Bob

I think the issue here is cost of drugs....they are way, way, way more expensive in the US for the very same drug made at the very same plant in other countries because of large bulk buying powers of governments etc...

Xebedee

Americans are the last people to need lecturing on economies of scale.
Hoestly. I ask you. Really.
Tsk, tut, ptooey.

RoadWarriorFromLP

I think that we've established that doctors don't want single-payer health care. The current crop enjoy riding the gravy train and want to maintain the status quo, for their benefit.

If the system was changed, then they would either suck it up or else leave the profession. I suspect that the majority of them would grumble, then go back to work when they realize that it helps to have income in order to make mortgage payments. The next crop of doctors will get over it, too.

Above, I provided a series of stats and my question remains -- what is it that is so laudatory and marvelous that we are defending here?

If the rules abroad were so onerous, then I would think that we would have more nurses than anyone else, because the profession would be so much better here. There should be more hospital and acute care beds, because the free market should be rushing in to serve the need that is not being met elsewhere in the suffering Outside World where people wait for years to get a flu shot, and then have to share needles in order to get one.

So there is a disconnect here. We get even less stuff than the poor downtrodden, suffering Europeans who pay less and end up with more caregivers and facilities. If your observations were accurate, then this situation should be reversed.

Our current system seems to provide us with no advantages at all. We spend more to get less. Others live slightly longer, substantially healthier lives. I suspect that these failures may be related.

tamms_1965

Maybe we give more scholarships to medical school so doctors do not owe $100,000+ when they get out of school. It would also open the doors to others who may not consider med school because of costs. I don't know how it is done now, but I do know it was done in the past. My child's first pediatrician (also mine) is from the Phillipines. Her husband and herself (both doctors) went to med school in the u.s. for free/reduced cost in exchange for their practicing in an area of the u.s. that desperately needed doctors.

I'm sure someone will come along and fill me in on how things are now.

Tracym

Excellent points. I cannot agree more.

I have no problem with the govt negotiating the costs of drugs. I do wonder (I do not know, I am wondering) if a lot of the new drug development is done in the US, and they recoup the costs - if you drive ALL the costs of drugs down, will this discourage new development?

To say the doctors will just deal with it might not be true. Given yanks' view of things - many do NOT want anything to do with working for the government. That might not be the case in other countries, but we're in THIS country. Look at how many are dropping out of Medicare. They do have the option of going elsewhere.

Also, the best and brightest may stop going into the profession. Doctors here train hard and long, and graduate with a lot of debt. Their motivation is often that they will be rewarded for all their work and efforts, by a lucrative profession. To say - oh, then we'll just get the noble people, who won't care about money.... well that sounds good in principle. But I don't think, in the US, that'd be too many of the brightest ones. It just doesn't match the culture very well.

I haven't gotten through all the studies (remodeling and planning a wedding at the same time here, you're gonna have to forgive me on that one) but all sorts of studies say all sorts of things, depeinding upon how they get their data. So just a few general comments from past readings:

The US was ranked #1 by (WHO or Commonwelath fund?) in providing the RIGHT care.

The US won the majority of awards (can't remember the type, I've posted the article before) for innovation.

The US is ranked #1 as emergency care (also link previously posted).

The majority of people in studies earlier in this thread, surprisingly even the uninsured, rate the quality of care they got as excellent or good.

These are not things to be discarded.

Number of beds is irrelevant - unless there aren't enough of them.
Longevity and long healthy life are affected by MANY things other than health care - you cannot attribute it just to that.

I am not sure that we get "less" than Europeans, at least not all countries. The uninsured might, but the well-insured, I am not convinced at this point.

RoadWarriorFromLP

If the medical profession was so much better here, then you would think that we'd have people lined up out the door to get into it. The stats indicate that this is not the case.

There is no data to support the contention that we have better doctors than others do.

It's quite relevant if you need one. And I find it difficult to believe that the Congo, to which we compare closely, is overflowing with the appropriate ratio of beds.

The point being, though, is that the argument that single-payer care= rationed care falls apart when you see that the "victims" of the rationing get more stuff than do those who are "enjoying" the benefits of the free market.

The negative comments about socialized system are largely built on scaremongering that aren't supported by the data.

Tracym

I find this a bit confusing.

I think many doctors and nurses ARE trying to come into the US - it's hard to get in, at least for nurses - look in "retrogression" on the forum.

I didn't say we had better doctors than others do - not sure where you're getting that. I said "the best and the brightest" high school/college graduates who are considering a medical career vs. other careers.

I have not heard of a great bed shortage in the US - like I said it's irrelevant UNLESS there aren't enough.

I am also not yet convinced that the "victims of rationing" as you put it get "more stuff" than we do.

I personally have never heard the scaremongering that you refer to, so that is not the basis of any of my opinions.

However - the point some of the yanks keep making is - the US is not the same as Europe. Even is something works perfectly in Europe does not mean it will work well here. Perhaps.... but not necessarily.

Tracym

OK, I did go back and look at those studies.

Again, I don't hear of a shortage of beds etc - many of those countries might have more horrid illnesses, and thus require more beds.

