HC passes Senate

[HumblePie]

I was discussing this the other day with some more intelligent co-workers and friends. Basically here is some of what we discussed.


The current healthcare system in America sucks. We all agree. No one can debate this. It sucks and gets worse year by year. So what are the main points I and my colleagues view as to why it sucks? Okay here it is.

1) Cost.

Healthcare in America costs way too damn much. Which begs one to ask the question, Why? Well there are a several major answers and factors into this. It's not as if there is a lack of supply or demand. Here are some of the major things I've seen, spoken with doctor friends, and people who run hospitals and medical accounts. There is 3 main reasons why medical care in America is too costly and only goes up and up every year.

a) To even earn the right to be a doctor in America, one must have proper education. Educational costs in America have skyrocketed. You see, the higher education system is not a true supply and demand scenario. It operates much like debeers. It's a bait and trap system. Meaning schools need bait to trap students. They do so by spending a ton of money for better campuses, better faculty, better fields, better sports, better tvs, or whatever. The education in most school doesn't differ if they are accredited. So many higher education schools do what debeers does with diamonds and "create" demand. They make it seem like a person gets a "better" education by going to their higher priced school. Then this is reinforced by prior graduates that enforce it later when it comes to hiring. In reality, it's not what you know it is who you know. This leads to doctors graduating with tons of debt from trying to get a degree from high priced schools. To end their debt, they charge more for their services.

b) Operation costs and supply costs. Doctors may know medicine, but rarely do they know much about costs or accounting. The problem is they hire people that may know it but have no problem buying the most expensive crap out there. I knew a doctor that was paying $5000 per stethoscope, when he could have bought the same thing for a couple hundred bucks. Why? He didn't know and the people that sell him supplies know he doesn't know. They also know he can afford it. Why? Because when he gets charged too much for supplies, he charges more for his services. The more his operating costs increase, the more he charges. The more he charges, the more the supply companies feel they can increase their charges to him. Add in the fact that some things are just ridiculously expensive because of damn near monopoly based items like MRI machines, and you got a recipe for increased healthcare. Does anyone know that MRI machines run into the MILLIONS, but cost no where near that amount to produce? Most MRI's are owned by multiple doctors taking out loans and collaborating funds to make a purchase. To pay off their debts, they have to charge the sick.

c) This is in relation to the previous example with supply costs, but is not from the doctors. An example is pharma companies drive demand for products with pervasive advertising. They also bully, strongarm, bribe, and flat out lie to doctors when it comes to their products. Go watch the old Dateline episode on Clariton and you'll be in for a real eye opener. Look, doctors know how to practice medicine, they don't know much more about the actual medicine they give out usually than what they read on a brochure. It's a corruption of costs by related industries to the healthcare system.

2) Declining care quality

Lets face it, we no longer have the best. America being hailed as the highest and finest standard of healthcare is no longer true. Some still boast it, but the fact remains that we aren't. Doctors and health professionals in other countries do much better jobs and is reflected in lives saved, healthy living styles, and life expectancy. Now, we aren't the worst, far from it, but our care isn't what it once was. Especially not for the price. I personally attribute this to a declining education that focuses more on prestige than actual education. Hiring managers that focus more on where someone comes from than what they've done. Doctors and healthcare professionals getting into the business for the money, because everyone knows doctors are rich! (yah that mentality), instead of becoming doctors to actually help people.

I am not saying we don't have some outstanding doctors, but most will charge so much that only a very few have access to their services.

3) Unequal treatment, pricing, and insurance

Have insurance? You get the red rug rolled out for you. Don't? Then you pay double, triple, or more... assuming they'll help at all. This is just how things currently are and they are wrong. Insurance companies shouldn't be able to dictate pricing and who can be seen and who can not. Insurance needs to do two things, collect money and pay. The whole point of insurance is a system that allows people to basically "pool" money together so that when one person needs it, then that person can gain access to it. The problem is when this is from a "for profit" organization who's interests aren't exactly the interests of the people they are taking money from. They are out to make money. They do so by taking in so much money, and then skimming however much they deem is fit. The other problem with insurance is it leads to corruption very easily. Large amounts of money from uncountable sources with little accountability can lead to corruption and disaster. There are tons of laws in place, now after decades of abuse and corruption, but most of them don't address the real problem with insurance companies. They are for PROFIT.

4) Insurance, more detail

I don't get this concept, every country has taxes. Most people in America have no problem with taxes, which is basically everyone giving up a little money so that we as America can have things that we individually couldn't afford. This includes roads, public schools, a military, and other things. Yes, there is corruption in the system, because where there is big money there are sharks looking to take a bite. However, the government has more restrictions and more people looking over the shoulders of others for more accountability. Why is it that Americans I know have no problem with adding money in for insurance to a for profit organization to provide us with social benefits, but has major objections doing the same for the government who already does this for us? It boggles my mind! Why would you feel more trust in giving money to an organization who's ultimate goal is PROFIT versus an organization who's ultimate goal should be for the people? Again, I am not some naive person that doesn't realize the government has some corruption and people looking for a payday, but it is typically harder for that to happen versus a company that has NO ONE looking over its shoulders. This leaves us paying into for profit companies that are out to only make more profit, which can only be done by increasing premiums because "healthcare costs are going up" which begs the question, are they not helping increase costs in the first place to earn more money?

We also know that insurance companies can, will, and do deny coverage for anything that they can get away with. Prior problem? No coverage. Reach an arbitrary maximum? No coverage. By letting for profit companies have the reigns on the healthcare industry for so long has only helped bring the system to where it currently is today, which is directly into the crapper.



