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Tags Affordable Care Act , donald trump , health care issues , health insurance issues

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Old 20th March 2017, 09:43 AM   #1361
Border Reiver
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[quote=xjx388;11763443]How could the obvious differences in the makeup of the country NOT be a factor in trying to transition to a UHC system, especially one as radically different as an NHS/Canada style system? [quote]

Canada's not that different from the US. We have plenty of smaller towns and cities, lots of empty spaces and several densely packed cities, plus health care administration is a provincial responsibility (similar to something being a state responsibility), however there is a federally mandated minimum standard of care.

Quote:
How do you convince doctors who have been used to running their own practices and having the freedom to limit government payers and accept more private payers to move to a 100% government-payer system?
I'd imagine knowing that if you want to get paid for services and that moving to a gov't paid system is how your mortgage will get paid is fairly good incentive to switch over. Also knowing that gov't cheques aren't prone to bouncing and you likely won't need to argue with the several different insurance companies before hauling someone to court to collect the balance might motivate others.

Quote:
How do you convince them to take a cut in pay?
How do you figure they'll get a cut in pay?

Here in Ontario, the doctor submits his paperwork to the hospital who submits it to the provincial office, or submits it directly to the provincial office and receives reimbursement for the services they provide. Since the doctor does not need to factor in delinquent, or defaulted payments in their pricing scheme the cost per procedure might be lower, but less needs to be spent on financial follow up.

Quote:
How do you convince them to start following government mandates in how they provide care? It won't be easy.
The government sets levels of care - not every doctor is required to provide every service. Hospitals, if they receive provincial funding are required to provide all the federally service levels.

This is a little bit of an ambiguous statement - as I'm not sure if you mean what services are provided, or if you mean the method of treatment. Method of treatment is governed by the provincial medical board (the Ontario College of Physicians and Surgeons for example, a professional association that regulates doctors in Ontario).

Quote:
That's one stakeholder -the doctors- who differ very greatly from their counterparts in other countries. Now consider all the other differences between stakeholders. How do you get them all to accept a new paradigm that will completely change the face of the industry in the US? Force it down their throats if they don't agree?
That's actually what I consider the democratic process for. If the majority of US voters want a UHS system you need to let your elected officials know and get them to enact it. Yes, not everyone will be happy. In the same way that not everyone was on board with things like seatbelts in vehicles
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Old 20th March 2017, 10:28 AM   #1362
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Originally Posted by Bob001 View Post
First, the British NHS and Canadian provincial insurance are quite different systems. And they both are different from the systems in France, Germany, Japan, Taiwan, etc., etc., many of which rely on private providers and private insurers. The ACA could have been an effective starting point if it had gotten support from the Republicans, who were the ones who originally designed it.
The Republicans did not design ACA. ACA used some ideas that were originally from conservatives but implemented them completely differently. In any case, that's a minor quibble.

I agree that ACA could have been a good starting point. But it ended up not being so.

Quote:
Why don't you say explicitly what you mean? If you mean that the U.S. is a melting pot of different races and ethnicities, yes, that would be true. But UHC works effectively in countries with widely varying histories, cultures and ethnicities. So you must mean something else. What is it?
I'll state it as plainly as I can.

US doctors, for example, make more money than their peers in other countries mostly because they operate in a capitalistic environment. They work hard to get through med school, which is difficult to get into and expensive to attend. They didn't get their school paid for by the government. When they get out, they expect a salary commensurate with the hard work they put into getting through along with the skill level they now possess. This is no different than people in other high-skill professions that are not healthcare: Engineers, lawyers, etc. Our system rewards people who put in the time and effort to acquire the expertise and skill to work in these high-demand areas. If we were to switch to a health system like the NHS, then all of that would be out the window. Docs in the UK aren't poor by any means, but they don't earn at the level of a US doctor. (The argument about whether or not physicians deserve such pay in the US is not relevant to my point about their expectations being different from their peers in other countries). So you have to convince US doctors that they should take a pay cut in order to get them on board with a new system. We also have to completely revamp doctor training in the US to make it both cheaper and more accessible to people who may not expect as high a salary.

Again, that's one stakeholder but other stakeholders have similar differences due to the fact that they have existed in a US system that is very different from other countries.


