To Want or Not Want Government Care?

[Pats20]

The United States has the most expensive healthcare system in the world.  Per capita, we pay better than 50% more per citizen than any other country.  In 2020, we spent, on average nearly $12,000 per person.  Only 1 other country spend more than $7,000 per person.  The average for industrial/post-industrial countries is around $5,700 per person, or less than half what we spend.

https://www.healthsystemtracker.org/char...untries-2/

So, why do we spend so much on healthcare?  Respectfully, it has nothing to do with military spending; the fact that we have a large military has ZERO relationship to our nation's ability to provide high-quality, affordable healthcare.

Lets start with providers: the average physician in the United States make more than $315,000 per year.  Germany pays its physicians, on average $183,000 per year; the United Kingdom $138,000 per year.  Just as an aside: nurses in the US make, on average, more per year than doctors in all but about a half-dozen countries.

https://www.beckersasc.com/benchmarking/...dings.html

And the insurance companies?  In the 2nd Quarter of 2020, Anthem reported $2.3 billion worth of income.  This is one insurance company and one quarter.  Anthem covers around 40 million Americans with its policies.  

https://www.nytimes.com/2020/08/05/healt...ofits.html



We have an expensive, inefficient healthcare system in the United States because there are many people who like it that way.  There are the physicians, nurses, healthcare executives, insurance companies, trial attorneys (suing a poor doctor isn't nearly as fun or profitable as suing a rich one!), and many others who have a real, vested interest in healthcare being as expensive as possible.  

There are the people who want to keep the government out of their lives--people who would much rather they and their employer pay, so 25% or their wages, for health insurance rather than paying nothing for insurance and having their taxes go up, say 10%.  They are willing to pay more for their "freedom."  

There are old people.  The United States already has a quasi-socialized medical system.  Its called Medicare.  It provides world-class coverage at very low cost to old people.  Most countries with real socialized medicine prioritize young, working people.  Other people are often given pain pills and allowed to die.  In the United States we allow productive, working 20- and 30-somethings to die but will spend millions of dollars providing surgeries and medicine to people in their 80s and 90s.  I remember the words of the lieutenant governor of Texas who said old people would willingly sacrifice themselves so that the state and economy would not be destroyed by Covid restrictions.  If only that were true.  Decades of voting and legislation show that is not at all true.

The reality is that we CAN have socialized medicine/Medicare for all, but we can't just expand Medicare without dramatic changes to the system.  Your family physician can't make $200,000 per year.  Your surgeon can't make $800,000 per year.  Your nurses can't make $100,000 per year.  The hospital can't make millions of dollars, despite its non-profit status.  The trial attorneys in your town can't put up hundreds of billboards on every street corner and on the back of every bus advertising how many millions/billions they have "recovered" for their clients.  And perhaps most controversially, we can't continue spending billions of dollars to prolong the lives of the oldest Americans who contribute very little to the economy.  And yes, that does mean we will have a "public" and a "private" system; the private system will focus on providing treatments of questionable necessity to old people.

 That will work. Instead of a broken system, we won’t have one at all. cmon man. You expect to have quality health care and quality physicians  by demanding they  make less than $200k ?  In the USA ? Lol. 
They’re going have that in student loans. Who in the world is going to go through 8-12 years of schooling to make peanuts ? Why in the world would anyone take on hundreds of thousands of dollars of debt, the liability , the stress,  work 80-100 hours per week to make $150k ? Heck their insurance is at least 50k a year for crying out loud. That’s the answer ? Pay doctors and nurses less ?  Golly. You think we have a doctor and nurse shortage now. Obamacare destroyed our system. Before Obamacare most family plans were in the neighborhood of $25 a week. $10 copays and $5 prescriptions. Now most working folks are paying an average of $150 per week for family plans with sky higher deductibles and copays. 
Let the free markets work and competition will drive down costs. 


And just let the old and sick die ?? Wow.

[freeloader]

If we are going to fundamentally change the healthcare system, let’s re-think the whole thing!  In the United Kingdom medical school is six years total, as opposed to 8 in the US (half undergraduate and half graduate). Why not shorten the education and the cost?  Given that a goodly part of that education, particularly at the undergraduate level has nothing to do with being an effective clinician, why is it required?

Let’s imagine the average physician finishes medical school at 27 and residency at 31 and works until they are 67. That is a 36 year career. If we move to a system where they spend 6 years becoming a qualified doctor instead of 8, they can now have a 38 year working career.  That is a 5.5% increase in their working career. If we did that, we would effectively increase the number of doctors in the United States by 5.5 percent.  

Let’s also break the monopoly of the AMA once and for all. There have been countless studies that have shown that APRN can provide a comparable or even superior qualify of care to that provided by MDs. The same is true for PA’s. Today, if an APRN or PA wants to become a doctor, they basically have to start over. Why?  Why not allow these highly skilled and qualified medical practitioners to “top-up” to an MD?