So those are the problems. There are many possible solutions, some better than others, but something needs to be done to address them ALL! If not we'll only be worse off than we currently are or we may get to the point that the only people that can get healthcare in this country are the elite rich.

 

[woolfe9999]

Just so I am clear, you support the current health care bill because it will make the situation worse for everyone, thus forcing good reform?

In my mind this falls under what I have heard phrased as the "chess piece" fallacy. In other words, people are not predictable. They will not move as you intend because they are not chess pieces whose movement is governed by well understood rules. I predict the outcome will not be what you predicted. I have no idea how different it will be, but I bet the people will surprise you.

Well, I don't know if I would put it quite that way. The bill does insure about 30 million more people, and many of the reform provisions will make things better for people. So I see a short term public good there. What I think is that the bill, and in fact the entire present system, is unsustainable in the middle to longer term, and that the bill will accelerate the public's awareness of that fact. It won't necessarily make things worse, but it might, during part of its running time. That depends on whether we decide to keep upping the subsidies to keep up with rising costs, in which case then it will be a deficit buster. And if we decide to not up the subsidies, then the bill just won't cover as many people. I guess what I'm saying is that in the best case, the bill will make us move to single payor relatively soon, e.g. 8-10 years, and in that case the bill itself will be a public good in the shortrun, leading to a longer term public good. In a worse scenario, the bill will not convince us to move to single payor for 20+ years, in which case then in the latter half of that period the bill may cause some harm. There is uncertainty in all of this, but in the longview it is better to have the bill than not have it, IMO.

I wouldn't support the bill if there was no public good in it, just so that it would make things worse and result in real reform later on. This is why it took me awhile to analyze the bill and decide that I supported it. I figured out early on that it was deeply flawed by adding 30 million more customers to a broken system, and that this would probably accelerate the process of real reform, but I needed to satisfy myself that there was sufficient public good in the bill for the shorter term before I could support it.

- wolf

 

[werepossum]

I was discussing this the other day with some more intelligent co-workers and friends. Basically here is some of what we discussed.


The current healthcare system in America sucks. We all agree. No one can debate this. It sucks and gets worse year by year. So what are the main points I and my colleagues view as to why it sucks? Okay here it is.

1) Cost.

Healthcare in America costs way too damn much. Which begs one to ask the question, Why? Well there are a several major answers and factors into this. It's not as if there is a lack of supply or demand. Here are some of the major things I've seen, spoken with doctor friends, and people who run hospitals and medical accounts. There is 3 main reasons why medical care in America is too costly and only goes up and up every year.

a) To even earn the right to be a doctor in America, one must have proper education. Educational costs in America have skyrocketed. You see, the higher education system is not a true supply and demand scenario. It operates much like debeers. It's a bait and trap system. Meaning schools need bait to trap students. They do so by spending a ton of money for better campuses, better faculty, better fields, better sports, better tvs, or whatever. The education in most school doesn't differ if they are accredited. So many higher education schools do what debeers does with diamonds and "create" demand. They make it seem like a person gets a "better" education by going to their higher priced school. Then this is reinforced by prior graduates that enforce it later when it comes to hiring. In reality, it's not what you know it is who you know. This leads to doctors graduating with tons of debt from trying to get a degree from high priced schools. To end their debt, they charge more for their services.

b) Operation costs and supply costs. Doctors may know medicine, but rarely do they know much about costs or accounting. The problem is they hire people that may know it but have no problem buying the most expensive crap out there. I knew a doctor that was paying $5000 per stethoscope, when he could have bought the same thing for a couple hundred bucks. Why? He didn't know and the people that sell him supplies know he doesn't know. They also know he can afford it. Why? Because when he gets charged too much for supplies, he charges more for his services. The more his operating costs increase, the more he charges. The more he charges, the more the supply companies feel they can increase their charges to him. Add in the fact that some things are just ridiculously expensive because of damn near monopoly based items like MRI machines, and you got a recipe for increased healthcare. Does anyone know that MRI machines run into the MILLIONS, but cost no where near that amount to produce? Most MRI's are owned by multiple doctors taking out loans and collaborating funds to make a purchase. To pay off their debts, they have to charge the sick.

c) This is in relation to the previous example with supply costs, but is not from the doctors. An example is pharma companies drive demand for products with pervasive advertising. They also bully, strongarm, bribe, and flat out lie to doctors when it comes to their products. Go watch the old Dateline episode on Clariton and you'll be in for a real eye opener. Look, doctors know how to practice medicine, they don't know much more about the actual medicine they give out usually than what they read on a brochure. It's a corruption of costs by related industries to the healthcare system.

2) Declining care quality

Lets face it, we no longer have the best. America being hailed as the highest and finest standard of healthcare is no longer true. Some still boast it, but the fact remains that we aren't. Doctors and health professionals in other countries do much better jobs and is reflected in lives saved, healthy living styles, and life expectancy. Now, we aren't the worst, far from it, but our care isn't what it once was. Especially not for the price. I personally attribute this to a declining education that focuses more on prestige than actual education. Hiring managers that focus more on where someone comes from than what they've done. Doctors and healthcare professionals getting into the business for the money, because everyone knows doctors are rich! (yah that mentality), instead of becoming doctors to actually help people.

I am not saying we don't have some outstanding doctors, but most will charge so much that only a very few have access to their services.