Quote:
Many doctors do not run their own businesses, or want to. That's why many thousands take salaried jobs with HMOs, hospitals and the VA. And others merge into large group practices not much different from large law firms. Maybe the model of the country doctor is antiquated. And maybe medical schools should focus on admitting people whose primary goal is delivering effective care rather than getting rich running a business.
I think most doctors in the US have both goals. Even the salaried ones make more than their peers in other countries. The point is that financial opportunities exist in the US that don't in other countries.

Quote:
That might actually mean expanded programs to pay for medical education, so new docs don't graduate with vast loan balances. It might mean expanding nurse practitioner and doctor assistant programs to deal with minor issues. It might mean more walk-in clinics. It might also mean getting away from the fee-per-procedure model, and paying a flat monthly or annual fee per patient based on health status and treatment outcomes. A doctor who counsels a patient should be paid as much for his time as if he spent it cutting something. Etc.
Yes. Now convince all the stakeholders to move to such a model. Good luck.

Quote:
You don't sound like somebody who actually cares for the sick. It sounds like you even feel some resentment toward the people who come to your office for help. If your interest is making sure all the "stakeholders" get paid as much as they expect with the least possible oversight, then yes, that's something that might need to change.
You made some good points above and I was enjoying the debate. Then you turn and make an ad hom like this? Don't try and read my mind. I'm merely making the point that stakeholders in the US have different expectations and you have to convince them that changing those expectations, even at great personal cost, is worth doing. Telling them they don't care about sick people isn't likely to be very effective.
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Old 20th March 2017, 11:05 AM   #1363
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Originally Posted by Border Reiver View Post
Originally Posted by xjx388 View Post
How could the obvious differences in the makeup of the country NOT be a factor in trying to transition to a UHC system, especially one as radically different as an NHS/Canada style system?
Canada's not that different from the US. We have plenty of smaller towns and cities, lots of empty spaces and several densely packed cities, plus health care administration is a provincial responsibility (similar to something being a state responsibility), however there is a federally mandated minimum standard of care.
Quote:
How do you convince doctors who have been used to running their own practices and having the freedom to limit government payers and accept more private payers to move to a 100% government-payer system?

I'd imagine knowing that if you want to get paid for services and that moving to a gov't paid system is how your mortgage will get paid is fairly good incentive to switch over. Also knowing that gov't cheques aren't prone to bouncing and you likely won't need to argue with the several different insurance companies before hauling someone to court to collect the balance might motivate others.

Quote:
How do you convince them to take a cut in pay?
How do you figure they'll get a cut in pay?

Here in Ontario, the doctor submits his paperwork to the hospital who submits it to the provincial office, or submits it directly to the provincial office and receives reimbursement for the services they provide. Since the doctor does not need to factor in delinquent, or defaulted payments in their pricing scheme the cost per procedure might be lower, but less needs to be spent on financial follow up.


Quote:
How do you convince them to start following government mandates in how they provide care? It won't be easy.
The government sets levels of care - not every doctor is required to provide every service. Hospitals, if they receive provincial funding are required to provide all the federally service levels.

This is a little bit of an ambiguous statement - as I'm not sure if you mean what services are provided, or if you mean the method of treatment. Method of treatment is governed by the provincial medical board (the Ontario College of Physicians and Surgeons for example, a professional association that regulates doctors in Ontario).


Quote:
That's one stakeholder -the doctors- who differ very greatly from their counterparts in other countries. Now consider all the other differences between stakeholders. How do you get them all to accept a new paradigm that will completely change the face of the industry in the US? Force it down their throats if they don't agree?
That's actually what I consider the democratic process for. If the majority of US voters want a UHS system you need to let your elected officials know and get them to enact it. Yes, not everyone will be happy. In the same way that not everyone was on board with things like seatbelts in vehicles
Further to that, Canada and the US had the same approach until Canada changed to its current system. It was after this that Canada's healthcare overtook the US.
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link is 2015 data (2013 Data below):
UK 8.5% of GDP of which 83.3% is public expenditure - 7.1% of GDP is public spending
US 16.4% of GDP of which 48.2% is public expenditure - 7.9% of GDP is public spending
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Old 20th March 2017, 11:24 AM   #1364
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Originally Posted by xjx388 View Post
....
You made some good points above and I was enjoying the debate. Then you turn and make an ad hom like this? Don't try and read my mind. I'm merely making the point that stakeholders in the US have different expectations and you have to convince them that changing those expectations, even at great personal cost, is worth doing. Telling them they don't care about sick people isn't likely to be very effective.
When you talk about American demographics, if you mean "rich doctors" that's what you should say. It's easy to (mis)interpret that as a sneer at a multicultural society.