I am all for torn reform, provided it goes hand in hand with reductions in reimbursements. I am not a fan of basically giving the highest class of wage-earners in this country a huge pay increase while also removing the single most effective tool for ensuring they provide quality care.

Respectfully, people would be doctors for less money than they are paid now if that’s what was available to them?  Would some qualified people decide to become engineers or lawyers or go work on Wall Street, etc?  Of course they would. But, as APRNs/PAs show, you don’t have to be an MD to be an effective healthcare provider.  There would, I promise you, be no shortage of highly-qualified people willing to serve as physicians. And, practically speaking, what would the current physicians do instead of medicine?  Sure, some of them would leave the field who were close to retirement age, but what, exactly, is a 50-year old surgeon going to do it he has to take a 50% pay cut?  Go work as an assistant manager at WalMart for $46,000/ year?  Respectfully, I think not.

In part, the last statement would be true because we should allow more access to the US healthcare market to foreign-trained physicians. Today, to practice medicine in the United States, you have to go through an American or Canadian residency.  Why?  Why not allow people who have received their advanced training abroad to practice here?  Perhaps you limit it to a handful of places (Western Europe, Australia/New Zealand, and Japan, for instance).  

And as for the free market?  The federal government spends the better part of a million dollars on EVERY physician in the United States, funding undergraduate, graduate, and post-graduate training. Where, exactly, would the money come from to replace that?  Is the answer to move residencies from the current system where residents are paid for their work for 3-8 years to a system where they pay for it themselves?  Given that a 4 year residency’s real cost is over a half-million dollars and given that the doctor would need living expanses, is the answer really the free market where that physician leaves with an extra 700,000 or so in student loan debt?  No?  So, the free market only works when it is propped up by a government-funded and controlled (eg, socialized) system for post-graduate-residency training?  Yes. That is ACTUALLY how it works.

Do I think old people should simply be allowed to die?  Not EXACTLY. There should be a cost-benefit analysis. If a person can receive a medicine or surgery at a reasonable price, the government should pay for it.  If the older person can pay for it, it should be done. BUT, if I have to chose between a system that prioritizes younger, working people (along with children) like most of the rest of the world or one that priorities the oldest people, like we have, I am going to chose the “other” model.

In my opinion, healthcare should be a public service.  I believe doctors, nurses, and others should be government employees. Realistically, that will never happen in the United States, and I know it.  

It has been estimated that by 2040, 1/4 of our GDP will go to healthcare expenses.  Healthcare in the United States has issues now, but it is heading toward a crisis.  Well, maybe then we, collectively, will stand up to a healthcare system that takes so much more from society than it provides.

[LevelUP]

Here's some math.  The average doctor sees 20 patients a day.

52 weeks X 5 days a week X 20 = 5,200 patients a year.

$200,000 / 5200 = $38 per patient.

"Almost a quarter of their time is taken up with nonclinical paperwork."
https://www.physicianleaders.org/news/ho...0paperwork.

[Alpha]

Here's some math.  The average doctor sees 20 patients a day.

52 weeks X 5 days a week X 20 = 5,200 patients a year.

$200,000 / 5200 = $38 per patient.

"Almost a quarter of their time is taken up with nonclinical paperwork."
https://www.physicianleaders.org/news/ho...0paperwork.

One small problem with your math is that no doctor works 52 weeks per year.  The standard for budgetary purposes is 44 weeks.  Also, while the "average" might be 20 patients per day, some specialists vary considerably.  An Orthopedic Surgeon might see only a few people on certain days.  An outpatient Psychiatrist in a clinic typically sees 4 people per hour for 6-7 hours per day.  In a private practice they see fewer people and take a larger percentage of the insurance payment.  MD salaries vary considerably.  The 200K you mentioned is rock bottom.
Average Doctor Salary by Medical Specialty | National Society of High School Scholars (nshss.org)

[LevelUP]

Here's some math.  The average doctor sees 20 patients a day.

52 weeks X 5 days a week X 20 = 5,200 patients a year.

$200,000 / 5200 = $38 per patient.

"Almost a quarter of their time is taken up with nonclinical paperwork."
https://www.physicianleaders.org/news/ho...0paperwork.

One small problem with your math is that no doctor works 52 weeks per year.  The standard for budgetary purposes is 44 weeks.  Also, while the "average" might be 20 patients per day, some specialists vary considerably.  An Orthopedic Surgeon might see only a few people on certain days.  An outpatient Psychiatrist in a clinic typically sees 4 people per hour for 6-7 hours per day.  In a private practice they see fewer people and take a larger percentage of the insurance payment.  MD salaries vary considerably.  The 200K you mentioned is rock bottom.
Average Doctor Salary by Medical Specialty | National Society of High School Scholars (nshss.org)

If you took out all the costs, then it would be close to $38 to see a family doctor as I said.

Check out https://sesamecare.com/ for online doctor costs.

You're right specialists do cost more.