3) Unequal treatment, pricing, and insurance

Have insurance? You get the red rug rolled out for you. Don't? Then you pay double, triple, or more... assuming they'll help at all. This is just how things currently are and they are wrong. Insurance companies shouldn't be able to dictate pricing and who can be seen and who can not. Insurance needs to do two things, collect money and pay. The whole point of insurance is a system that allows people to basically "pool" money together so that when one person needs it, then that person can gain access to it. The problem is when this is from a "for profit" organization who's interests aren't exactly the interests of the people they are taking money from. They are out to make money. They do so by taking in so much money, and then skimming however much they deem is fit. The other problem with insurance is it leads to corruption very easily. Large amounts of money from uncountable sources with little accountability can lead to corruption and disaster. There are tons of laws in place, now after decades of abuse and corruption, but most of them don't address the real problem with insurance companies. They are for PROFIT.

4) Insurance, more detail

I don't get this concept, every country has taxes. Most people in America have no problem with taxes, which is basically everyone giving up a little money so that we as America can have things that we individually couldn't afford. This includes roads, public schools, a military, and other things. Yes, there is corruption in the system, because where there is big money there are sharks looking to take a bite. However, the government has more restrictions and more people looking over the shoulders of others for more accountability. Why is it that Americans I know have no problem with adding money in for insurance to a for profit organization to provide us with social benefits, but has major objections doing the same for the government who already does this for us? It boggles my mind! Why would you feel more trust in giving money to an organization who's ultimate goal is PROFIT versus an organization who's ultimate goal should be for the people? Again, I am not some naive person that doesn't realize the government has some corruption and people looking for a payday, but it is typically harder for that to happen versus a company that has NO ONE looking over its shoulders. This leaves us paying into for profit companies that are out to only make more profit, which can only be done by increasing premiums because "healthcare costs are going up" which begs the question, are they not helping increase costs in the first place to earn more money?

We also know that insurance companies can, will, and do deny coverage for anything that they can get away with. Prior problem? No coverage. Reach an arbitrary maximum? No coverage. By letting for profit companies have the reigns on the healthcare industry for so long has only helped bring the system to where it currently is today, which is directly into the crapper.



So those are the problems. There are many possible solutions, some better than others, but something needs to be done to address them ALL! If not we'll only be worse off than we currently are or we may get to the point that the only people that can get healthcare in this country are the elite rich.

Man, that's a long and well-written post for me to disagree with pretty much everything in it, but I do. First, quality of care. Survival rates for pretty much everything are highest in the USA when correction for patient factors (such as obesity and diabetes) are included. These things could perhaps be minimized if we have a healthier lifestyle, but that requires either a sea change in attitudes or giving government control over every facet of your life, including diet and exercise. Not so attractive to me anyway. Look at the number of people coming from other countries (such as Canada) to get health care on such things as heart or bypass surgery.

For quality of care, the USA has far greater supplies of sophisticated medical diagnostic equipment available. If your physician wants an MRI scan or other advanced scan in the USA, he or she can schedule it within a few days. In countries with socialized medicine, quantities of such equipment (which is both quite expensive and requires highly trained technicians to operate) are much lower; either your physician puts you in the queue with a wait time of weeks or even months, or he or she proceeds without benefit of the scan. (Although if you have the money, your pet can get an MRI the same day; the benefits of capitalism.) This same principle applies to quality of life issues; people (especially older people) simply have to learn to live with pain or debilitating physical factors in other countries, as hip or knee replacements are simply not available on the scale they are here. Again, those things greatly drive up the cost of health care, but if you're the senior whose future is either a hip replacement or a walker, it means a lot.

I've done electrical design for a fair amount of labs for MRIs, PET or cat scans, and similar high tech diagnostic equipment, sometimes for doctors but usually for hospitals. In most cases there are three to six manufacturers competing for the projects, all of whom can deliver a satisfactory, quality product, based on price, performance and warranty. It's not a monopoly, nor are the people making these decisions in any way foolish or uninformed.

For insurance companies versus government control, insurance companies have two additional controls not available to government - government oversight, and competitors. Government is free to make restrictions controlling the behavior of insurance companies, and to enforce them. Patients are free to petition the (government) courts for redress of any damages or improper denials by insurance companies; government may be sued only where it chooses to give up its sovereign immunity. For the second control, no area has only one health insurance company available, though state government controls have often given making it so the old college try. For-profit insurance companies also compete with not-for-profit insurance companies. For an example of relative efficiencies, look at the number of Medicare supplement policies offered and sold versus the number of private health care supplement policies offered and sold.

For another measure of relative efficiency, stop and think of how many people you know who have been fired or let go because of poor job performance, poor efficiency, or poor work habits. Now stop think of how many people you know who have been fired or let go because of poor job performance, poor efficiency, or poor work habits from government jobs. Other than perhaps postal workers, efficiency is simply not an issue in government jobs.

 

[dyna]

Well, I don't know if I would put it quite that way. The bill does insure about 30 million more people, and many of the reform provisions will make things better for people. So I see a short term public good there. What I think is that the bill, and in fact the entire present system, is unsustainable in the middle to longer term, and that the bill will accelerate the public's awareness of that fact. It won't necessarily make things worse, but it might, during part of its running time. That depends on whether we decide to keep upping the subsidies to keep up with rising costs, in which case then it will be a deficit buster. And if we decide to not up the subsidies, then the bill just won't cover as many people. I guess what I'm saying is that in the best case, the bill will make us move to single payor relatively soon, e.g. 8-10 years, and in that case the bill itself will be a public good in the shortrun, leading to a longer term public good. In a worse scenario, the bill will not convince us to move to single payor for 20+ years, in which case then in the latter half of that period the bill may cause some harm. There is uncertainty in all of this, but in the longview it is better to have the bill than not have it, IMO.