As I understand it, doctors' incomes are a relatively small part of the health-care picture. The big money goes to profit-based health care businesses -- including vast hospital chains, insurance companies and pharmaceutical companies, all of whose executives and stockholders (not stakeholders) make many millions of dollars. UHC systems are either regulated like public utilities or designed to eliminate the profit motive entirely. There would be plenty of money to pay doctors well in any UHC system here, but it might mean primary-care doctors would get a boost, and specialists who are accustomed to charging whatever they want per procedure would take a hit -- maybe in exchange for a certain amount of security and debt relief. And I question whether all doctors are primarily motivated by money. Just as some lawyers enter public service instead of becoming Wall Street partners, many doctors work in clinics and hospitals for smaller salaries than they could make as plastic surgeons in L.A. Doctors will always be well-paid, well-respected professionals. They would be even more respected if patients didn't worry about getting gouged for unnecessary procedures. There's no obvious reason why some doctors -- certainly not all -- should get rich.

Last edited by Bob001; 20th March 2017 at 11:42 AM.
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Old 20th March 2017, 12:13 PM   #1365
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Doctors in Ontario for instance get paid based on the number and type of procedures they carry out - so much for a consult, so much for a checkup, so much for an appendectomy, etc. Their income is very much tied to how much they work, and like any independent contractor, how fast they turn in their paperwork.
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Old 20th March 2017, 12:36 PM   #1366
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Originally Posted by xjx388 View Post
US doctors, for example, make more money than their peers in other countries mostly because they operate in a capitalistic environment. They work hard to get through med school, which is difficult to get into and expensive to attend. They didn't get their school paid for by the government. When they get out, they expect a salary commensurate with the hard work they put into getting through along with the skill level they now possess.
Doctors in the U.S. make something like five to eight times as much as Swedish doctors (depending on field, etc). Do you really think that's because of their hard work and expensive schools?
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Old 20th March 2017, 12:41 PM   #1367
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Originally Posted by Bob001 View Post
When you talk about American demographics, if you mean "rich doctors" that's what you should say. It's easy to (mis)interpret that as a sneer at a multicultural society.
I just mean doctors without any of the baggage that comes along with modifiers such as "rich."

Having a diverse population is also a difference between the US and other countries. That's not a "sneer," just a fact. But beyond the largely irrelevant "melting pot," fact, the US has a higher prevalence of chronic disease than other countries. That's a major reason for increased costs here and why you can't simply transplant another country's health care system here and expect the same results.

