Scots Taffer on 7/10/2009 at 23:51
Quote Posted by Subjective Effect
You're not saying that the number of doctors is purposely limited so that they can be in demand and thus request high salaries are you?
I reckon this is true of a lot of professions to be honest, doctors, lawyers, actuaries, surgeons, dentists etc. It's not so much directly limited in terms of numbers but progression is often limited due to old school ties, networks, politics, and nepotism is rife. This prevents many people from entering because they perceive it to be hard work on top of hard work in order to get anywhere. This, at least, was very true in terms of the experiences of friends and family in the UK.
Quote Posted by Subjective Effect
Doctoring requires a lot of hard work and one hell of a lot of responsibility. Its the responsibility and the specific skill-set that demands the level of remuneration, which - given the awful unsocial hours and all the rest of it (don't get me started) - isn't really that much.
This is perhaps true in the early going but you're not going to seriously suggest that private practice doctors and GPs have anything near the level of responsibility, stress, unsociable hours and so on of a young intern doctor. It becomes a disgustingly lucrative venture if you can sow something up later on in your career. (Not that they don't deserve it for their hard work, mind you, but I reckon profiting from healthcare is a bit immoral at the best of times)
the_grip on 8/10/2009 at 00:18
Agreed scots... also throw in the nurses and the folks providing care in an ER situation. I can't imagine that level of stress, but it is not a particularly lucrative career in the spectrum of docs.
CCCToad on 8/10/2009 at 01:06
The way I see it, the biggest problem is that, while the American health care system desperately needs reform, nobody capable of changing it wants to change it in a way that will benefit average Americans. In other words, there aren't any good guys at the moment.
Insurance and other large monied healthcare interests don't want any reform at all, and the current version of the government plan doesn't help at all: it is simply more taxes and punishment for people who don't use health insurance (ie, it HELPS the insurance companies). Those few in the government who aren't working for "big health" seem simply interested in using health care as a gateway to intrusive laws such as the mandatory end of life consultations, home inspections, and bank access that were proposed (some of those amendments by "conservative" congressmen).
My solution? to be honest, I'm somewhat at a loss. While entitlement programs and insurance have driven up costs by insulating doctors from their patients, dropping those programs could have a devastating impact. We've built an unsustainable business model, and I don't think there's a clean way to fix it: somebody's wallet is gonna get hurt no matter what we do.
heywood on 8/10/2009 at 03:07
Here is a link to a 2007 Congressional Research Service report which is one of the more objective sources of data I've found by Googling around:
(
http://assets.opencrs.com/rpts/RL34175_20070917.pdf) http://assets.opencrs.com/rpts/RL34175_20070917.pdf
According to Table 4, US spending per capita on inpatient & outpatient care is $2516 above the study median. Pharmaceutical and administrative costs together are only $744 above study median. That seems to refute the claim that prescription drug spending and administrative/insurance costs are the main reasons why US health care spending is more expensive.
Granted, we do spend more than average on pharmaceuticals, but it's not a big difference compared to inpatient & outpatient care. And prescription drug spending in the US has declined as a percentage of overall health care costs since the data for this table was compiled, so it's currently even less of a factor than this table suggests. This report also shows that prescription drug prices are not as high as people think in the US. According to Figure 16, the US pays more for brand name drugs but less for generic drugs.
It also show that administrative costs are way above average. And I've seen other studies that corroborate that. But again, compared to the difference in inpatient + outpatient treatment costs, that doesn't seem very significant.
So what explanations does it offer for the high cost of inpatient & outpatient care? Without going into detail: greater use of the latest medical test equipment, higher wages for health care professionals, greater use of specialists and higher frequency of expensive surgical procedures, and consolidation of hospitals.
-----------------
Anecdotally, some of the medical costs I've seen seem reasonable and some not. For example, a whole maternity goes for $10-15k including prenatal visits, ultrasound, childbirth, epidural, 2-3 day hospital stay. That seems OK. But last year, one of my friends passed out due to dehydration while out to lunch with us. He got a 10 minute ambulance ride, then sat in the hospital for 2 hours with a saline IV before being discharged. Cost: ~$2500, of which $1400 or $1500 was just for the ambulance. That's definitely in the WTF category. And my brother spent over $1200 for an ambulance ride a couple years before that.
Also, I'm still trying to figure out why my state isn't following the stereotypes. The health insurance market here is dominated by non-profit insurers, yet we have the highest health care costs in the nation. Also, we have a much higher percentage of HMO/managed care plans here than the rest of the US. If you belive
Sicko, the only purpose for HMOs is to screw people out of treatment to make profit. But the HMOs we have here are predominantly non-profit, and they deliver some of the best health care: the three biggest insurers here are ranked 1st, 2nd, and 9th in the US and subscribers seem very happy with them. But they're bloody expensive. It seems to support a "get what you pay for" argument, but I know that's not true when comparing the US vs. other nations.
Koki on 8/10/2009 at 09:39
Quote Posted by MrDuck
This.
I <3 u.
Change's always hard...lets see how it goes.
I honestly did not expect CHANGE! argument till at least page 2.
theBlackman on 8/10/2009 at 09:42
How about like the Chinese used to. You only pay the doctor/hospital when you are cured. :ebil:
Aerothorn on 8/10/2009 at 13:01
Quote Posted by the_grip
I'm speculating on it. The American Dental Association (granted, this is dentistry) has been on record actually creating standards to protect their standards of living.
Slate just had this (
http://www.slate.com/id/2229630/) massive seven-part series on how fucked up the American dental association is. But that's going to basically be ignored because general health care is taking precedent right now.
As for the health care plan, it's starting to look a bit better- latest CBO estimates say that it will shave 81 billion off the deficit, which is worth something in and of itself. The real question is what the "public option lite" is going to look like.
As for scarykitten's dads claim that our health care system is a "necessary evil," he clearly hasn't spent any time living in (or researching) the health care systems of other countries. I mean, even ignoring Canada/Britain, does he really think our system is better than, say, The Netherlands'?
the_grip on 8/10/2009 at 13:24
Supposedly I've heard France's is actually fairly top notch.
scarykitties on 8/10/2009 at 13:29
Consider that my dad gain most of his knowledge through a bookshelf-full of conservative and Christian-written books, Fox News, and The Drudge Report. That is compared to me, who at best gets what he knows from what others have said, what Wikipedia has told him, and what assorted news articles offer. So, I'm not going to assert knowing any of this, only offer what I've heard for someone more knowledgeable to clarify upon.
My dad's claim is that the United States has the best health care system in the world, and anywhere else has troubles of either people lining up for urgent health care procedures, or various discriminations of age. As he'd say, "Canadians are coming HERE to get healed!"
So, do you believe Michael Moore's Sicko, or a father who is an extremely intelligent and well-educated individual who knows what he's talking about, if perhaps his sources don't?
Stitch on 8/10/2009 at 14:23
Intelligent your father may be, but he is spectacularly misinformed.