I wouldn't support the bill if there was no public good in it, just so that it would make things worse and result in real reform later on. This is why it took me awhile to analyze the bill and decide that I supported it. I figured out early on that it was deeply flawed by adding 30 million more customers to a broken system, and that this would probably accelerate the process of real reform, but I needed to satisfy myself that there was sufficient public good in the bill for the shorter term before I could support it.

- wolf

How can you support a bill if its already broken? "Real reform" as you call it will cost more money. This bill is a bloated, pork filled, stick it to the republicans legislation. "Real reform" should be small focused fixes to the system over time. If congress actually came up with a plan that reduces costs the need for insurance will not be a necessity. Insurance companies want the prices to remain high, it makes us depend on them. Insurance doesn't give that much security. I have it and I fear having to go to the hospital and see what my final cost will be, just that now 30 million others are going to feel the same way.

 

[daishi5]

Well, I don't know if I would put it quite that way. The bill does insure about 30 million more people, and many of the reform provisions will make things better for people. So I see a short term public good there. What I think is that the bill, and in fact the entire present system, is unsustainable in the middle to longer term, and that the bill will accelerate the public's awareness of that fact. It won't necessarily make things worse, but it might, during part of its running time. That depends on whether we decide to keep upping the subsidies to keep up with rising costs, in which case then it will be a deficit buster. And if we decide to not up the subsidies, then the bill just won't cover as many people. I guess what I'm saying is that in the best case, the bill will make us move to single payor relatively soon, e.g. 8-10 years, and in that case the bill itself will be a public good in the shortrun, leading to a longer term public good. In a worse scenario, the bill will not convince us to move to single payor for 20+ years, in which case then in the latter half of that period the bill may cause some harm. There is uncertainty in all of this, but in the longview it is better to have the bill than not have it, IMO.

I wouldn't support the bill if there was no public good in it, just so that it would make things worse and result in real reform later on. This is why it took me awhile to analyze the bill and decide that I supported it. I figured out early on that it was deeply flawed by adding 30 million more customers to a broken system, and that this would probably accelerate the process of real reform, but I needed to satisfy myself that there was sufficient public good in the bill for the shorter term before I could support it.

- wolf

How do you believe the bill covers 30 million people? Unless I am mistaken,
-the bill itself does not cover them, nor does it establish a public entity to allow them to gain coverage
-It requires that they purchase insurance coverage
-It also requires that insurers drop the pre-existing condition refusals they have now.

I will surrender the point that anyone who could not get insurance coverage because of a "pre-existing condition" will benefit from this legislation. However, I believe that the benefit is merely a redistribution of costs. Those people are not actually buying health insurance they are seeking a financial program that allows them to pay less than the cost of their actual health care, and to force other members of that program to bear the costs. Insurance is group pooling of risk, once a person actually has a condition it is no longer a risk but a cost.

However, for the rest of those people, I do not see how we are actually benefiting them. They could have bought insurance before this bill but either; chose not to or could not afford to buy it. We are going to force the first group to buy something it did not want and fine the second group because they don't have enough money to purchase something they do want.

Did I miss something in this assessment, because it seems to me that this bill hurts a good majority of that 30 million? Although, I do admit that this debate has been so stupid with the republican attack machine in full gear that I don't have the will to research all of it myself to seperate the FUD from the truth. (Which may be part of the republicans plan.)

 

[Hayabusa Rider]

a) To even earn the right to be a doctor in America, one must have proper education. Educational costs in America have skyrocketed. You see, the higher education system is not a true supply and demand scenario. It operates much like debeers. It's a bait and trap system. Meaning schools need bait to trap students. They do so by spending a ton of money for better campuses, better faculty, better fields, better sports, better tvs, or whatever. The education in most school doesn't differ if they are accredited. So many higher education schools do what debeers does with diamonds and "create" demand. They make it seem like a person gets a "better" education by going to their higher priced school. Then this is reinforced by prior graduates that enforce it later when it comes to hiring. In reality, it's not what you know it is who you know. This leads to doctors graduating with tons of debt from trying to get a degree from high priced schools. To end their debt, they charge more for their services.

I haven't time to address everything, but what do you think someone who has gone to school far longer than most people and therefore have lost income while incurring debt, who then have the responsibility of making life and death decisions should earn? What do you think they now earn? Yes I can pull what the Houses of medicine earn who are at the very top of their game, but what is the reasonable expectation a physician entering practice has now?

Also, do you know what the cost of "excessive" wages are compared to the two trillion or so that health cares costs per year?

You make some valid points, which I haven't time to go into, but not all of them withstand scrutiny.

 

[woolfe9999]

How do you believe the bill covers 30 million people? Unless I am mistaken,
-the bill itself does not cover them, nor does it establish a public entity to allow them to gain coverage
-It requires that they purchase insurance coverage
-It also requires that insurers drop the pre-existing condition refusals they have now.

I will surrender the point that anyone who could not get insurance coverage because of a "pre-existing condition" will benefit from this legislation. However, I believe that the benefit is merely a redistribution of costs. Those people are not actually buying health insurance they are seeking a financial program that allows them to pay less than the cost of their actual health care, and to force other members of that program to bear the costs. Insurance is group pooling of risk, once a person actually has a condition it is no longer a risk but a cost.

However, for the rest of those people, I do not see how we are actually benefiting them. They could have bought insurance before this bill but either; chose not to or could not afford to buy it. We are going to force the first group to buy something it did not want and fine the second group because they don't have enough money to purchase something they do want.

Did I miss something in this assessment, because it seems to me that this bill hurts a good majority of that 30 million? Although, I do admit that this debate has been so stupid with the republican attack machine in full gear that I don't have the will to research all of it myself to seperate the FUD from the truth. (Which may be part of the republicans plan.)

