school" education in Europe is equivalent to a 2 year college education in the USA. Generally speaking Europe's undergraduate degree is very different than in the USA. They focus on their major and not on a bunch of electives and general education.

Also, the residency times vary quite a bit.

The "incompatibility" is when you switch between the systems since they will want you to redo your residency and retake the tests.

 

[xj0hnx]

The stupidity of it isn't the idea -- it's the notion that this is even up for debate.

If you have a better idea, get it passed via law and repeal Obamacare. Really, it is that simple.

That "simple" huh? Fucking ignorant.

 

[dank69]

That "simple" huh? Fucking ignorant.

Well, the first step to acheiving that goal isn't so simple. Namely, transforming the GOP into a party that can get elected once again.