Quote:
As I understand it, doctors' incomes are a relatively small part of the health-care picture. The big money goes to profit-based health care businesses -- including vast hospital chains, insurance companies and pharmaceutical companies, all of whose executives and stockholders (not stakeholders) make many millions of dollars.
And those stockholders, et. al. are also stakeholders in the US healthcare system that are very different from other countries.
Quote:
UHC systems are either regulated like public utilities or designed to eliminate the profit motive entirely. There would be plenty of money to pay doctors well in any UHC system here, but it might mean primary-care doctors would get a boost, and specialists who are accustomed to charging whatever they want per procedure would take a hit -- maybe in exchange for a certain amount of security and debt relief.
Right . . . now convince all the stakeholders involved in the US healthcare system that these kinds of changes would be good.
Quote:
And I question whether all doctors are primarily motivated by money. Just as some lawyers enter public service instead of becoming Wall Street partners, many doctors work in clinics and hospitals for smaller salaries than they could make as plastic surgeons in L.A.
Well, sure. I never said their sole motivation was money. But even those that take lower salaries than LA plastic surgeons still make more on average than their counterparts in most other countries. Even if money isn't their main motivation, they are going to have a problem taking a significant pay cut. How would it go over if we told teachers, engineers, etc that we are going to cut their average pay levels by even 10%? I would even say most doctors are motivated by the desire to help people; they still want to make money doing what they love.
Quote:
Doctors will always be well-paid, well-respected professionals. They would be even more respected if patients didn't worry about getting gouged for unnecessary procedures. There's no obvious reason why some doctors -- certainly not all -- should get rich.
There's no obvious reason why they shouldn't be rich either. Is there an obvious reason why anyone should be rich? Maybe it's because we should be rewarding the people who provide the most benefit to society. If healthcare is such an important thing, then shouldn't the providers of that care be among the richest of all?
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Old 20th March 2017, 12:43 PM   #1368
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Originally Posted by TubbaBlubba View Post
Doctors in the U.S. make something like five to eight times as much as Swedish doctors (depending on field, etc). Do you really think that's because of their hard work and expensive schools?
No, it is because the AMA limit the number of residencies granted every year. There will never be enough doctors in the US and that is just how the doctors want it. So we have people who have graduated form medical school who have to go find other jobs because they didn't get a residency.
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Old 20th March 2017, 12:46 PM   #1369
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Originally Posted by TubbaBlubba View Post
Doctors in the U.S. make something like five to eight times as much as Swedish doctors (depending on field, etc). Do you really think that's because of their hard work and expensive schools?
Partly. IOW, it wouldn't be worth all that work and sacrifice if they made $60,000 a year. The people who make it into medical school would end up choosing another career path.

Again, the argument about whether or not US doctors are "better" or "worth more" than their peers in other countries is not relevant to my point that US doctors have different expectations.
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Old 20th March 2017, 12:47 PM   #1370
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Originally Posted by xjx388 View Post
There's no obvious reason why they shouldn't be rich either. Is there an obvious reason why anyone should be rich? Maybe it's because we should be rewarding the people who provide the most benefit to society. If healthcare is such an important thing, then shouldn't the providers of that care be among the richest of all?
If that were the case most teachers would be millionaires
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Old 20th March 2017, 12:50 PM   #1371
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Originally Posted by twinstead View Post
If that were the case most teachers would be millionaires
But they aren't because a long time ago we decided that teachers should be a government job. Don't think the doctors haven't noticed that . . .
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Old 20th March 2017, 12:57 PM   #1372
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Consultants in the NHS are not poorly paid. Especially as they often have private practices too.
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link is 2015 data (2013 Data below):
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US 16.4% of GDP of which 48.2% is public expenditure - 7.9% of GDP is public spending
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Old 20th March 2017, 01:21 PM   #1373
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Originally Posted by jimbob View Post
Consultants in the NHS are not poorly paid. Especially as they often have private practices too.
So what's an average? The average Family Medicine doctor in the US makes about $225k/year. According to this, the highest pay grade for NHS consultants is about $126K which kicks in after 19 years of service. I can't find any good information on what doctors who have private practices in the UK make.
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Old 20th March 2017, 01:25 PM   #1374
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Originally Posted by jimbob View Post
Consultants in the NHS are not poorly paid. Especially as they often have private practices too.
How are there private practices if heathcare is universal and publicly funded? Who is paying the private docs and why?
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Old 20th March 2017, 01:38 PM   #1375
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Originally Posted by marplots View Post
How are there private practices if heathcare is universal and publicly funded? Who is paying the private docs and why?
There are reasons - in a previous thread, Rolfe said that she went private because she wanted to get some not-very-urgent condition surgically treated quicker. I can't be bothered to search for the details.

If you look at my signature, you'll see that about 17% of healthcare spending in the UK is private.

The NHS is very cost effective, but it isn't perfect.
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link is 2015 data (2013 Data below):
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US 16.4% of GDP of which 48.2% is public expenditure - 7.9% of GDP is public spending
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Old 20th March 2017, 01:42 PM   #1376
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Originally Posted by jimbob View Post
There are reasons - in a previous thread, Rolfe said that she went private because she wanted to get some not-very-urgent condition surgically treated quicker. I can't be bothered to search for the details.

If you look at my signature, you'll see that about 17% of healthcare spending in the UK is private.

The NHS is very cost effective, but it isn't perfect.
I wonder how much of that is woo.