The 31 million covered is from the CBO analysis of the bill. It breaks down as follows. About half of that, or 15 million, will come in under the expansion of Medicaid and CHIP. The rest will go to private insurance. There is a mandate, with hardship exceptions and a low penalty for non-compliance, and there are subsidies which pay about 2/3's of the premium costs. So you are sort of correct. People are being forced, under low penalty, to buy the insurance, which will be relatively inexpensive. The CBO estimate is based on how many are expected to comply or not comply and take the penalty. In the house version of the bill, the penalty is much higher, which is why CBO estimates 36 million covered for that version.

- Dave

 

[Hayabusa Rider]

The 31 million covered is from the CBO analysis of the bill. It breaks down as follows. About half of that, or 15 million, will come in under the expansion of Medicaid and CHIP. The rest will go to private insurance. There is a mandate, with hardship exceptions and a low penalty for non-compliance, and there are subsidies which pay about 2/3's of the premium costs. So you are sort of correct. People are being forced, under low penalty, to buy the insurance, which will be relatively inexpensive. The CBO estimate is based on how many are expected to comply or not comply and take the penalty. In the house version of the bill, the penalty is much higher, which is why CBO estimates 36 million covered for that version.

- Dave

Wait, medicaid is a cluster which the government hasn't fixed in half a century, and they are going to expand it?

What's in the bill to fix the deficiencies, and to fund it without killing the states?

 

[HumblePie]

To werepossum:

I am not saying that individual hospitals aren't up to snuff in terms of care, or certain operations. I am well aware of the fact, and stated in my post, that we do have some really good doctors that know and do their stuff. I was making a point to the AVERAGE, the vast majority. Look, I know medical doctors. I go into why I know a large quantity of doctors but that doesn't matter that much. I'll just say this that I am related to someone that handles medical contracts for a large group of doctors and hospitals. I mean a LARGE amount. I have certain insights into this industry I doubt many on this board has.

What I am trying to say is that while there are certain good or even elite individuals, more and more doctors aren't really up to snuff in the US anymore. Quality of overall care has gone down. I am also well aware of how other countries do worse or better than us in many specific examples. You can cherry pick all the examples you want to say, "See I am right with everything because in this one instance you wrong humblepie." Error by division as I hear it is called. Yes, there are some hospitals that are a bit smarter with their finances and look for multiple manufacturers of expensive equipment to play off each other for a better price. Many don't however. Is it because of poor administration? Partly. Is it because of lack of choices where they are at? More so. Is it because of backroom deals and strongarm tactics by either insurance companies or suppliers? Mostly. As I said, I know for a fact there was a Dateline episode that briefly touched upon this subject in regards to the healthcare system. It was done a few years back, but I am telling you it has only gotten worse, not better.

To Hayabusa Rider:

I understand and agree that doctors that spend longer in "training" to earn a degree without making a wage and incurring a huge debt doing so are going to have to make it up somehow. What I do NOT agree with is the system setup to do this. In all seriousness, I have only a bachelors degree and I would say a good half of the classes I was forced to take were worthless to me. At least I was able to CLEP and Dante out of quite a few classes, but I still was left taking some wierd classes just because the school wanted their money out of me in the name of "balanced education."

The higher education system in America is a joke. Sure we have some good schools, and some nice campuses, and some good sports programs but it is not really all that great overall. Do doctors really need to spend 8+ years of their life in school when they are forced to learn subjects that will have no future bearing on their vocation? I think much of the curriculum "fat" could be excised from the education system. We are also one of the few countries which hypes out "colleges and universities" and have very few vocational or trade schools. Not that we are without, I mean if you want to be a welder you can go to a trade school, but if you want to be a doctor, you can't go to a doctor only vocational school around here can you? Something and is a bit more specific and focused upon teaching you only the thing you need to do your future job.

As I said, the higher education system is NOT a supply and demand based model. It's all about bragging to potential students that your school is the "best" because you charge X amount more than any other school. At least that is what it boils down to. Look, I know some complete idiots that have graduated from places like Havard and Yale, and can get a job anywhere because of WHERE they went. That is a fundamental flaw in the education and professional system we have in America. If things were more standardized from the education system, it might have a positive effect in professional field, including healthcare.


Here's the way I look at it. If you have a problem you don't put a bandaid on it. You find the root(s) of the problem and fix it there. No matter how painful, or how much hurt in the immediate future it brings, doing it right from the beginning is the only way to solve the issue. Sticking a bandaid with a soft cushion over a puss filled boil helps a little bit right now, but until you lance that sucker and take a bunch of antibiotics it's only going to get worse eventually.

 

[Hayabusa Rider]

HumblePie, being a provider I'd say that yes, that's a reasonable amount of time considering all that medicine involves. I don't know what you do with your BS degree, but how many times does the life of someone depend on your decision? With a physician, it's every time. Screw up and some gets hurt or dead. I don't think most people understand just how complicated medicine is. You can't learn it from the internet, or in a conventional setting. You can't get an undergrad degree and be competent, and there isn't much fluff in a medical degree program. My wife is a biology professor and is an adviser for pre-med students. They bust their nuts trying to cram in all the things they MUST know to do the job right, and remedial finger painting isn't among the courses they take.

