First off, as some may be aware, I am an Emergency medicine physician in the US. I was in the top 5% of grads in undergraduate and had to compete for entrance to medical school. I then paid $150,000 in tuition which had accrued to $180,000 before I could earn a dime. While a resident I worked 80hr/week with about 36hr shifts every 6 days. I moonlighted to begin paying off my loans. For 4 years of residency I made about $26,000/year and was still $170,000 in debt when I finished residency. I work about 16 twelve hour shifts per month split 50/50 day/night. I have no sickdays (thats not paid sick days), short of being admitted to the hospital I must work my assigned shifts and you can't close an ER. I see between 24 and 50 patients per day depending on where I am. I get no lunch or breaks and often eat while charting. I often delay bathroom breaks due to heavy patient volume.
Is my work Ideal, hell no. But it is the most challanging form of medicine. I see everyone, rich or poor, insured or not, I don't even know a persons coverage unless they tell me due to some concern. I care about my patients and wish to provide the best care I can.
I have time and monitary expendures to maintain my ability to practice to the tune of 50 hours and $6000/year.
For this I am paid well by many standard but to date am still up to my eyeballs in debt.
You may say that I am not impartial but I also have 10 years of practice that tells me that if you remove the forces of capitalism from this equation, there will be consequenses.
First, those students who chose to enter the profession, if there is no incentive, will be of a lower caliber. You have to realize that these students are also considering other fields, business, law, etc, and the best will go to the field that offers the most for their future, both monitarily and lifestyle.
I have worked with doctors in UK and Austrailia with doctors without borders and will tell you that these men and women although often fine physicians work about half as hard as US physicians. If the fed started a national health agency such as that in UK, we would require a doubling of the physician force, and midlevel provider force. This would be difficult without lowering the standards for licensure.
Our ER is already inundated with patient who cannot see their physician for 2 weeks when they are sick. This would worsen significantly. Many people would be forced to see a midlevel provider which for many problem is adequate however health care dollars saved in physician salary will get eaten up with missed and undiagnosed disease. Without some expenditure of the patient, many will seek care for very minor causes, doubling the ER volumes causing a significant wait. (When I worked at Jackson Memorial ER in Miami, the average wait for non-lifethreating illness was 24hours due to the heavy indigent population)
So how do we fix it?
First, remove all effects of monopolization of the market. Insurance companies are making huge profits. Why? Because they sell there product only to groups. If my car insurance cost to much I can comparison shop, if they refuse to pay on a claim or insist on using used parts, or use the crappy repair shop, I can switch. Also remember that benifits are just money that is spent on your behalf, my employer gives all full time employees a stipend that pays $1250/month. I can choose to spend that on healthcare, retirement plan or get it as pay.
I see the collapse of the system everyday; patients that get worse because they can't get into thier primay doctors office, patients with pneumonia who cant afford the chest xray, patients who cant afford the right medicine, or stop meds due to finances, patients who come to the ER with no intension of paying the bill expecting the rest of us to cover them, Physicians leaving the hospital or going cash only, refusing to take call.
I am afraid that we have just entered the tunnel and the light at the end will not be seen for several decades, but worse yet there may not be any track in the tunnel.
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