So I finally watched Sicko last night....

[LAisntsobad]

As expected, it painted too pretty a picture of France and Canada by one-sided extremist fucktard Moore (the left's version of Disco lol). I agree with Moore that greed by politicians and healthcare industry is largely to blame but it also showed another reason why universal healthcare wouldn't work so well here.

It's not that the US can't afford it or implement it. Canadian and French systems won't work here because of greed up top and....

Too many Americans are:
A) uneducated
B) uncultured
=
they will take advantage of the system
=
the system will overload/malfunction


Too many f*cktards here to make it work...unfortunately.


One possible solution is to make healthcare cheaper by socializing medical training. Costs too much to make doctors here.

 

[JLW]

Excuse my ignorance but what would it mean to socialize medical training?

My dad is a doctor and he says that universal healthcare would result in lower quality care on the whole.

 

[LAisntsobad]

Excuse my ignorance but what would it mean to socialize medical training?

My idea is that there is no excuse for the US not already having it. But realistically speaking, you can't overhaul an entire system overnight, add uncultured Ameritards taking advatage of the sytem and you have fail.

So I propose a way to make costs cheaper by increasing the number of capable doctors by making medical training more affordable (paid/controlled by the govt). This will cause more competition and drive down costs. This will also cause competition among insurance companies. You'd be surprised how many capable and potentially better doctors give up half way through their education because of costs.

My dad is a doctor and he says that universal healthcare would result in lower quality care on the whole.

Then ask your dad to explain why countries like Britain and Italy spend less, yet have better care.

If your dad is right, then his entire profession in the US needs to be reviewed because that is going from bad to worse. Even with the current private system, where less people are able to afford care, the quality sucks. If the quality sucks, then I'd rather it be cheaper. Right now, your dad's industry is having us pay a high price for sh*t, basically.

Would you pay $50K for a Toyota Corolla? Or spend $40 at McDonald's for 1 person? Because that's what we're doing when it comes to medical care.

But I don't blame doctor's alone, actually higher blame is on lawyers and their f*cked up liability suits.

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds.

http://www.who.int/whr/2000/media_centre/press_release/en/index.html

 

[misterhat]

I think doctors themselves are the main problem, specifically the AMA and the bodies it controls.

They've fought tooth and nail to artificially limit the number of doctors in order to guarantee high salaries and a shitload of societal prestige for their members, at the direct expense of the healthcare of this country.

Standardized education and licensing for med students is really important to protect people from dangerous quacks and hacks. But when it comes down to that most doctors just don't care. The demand for healthcare has skyrocketed since the founding of the AMA, but they have done jack poop to meet that demand because it guarantees the scarcity that affords them high salaries and lots of prestige. I don't have the numbers in front of me, but for something like 80+ years (could be longer, i cant find the exact number thru google and i dont want to exaggerate) there was not a single new medical school.

I think all of the major problems with medicine would be solved if they figured out a way to tie the number of med school slots to health care demand.

Kinda as a corollary to this you get a lot of good, compassionate people who would be excellent doctors refusing to go down the application path (pre med classes, to mcats to applications) because of the very high probability that it will not work out. Most of the people who do have the numbers (GPA and MCATS) to get into med school spent so much time studying that they have zero social skills, which in turn kills their ability to talk to and effectively communicate with their patients.

Here is a really good article by Milton Friedman: http://www.fff.org/freedom/0194e.asp

 

[JLW]

While doctors do make a lot of money, they make a LOT less than they used to (back in the '80s for example), due to liability suits. They spend more time filling out paperwork and bullshit than actually helping the patients.

The medical care system is screwed over basically because lawyers make them go through all of this paperwork before they can even touch the patient.

Lawyers are supposed to protect the patients, but as a result of the protection being over-regulated, doctors make less money, are less motivated as a result, and in turn give lower quality care (once again, because they spend all the time filling out the paperwork).

 

[misterhat]

While doctors do make a lot of money, they make a LOT less than they used to (back in the '80s for example), due to liability suits. They spend more time filling out paperwork and bullshit than actually helping the patients.

The medical care system is screwed over basically because lawyers make them go through all of this paperwork before they can even touch the patient.

Lawyers are supposed to protect the patients, but as a result of the protection being over-regulated, doctors make less money, are less motivated as a result, and in turn give lower quality care (once again, because they spend all the time filling out the paperwork).

The medical system is screwed because there are far too few doctors practicing relative to health care demand.

I would bet you a penny that if there were more doctors, they would not be as overworked and make fewer mistakes. If medical liability is truely as big of a problem you claim, I have no sympathy. The chickens coming home for the 100 year roost.

Back to mistakes, I found this article strangely telling about the state of medicine. It's long, but it's good:

http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande

Since I know it's relatively unlikely that you will invest the 15-20 min, look at this quote

In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check. These steps are no-brainers; they have been known and taught for years. So it seemed silly to make a checklist just for them. Still, Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.

Doctors are becoming more hated than lawyers.

Edit: And I find it both funny and upsetting that a "to-do" list has fixed a large number of doctor mistakes. If there simply were enough doctors to match demand they wouldn't be rushed and make mistakes. Lawsuits would drop precipitously, but more importantly patients would get better care.

http://www.time.com/time/specials/2007/article/0,28804,1733748_1733754_1735344,00.html

 

[JLW]

i read the article and it was interesting. Definitely some good points.

However, I still think that lawyers are to blame. Part of the reason why the cost for care is so high is because of insurance.

I haven't heavily researched the subject so i don't know the exact numbers. What I do know is that malpractice/professional liability insurance is expensive

Finally, I won't argue your points because it's pretty clear that i don't have a lot of knowledge on the subject.