 

[werepossum]

HumblePie, being a provider I'd say that yes, that's a reasonable amount of time considering all that medicine involves. I don't know what you do with your BS degree, but how many times does the life of someone depend on your decision? With a physician, it's every time. Screw up and some gets hurt or dead. I don't think most people understand just how complicated medicine is. You can't learn it from the internet, or in a conventional setting. You can't get an undergrad degree and be competent, and there isn't much fluff in a medical degree program. My wife is a biology professor and is an adviser for pre-med students. They bust their nuts trying to cram in all the things they MUST know to do the job right, and remedial finger painting isn't among the courses they take.

Our doctors are generally among our best and brightest in large part because it is such a high-income profession and therefore attractive. Those would-be doctors who get fluff undergraduate degrees have little chance of even being accepted into medical school, let alone keeping up and graduating. The intentionally limited (to maintain medical degrees as elite and highly paid) number of spaces in medical schools, coupled with the demanding course loads, tends to weed out those who aren't significantly above average intelligence and drive.

For instance, engineering and medicine are both demanding courses of study. I've known a lot of engineers, and some are dumb as soup. Those people made it through four years of engineering and may practice engineering even without a license, and some have passed the PE exam to obtain a license. In medicine those people would likely not be accepted to medical school and would almost certainly not become doctors, leaving them with a not-so-valuable degree in biology or chemistry or health. They would not be doctors. Which is why I've never known a doctor who isn't a pretty sharp character, although I have known a couple who were asshats.

 

[fskimospy]

Our doctors are generally among our best and brightest in large part because it is such a high-income profession and therefore attractive. Those would-be doctors who get fluff undergraduate degrees have little chance of even being accepted into medical school, let alone keeping up and graduating. The intentionally limited (to maintain medical degrees as elite and highly paid) number of spaces in medical schools, coupled with the demanding course loads, tends to weed out those who aren't significantly above average intelligence and drive.

For instance, engineering and medicine are both demanding courses of study. I've known a lot of engineers, and some are dumb as soup. Those people made it through four years of engineering and may practice engineering even without a license, and some have passed the PE exam to obtain a license. In medicine those people would likely not be accepted to medical school and would almost certainly not become doctors, leaving them with a not-so-valuable degree in biology or chemistry or health. They would not be doctors. Which is why I've never known a doctor who isn't a pretty sharp character, although I have known a couple who were asshats.

But why is that desirable? In a perfect world you want only the best and brightest doing everything, but in the real world we want to set the bar to the point at which we maximize the number of people in a profession who can acceptably perform the duties of that profession. The argument here is that our bar is inefficiently high, and I think that the experience of other countries is pretty good evidence for that. I'm not interested in paying doctors an artificially inflated salary.

 

[HumblePie]

There are doctors that specialize and doctors that don't. Not every decision a doctor makes is a life and death one. To the contrary, only certain types of doctors make this decision every day. That vast majority of doctors are the one trying to decide which cough medicine to give out for the cold.

The problem is the specialized doctors, while given an education in things they don't need from a medical perspective (not really a finger painting course), are given education in other medical fields un-related to their specialty as well. Some overlap is needed for certain, but some of it is really filler. I don't have a course schedule right in front of me, but I have see a few as I talked to others about what they did when they went to school.

I have also known quite a few doctors, currently practicing, who aren't exactly the sharpest pencils. Some of them are pretty specialized as well. Not a whole lot, but enough to realize that doctors are people too. By definition of any statistical group, there are some really bright ones, some really dumb ones, and a whole lot of average. I will state that on average that doctors are typically smarter than say your average construction worker. I will not say they are smarter than your average scientist, or engineer, or even computer guy. Why? Doctors do two things primarily. Trouble shooting and memorizing. Unless they are research docs who I have a WHOLE lot more respect for. Those guys are typically geniuses. I am actually pretty good friends with a guy who is the head of a Podiatry department. One of his jokes is that he is basically a "carpenter" and that's most of all he needs to know to do. While being a little bit far fetched, in the fact he needs to know a bit more than a carpenter, what he is getting at is besides that extra bit of memorized knowledge his skill set at heart is really no different.

People portray doctors in a shinier light than they currently are. It all goes back somewhat to the mystery of the medicine man for cultures. The guy who holds life and death in his hands. That sort of mumbo jumbo. He must be smart to outwit death! In reality, most doctors aren't that smart and don't need to be. They just need to know how to diagnose, or look up information when needed. Then they treat a patient like a guinea pig in the fact they proscribe a medicine or procedure that works on the majority of people and hope it works on the current patient. Most of the time it works with some exceptions. The exceptions usually lead to lawsuits but that is a different topic. Anyhow, the value attributed to being a "medical professional" in this country has been artificially inflated and that is what I was trying to point out.

 

[daishi5]

But why is that desirable? In a perfect world you want only the best and brightest doing everything, but in the real world we want to set the bar to the point at which we maximize the number of people in a profession who can acceptably perform the duties of that profession. The argument here is that our bar is inefficiently high, and I think that the experience of other countries is pretty good evidence for that. I'm not interested in paying doctors an artificially inflated salary.

Because people get hurt more often by doctors of lesser caliber. Then we come up with some program to prevent these ills, and viola the bar goes back to being higher. We just had a small internal review of complaints to identify where we can improve, and I must say I am amazed we put up with the doctors we have. It may be logical and intelligent to set the bar lower and accept more mistakes for a more cost efficient care system. However, when your husband/wife/child is harmed directly by a lower bar of quality, those things that help society as a whole begin to look less good.