Again, the number of beds, nurses, etc. is only relevent IF we are experiencing a shortage. I'm not aware of one - if you find it, then fair enough.

jumping doris

[QUOTE=Tracym;5994792]
Also, the best and brightest may stop going into the profession. Doctors here train hard and long, and graduate with a lot of debt. Their motivation is often that they will be rewarded for all their work and efforts, by a lucrative profession. To say - oh, then we'll just get the noble people, who won't care about money.... well that sounds good in principle. But I don't think, in the US, that'd be too many of the brightest ones. It just doesn't match the culture very well.

QUOTE]

Doctors train long and hard in Europe too and eventually are rewarded well.
I don't know what sort of debt they end up with now because University grants have changed so much.

Junior doctors everywhere work long hours and we only have to look at Nadnad's thread to realise he isn't going to be paid very much at first here in Pittsburgh.

In the UK doctors can work for the NHS and also have a private practice and yes I know that someone will be along to point out that if you pay to see a Dr privately you obviously "jump the queue" and that keeps others waiting.

I was listening to NPR the other morning and they were reporting on George Bush's trip to Africa. The woman reporter was horrified that in Mali or somewhere they didn't have easy access to a Dr. The government had built clinics but they were operated privately and had to break even or make a profit. This meant that healthcare was very expensive and often cost more than the average person earned.
The result was that people became sick and delayed getting treatment because they just couldn't afford it.
The reporter's tone was indignant that this could be so and she didn't seem to see any parallel between these poor people and some of the poor people in her own country!

I just really don't understand why there isn't more of an outcry here about the millions of uninsured and the people brought to their knees financially by the cost of medical care.

RoadWarriorFromLP

You imply that the quality of professionals would worsen under single payer. That would suggest others who suffer under single payer should have inferior caregivers. But they don't seem to.

In economic terms, it's quite possible that the demand curve for the demand of health care jobs among would-be workers is inelastic, i.e. that a change in compensation doesn't do much to change the level of interest to enter or remain in the profession. If our compensation schemes were so much better, then we should see the benefit of this by having more would-be professionals clamoring to get in, while others go begging for caregivers, but this is not the case.

In any case, I have no doubt that East Indians would prefer to get the benefits of US training over what they have locally. But they are trying to get into the NHS, too.

You miss the point. If those who are in single-payer systems suffer from rationing, while we don't, then this should be evident in the quantity of services that each receives. In this case, that means that they should have notably less than we do. They should have fewer facilities and less staffing, given that they are burdened by rationing, while we should have an abundance of everything, thanks to the free market and our obvious ability to spend more.

In fact, this is not the case, and the situation is actually reversed. We get less than they do, even though we should be getting more because of market forces and our level of expenditures.

The fact that we actually get less is an indicator that the free market does not provide the benefits that you allege. By any other measure of prosperity, this is the means by which we make comparisons in order to see who is faring best.

I don't see any proof that the US can't implement a successful system if it so chooses.

What I do know is that the current system doesn't work. We spend more money, but the results don't follow.

As a results-oriented free marketeer, I expect the free market to do a better job in most circumstances. When I see the glaring exception that is noteworthy in healthcare, I have to ask why this is.

And it doesn't take much to see where the problem lies -- insurers are firmly entrenched in the system, yet add no value to the supply chain. All they do is ration services in order to increase their own profits, while unnecessarily complicating the billing process. They force physicians to hire support staff whose only function is to deal with payments and collections. Somebody has to pay for that added overhead, and that would happen to be the patient.

Giantaxe

And yet ironically this is the one medical service that providers are legally required to provide regardless of the ability of the patient to pay!

neil

That reminds me of seeing Bush on that trip saying how terrible it was that kids were dying because they didn't have access to medication that could save them.

Giantaxe

Doctors also drop specific insurance companies all the time too. You hear much less about that because Medicare is a bigger target for the AMA and fits their agenda of resisting anything that the "socialized" label can be pinned to. I'm actually in a dispute right now with a doctor who I was referred to that dropped my insurance halfway through a course of treatment.

What also strikes me about the fragmented insurance-based system is the unbelievable amount of time doctors and their offices spend dealing with non-medical matters:- billing, checking what doctor is covered by what insurance company for referrals, checking what drug is available at a reasonable price etc etc. All this eats into a doctor's time and costs. Small wonder that until the NHS increased its funding over the last few years, the US spent almost as much as a percentage of its GDP in healthcare administration as the NHS did in total. And this doesn't even take into account the time and money patients themselves spend in dealing with their insurance companies. The US system really is a totally inefficient mess.

tamms_1965

Because medical schools here only accept the best and brightest, it is not that easy to get in (MCATs). It is a very rigorous program (you basically give up every other part of your life), and it is expensive. I do not know too many u.s. doctors leaving the country to go practice elsewhere. However, I do know several doctors that came here from other countries to practice.

RoadWarriorFromLP

US training is among some of the best in the world -- I would guess that the US and France have the best medical schools in the world.

Patient care is another matter. We clearly don't have the best care in the world, given our relatively mediocre quantity of facilities and staffing.

The data is unambiguous -- we don't get value for our money. With this level of spending, we should be head-and-shoulders above everyone else by a substantial margin, the undisputed leaders who get far better treatment than everyone else on the planet.

So even if we are on par, that is still not good enough, in light of what we spend. We are obviously being fleeced.

If our goal is to remain mediocre, then we should be figuring out how to cut our spending by about half. There is no reason for us to spend as much as we do, yet get nothing more out of it than everyone else who spends a fraction of what we do. We are paying Ferrari prices for the equivalent of a Ford.