 

[afoaf]

how is the medical service received by servicemen and their
families?

this is how I envision socialized health care in the US
playing out for all of us.

 

[blakestah]

Disclaimer: I am faculty at a major US medical school, and have been for about a decade (at different schools). These are my own opinions, not those of my employers.

There are big problems in US medical care today. The doctor shortage is getting worse every year because older people require more doctors per person, and the baby boomers are aging. This is forecast to get pretty bad in the next ten years. Most medical schools are increasing class sizes substantially, there will probably be a glut of doctors in another 25 years. The system cannot train doctors fast enough. For a medical school to train another 50 people a year, they need a LOT of resources. It can take 5-10 years to get those resources, and 5-9 years for the students to go from enrollment to doctors. By then the crisis is over.

Doctors make substantially less than they did 25 years ago, relative to their peers. Insurance companies are largely the reason. Standard procedures are cost-rated, and if you are a doctor that performs the same standard procedures over and over (and most doctors are), you will receive the same pay as EVERY OTHER DOCTOR that performs those procedures. Talk about bad socialization of medicine - no incentive to do well! Doctors who want to make more money have to specialize in more costly procedures.

The cost of medicine is too high. We spend 16% of our GDP on health care. Other countries with socialized medicine spend 8%. However, socialized medicine is not really the answer. The answer is that the USA does not have a cost-benefit analysis built in to the application of medicine. Other countries do. By this I mean, if you have terminal lung cancer and want your insurance to pay for a risky low probability procedure, you can get it done. That money takes away from health care for others, because the insurance companies have a fixed resource pool. In other nations they turn you away and say you can't get the medical system to spend its money that way. Really, the whole nation needs to reject poor expenditures of money by insurance companies or medicaid when medical outcomes are not commensurate with medical costs.

That will be a MAJOR change.

Socialization will help in some areas, like prophylactic application of immunizations, regular checking for common conditions (prostate cancer in older men, breast cancer in older women, etc).

 

[john4surf]

Thanks Blakestah. Very interesting read. Several of my staff who are Canadian's seem to think their system is a failure (unless the medical condition is severe). Co-workers in the UK and Israel think their systems are excellent although neither pay the medical profession like many doctors with successful practices were used to in the States several decades ago.

Although I'm a 'vet' I have never reached out to the VA for anything because of fortunate circumstances and, a belief that others who need loans or medical help more than me should be first in line. But now that I am in my early 60s and hear my body tell me to slow down (just taking my board from the van to the water is a good example) I expect I will need some medical help going into my 70s.

As long as I can work effectively, I have great access to health insurance. The premiums after I retire may force me to seek help from the VA (and eventually medicare).

 

[LAisntsobad]

Blakestah, thanks for the inside info. I also do agree that insurance companies (ie lawyers behind them) share a huge part of the responsibility. And all your points are valid except for this one...

However, socialized medicine is not really the answer

Because no matter what you say, the fact is that the US is the ONLY industrialized nation without socialized medicine and it is working in other countries. And yes the quality of the care in other countries are just as good if not better than the care in the US.

Until that fact changes, there is really nothing you can say to convince me that working towards socialized medicine is not the answer (although I don't think we can overhaul overnight either).

 

[blakestah]

Blakestah, thanks for the inside info. I also do agree that insurance companies (ie lawyers behind them) share a huge part of the responsibility. And all your points are valid except for this one...

However, socialized medicine is not really the answer

Because no matter what you say, the fact is that the US is the ONLY industrialized nation without socialized medicine and it is working in other countries. And yes the quality of the care in other countries are just as good if not better than the care in the US.

Until that fact changes, there is really nothing you can say to convince me that working towards socialized medicine is not the answer (although I don't think we can overhaul overnight either).

You cannot just wave a socialist wand over the hospitals and cut costs in half.

You need to determine which costs are not getting you medical returns, and which costs you are not using would be getting you great returns. And change accordingly.

Most socialized medical systems have such a framework. But I am not convinced socialized medicine is REQUIRED to have such a framework.

What will change is that a lot of end-of-life care will be denied, and a lot of people will be unhappy about that. You will need to get Ted Kennedy to understand that a $150k brain surgery to buy him 4 more months is not worth it when we could spend that money on vaccinations for thousands of children.

 

[LAisntsobad]

You cannot just wave a socialist wand over the hospitals and cut costs in half.

You need to determine which costs are not getting you medical returns, and which costs you are not using would be getting you great returns. And change accordingly.

When I said USA should have Univ Healthcare, it was assumed that we would need to change many things in order to make it successful. One of the many would obviously be managing costs.

The bottom line is other countries have been able to manage costs so there no reason the US can't. If the most disorganized people on the planet like Italians (I know I'm half wop) can pull it off, there is no reason that the US can't.

 

[blakestah]

You cannot just wave a socialist wand over the hospitals and cut costs in half.

You need to determine which costs are not getting you medical returns, and which costs you are not using would be getting you great returns. And change accordingly.

When I said USA should have Univ Healthcare, it was assumed that we would need to change many things in order to make it successful. One of the many would obviously be managing costs.

The bottom line is other countries have been able to manage costs so there no reason the US can't. If the most disorganized people on the planet like Italians (I know I'm half wop) can pull it off, there is no reason that the US can't.

The point I'd like to make is that managing costs without socializing medicine may be a lot easier. We would need a framework for medical providers to point to in order to decide whether costs could be covered by medicare, or insurance, or out-of-pocket.

Once the framework is established, the rest will fall into place. It may be that universal health care is the easiest answer for the USA, but I doubt it. It may be that boosting medicare to cover the highest return medical costs, and establishing a cost-benefit framework through medicare, would be enough to make everything else fall into place.