There is a second problem, the people who have the most power, and therefore the ability to afford expensive doctors want to make sure their doctors are of the highest quality. They benefit the most by raising the quality bar, while the poor suffer. But it is those who have the power who make the decision. There has always been attempts to push back against lower quality products (doctors/food/cars) that provide the poor better access through lower costs. The people who can afford high quality never want low quality products taking over a market, look at all the people who complain about chinese imports and walmart. China and Walmart have raised the living conditions of our nations poor more than many people know, but people want to stop china and wal-mart because of their poor quality. With toys and other cheap crap, cheap won, with healthcare I fear it will not be the same.

 

[woolfe9999]

Wait, medicaid is a cluster which the government hasn't fixed in half a century, and they are going to expand it?

What's in the bill to fix the deficiencies, and to fund it without killing the states?

The fed is picking up the tab for the expansion until 2017. After 2017, my understanding, and don't quote me on the exact number because it comes from a news report I read that could be wrong, is that the fed is picking up 91% of the expansion cost with the other 9% being picked up by the states. Except Nebraska, of course.

- wolf

 

[fskimospy]

Because people get hurt more often by doctors of lesser caliber. Then we come up with some program to prevent these ills, and viola the bar goes back to being higher. We just had a small internal review of complaints to identify where we can improve, and I must say I am amazed we put up with the doctors we have. It may be logical and intelligent to set the bar lower and accept more mistakes for a more cost efficient care system. However, when your husband/wife/child is harmed directly by a lower bar of quality, those things that help society as a whole begin to look less good.

There is a second problem, the people who have the most power, and therefore the ability to afford expensive doctors want to make sure their doctors are of the highest quality. They benefit the most by raising the quality bar, while the poor suffer. But it is those who have the power who make the decision. There has always been attempts to push back against lower quality products (doctors/food/cars) that provide the poor better access through lower costs. The people who can afford high quality never want low quality products taking over a market, look at all the people who complain about chinese imports and walmart. China and Walmart have raised the living conditions of our nations poor more than many people know, but people want to stop china and wal-mart because of their poor quality. With toys and other cheap crap, cheap won, with healthcare I fear it will not be the same.

On what basis are you determining that these medical errors are taking place due to insufficient knowledge, skill, or brainpower by the doctor? Couldn't a VERY plausible reason also be that the doctor cannot spend sufficient time on each patient because there are not enough doctors to go around? The medical industry sure seems to think so as they have been heavily pushing less-than-doctors into roles traditionally done by doctors. (nurse practitioners, physician's assistant, etc.) I've tried to look for a study correlating medical school GPA/class rank to future malpractice suits, but I haven't been able to find one.

 

[woolfe9999]

On what basis are you determining that these medical errors are taking place due to insufficient knowledge, skill, or brainpower by the doctor? Couldn't a VERY plausible reason also be that the doctor cannot spend sufficient time on each patient because there are not enough doctors to go around? The medical industry sure seems to think so as they have been heavily pushing less-than-doctors into roles traditionally done by doctors. (nurse practitioners, physician's assistant, etc.) I've tried to look for a study correlating medical school GPA/class rank to future malpractice suits, but I haven't been able to find one.

While you may or may not be able to find such a study, isn't it axiomatic that people who are less intelligent, well trained, knowledgeable, etc. are more prone to errors? You are certainly correct that errors can also be caused by numerous factors unrelated to intelligence or training, yet intelligence and training would seem in general to be good things, rather than bad, no? The question is whether having high standards, and high pay, is worth the tradeoff for higher healthcare costs. I would point out that in assessing this tradeoff, errors are not the only issue. Brilliant doctors can do things that non-brilliant doctors cannot. My father recently had a very difficult surgery that most surgeons are simply not competent to perform, and this operation has an overall 20% mortality rate, but certain surgeons have mortality rates around 5%. If you pay doctors less money you will not attract the most talented people, and hence if you need the operation, there will far fewer 5%ers around and far more 20%ers, no? Lastly, I will point out that there are many ways to save on healthcare costs without cutting doctor's salaries.

- wolf

 

[daishi5]

On what basis are you determining that these medical errors are taking place due to insufficient knowledge, skill, or brainpower by the doctor? Couldn't a VERY plausible reason also be that the doctor cannot spend sufficient time on each patient because there are not enough doctors to go around? The medical industry sure seems to think so as they have been heavily pushing less-than-doctors into roles traditionally done by doctors. (nurse practitioners, physician's assistant, etc.) I've tried to look for a study correlating medical school GPA/class rank to future malpractice suits, but I haven't been able to find one.

If there was no correlation between success in education and high standards, would that not imply that the education and standards had no impact? I did make an assumption that training and education had an impact, and that success in training and education would lead to success in medical practice. If you feel that lower standards in training and education would not lead to lower treatment success that is plausible. However, I doubt you could convince the public that all those years of training doctors go through was really pointless. Even if you are right, I believe the public in general believes higher quality standards at med schools means better doctors, so even if their is no correlation I still believe my assumption about what would happen is true. I.E. One or two bad accidents happen, people suffer from availability bias and assume this means its worse, they look for a cause, they see we lowered standards, they demand we raise standards.

 

[fskimospy]

If there was no correlation between success in education and high standards, would that not imply that the education and standards had no impact? I did make an assumption that training and education had an impact, and that success in training and education would lead to success in medical practice. If you feel that lower standards in training and education would not lead to lower treatment success that is plausible. However, I doubt you could convince the public that all those years of training doctors go through was really pointless. Even if you are right, I believe the public in general believes higher quality standards at med schools means better doctors, so even if their is no correlation I still believe my assumption about what would happen is true. I.E. One or two bad accidents happen, people suffer from availability bias and assume this means its worse, they look for a cause, they see we lowered standards, they demand we raise standards.

I'm not saying that training and education have no impact, merely that their impact could very well be secondary to the fact that doctors are overworked due to the current severe shortage, so you would have a net gain in overall doctor performance.

 

[Hayabusa Rider]

But why is that desirable? In a perfect world you want only the best and brightest doing everything, but in the real world we want to set the bar to the point at which we maximize the number of people in a profession who can acceptably perform the duties of that profession. The argument here is that our bar is inefficiently high, and I think that the experience of other countries is pretty good evidence for that. I'm not interested in paying doctors an artificially inflated salary.

Now that's an interesting concept. Lower the bar for those you will one day depend on for your life. You know what the difference between a physician and a Wall Street exec is? If the latter screws up it's money. If the doc does you are dead. What number of injuries and deaths is it worth to shave perhaps 0.01% off of health care?

 

[HumblePie]

Now that's an interesting concept. Lower the bar for those you will one day depend on for your life. You know what the difference between a physician and a Wall Street exec is? If the latter screws up it's money. If the doc does you are dead. What number of injuries and deaths is it worth to shave perhaps 0.01% off of health care?

Way to be alarmist and blow it out of proportion. If the average doctor screws up you just end up not being rid of your sniffles more than likely. Actually, this happens all the time. As I said, the majority of doctor visits =/= life threatening. In fact, most are for the common cold. Seriously.

Again, different levels of care. I want my heart surgeon to be the best, and I expect a heart surgeon to cost more. At the same time I don't want my doctor prescribed Robutussin to cost an arm and a leg either. I once had no insurance from being out of work. I got a bad enough fever from the flu and made a doctor visit. Do you want to know the cost? Yah about $8,000 for an IV bag for dehydration and some fever medicine. This wasn't even through the ER or it might have been higher and no ambulance.

Talking about ambulance rides... I am prior military. The base I was stationed at had no major hospital nor ambulance. So they use the local civilian one but payed the costs. I was playing intramural football one night and got elbowed really badly in the face. Broke my brow, nose, and needed tons of stitches. My head whip-lashed back so bad everyone though I might have broke my neck as well so they called an ambulance to pick me up from the field.

The hospital had no problem with billing the military for their part and I never saw the cost they had, but the ambulance company kept sending the bill for payment to me directly. It took a few months to clear it up, but that was one expensive ride. Something like $4000.

I grew up as a military brat and had used "socialized" medicine for most of my life. It was a real eye opener in recent years to learn how much it all cost. Or at least was charged.

Do we really need ambulance rides that cost thousands of dollars? Seriously? Do we need to take out a second mortgage just to pay for a doctor visit for flu medicine? Really? If having a "second rate" doctor to make sure I have the flu and give me medicine brings down the un-insured price to something more affordable, I am all for a second rate doctors. Wait, aren't those nurses anyhow?

 

[werepossum]

Now that's an interesting concept. Lower the bar for those you will one day depend on for your life. You know what the difference between a physician and a Wall Street exec is? If the latter screws up it's money. If the doc does you are dead. What number of injuries and deaths is it worth to shave perhaps 0.01% off of health care?

But his point is still valid in that a highly intelligent, highly trained doctor with little time might well be just as likely to miss something important as a less well trained nurse practitioner who can afford to spend more time with the patient. Even an excellent diagnostic doctor may miss potentially fatal complications or rare disorders which largely share symptoms with common but less dangerous disorders, especially if hurried and harried. I'm a big advocate of not lowering the bar for doctors, but I agree that shifting some work to lower paid nurse practitioners makes sense as a way of maximizing scarce resources.

Assuming the extra doctors' time could be shifted into doctors spending more time with patients who obviously need it, and perhaps people who otherwise would not see a doctor or a nurse practitioner could then get time with one or the other, then the number of deaths and available serious complications could conceivably remain constant or even decrease. More highly trained health care providers would be available for less cost than adding an equal number of doctors, and as expanding the number of doctors would probably require mining the ranks of these nurse practitioners anyway the average intelligence wouldn't necessarily decrease (over that of an equally expanded group of doctors.) Average education and training would necessarily drop, but since more health care provider time would also be available the overall affect on society could well be positive. Or so it seems to me. Certainly I have no objection to seeing a nurse practitioner, and if I think I need to see the doctor I'll ask to do so, but generally I assume the nurse practitioner is a better judge of whether or not I need to see the doctor than am I.

 

[fskimospy]

Now that's an interesting concept. Lower the bar for those you will one day depend on for your life. You know what the difference between a physician and a Wall Street exec is? If the latter screws up it's money. If the doc does you are dead. What number of injuries and deaths is it worth to shave perhaps 0.01% off of health care?

I'm not sure what's so hard to grasp about this. I'm saying there is a plausible theory for lowering the bar that will result in IMPROVED performance for doctors. With health care spending you can ask the 'what number of deaths is it worth to do XXX' for literally every question imaginable.

Maybe if it comes down to having to depend on a guy who can devote 15 minutes to my life or a guy who's slightly less capable being able to spend all day, I would choose the latter. Something to think about.

 

[gingermeggs]

And conservatives keep calling this puppet chump a "socialist"!
No public option=lose, lose!
We'll never be able to have a man like Kucinich as POTUS, as long as the corporats own the system! Wonder what would happen if every single little pawny worker went on strike for just one day, the same day, all over the industrialized world? If they honored one another more then their debts to banker overlords, to buy things they don't need, and saw gain not pain in having less materialism in their lives, I wonder how that would fly for a change!

 

[Zorkorist]

Yawn...

Do it for the 6 months plus of the reserve the Bourgeoisie.

What is it ya'll workers want? A hand out? Not having to work very hard? Dance with my sister?

-John