Interesting that there's that much unmet demand. I rarely see it mentioned.
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Old 20th March 2017, 01:48 PM   #1377
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Originally Posted by marplots View Post
I wonder how much of that is woo.

Interesting that there's that much unmet demand. I rarely see it mentioned.
Yes, and it's sometimes not brilliant for stuff like physio. But in general, it's pretty good for the money that is spent on it.
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Expenditure on healthcare
http://www.oecd.org/els/health-systems/health-data.htm
link is 2015 data (2013 Data below):
UK 8.5% of GDP of which 83.3% is public expenditure - 7.1% of GDP is public spending
US 16.4% of GDP of which 48.2% is public expenditure - 7.9% of GDP is public spending
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Old 20th March 2017, 01:55 PM   #1378
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Want a boob job? Unless there's a good reason, one might have to go outside the NHS.

Or getting a non life threatening surgery quicker. Some people do have money and are willing to spend it.

But get cancer, and you are just as well off inside the system, free long term treatment. Want a private room, and you might have to pay for that personally.
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Old 20th March 2017, 02:31 PM   #1379
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Originally Posted by Dr. Keith View Post
No, it is because the AMA limit the number of residencies granted every year. There will never be enough doctors in the US and that is just how the doctors want it. So we have people who have graduated form medical school who have to go find other jobs because they didn't get a residency.
Can that really be right? A certain percentage of medical school grads go into research or administration because that's what they want to do. But is there really evidence that qualified med school grads who want to practice can't?
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Old 20th March 2017, 02:39 PM   #1380
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Originally Posted by Bob001 View Post
Can that really be right? A certain percentage of medical school grads go into research or administration because that's what they want to do. But is there really evidence that qualified med school grads who want to practice can't?
We have a friend whose son graduated but couldn't get a residency. Went back to nursing school and is working as a traveling nurse to pay off his debts. I don't know the kid, so maybe he didn't deserve a residency. Seems harsh to let him continue and graduate though if that was the case.
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Old 20th March 2017, 02:42 PM   #1381
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Originally Posted by xjx388 View Post
....
And those stockholders, et. al. are also stakeholders in the US healthcare system that are very different from other countries. Right . . . now convince all the stakeholders involved in the US healthcare system that these kinds of changes would be good.
.....
By most accounts, the U.S. health care system spends as much as 25% on administration. In UHC systems, the number is as low as 10%. If you could take 15% off the top of U.S. health care costs, that would be a big bucket of money that could be distributed differently, including pay for doctors and other professionals. Obviously, the people who benefit most from the current system -- and who are the biggest contributors to political campaigns -- won't be happy about any changes. The ACA was undercut by forces that blocked a public option and prevented the government from negotiating drug prices, among other factors. But at some point, the vast majority of the population is going to start fighting back against the forces that are holding their health and even their lives hostage.
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Old 20th March 2017, 02:44 PM   #1382
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Originally Posted by Bob001 View Post
Can that really be right? A certain percentage of medical school grads go into research or administration because that's what they want to do. But is there really evidence that qualified med school grads who want to practice can't?
My understanding is "yes," but that most of the MDs who cannot secure a residency in the US, did not themselves obtain their medical degree in the US.

eg: a Ukranian MD moves to the USA, cannot practice medicine until completing a residency, and has been turned down by every program he's applied to.

This happens in a lot of countries. Here in Canada, my friend's dad was an Iranian MD but could not practice medicine in Canada, as he was not able to get into an accredited residency program.


So that's the majority of cases. However, there's a minority of cases where you have a domestic MD who does not get into a residency program. There are several reasons:
  • the MD's grades, reputation, and references are terrible (eg: had to repeat two years in medical school, is a registered sex offender, all his references are from people who are not medical, such as priest or personal psychotherapist)
  • the student wants to get into exactly one specialty and is not applying to others; my friend really wanted to be a surgeon and applied to all the surgery residencies in Canada when he graduated from medical school; non accepted him; he had to wait a year for the next round and expanded to other specialties, and is now an obstetrician.
  • the MD did not graduate from an accredited domestic institution; very few residency programs will accept an MD from a disreputable school
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Old 20th March 2017, 03:01 PM   #1383
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Originally Posted by TubbaBlubba View Post
Doctors in the U.S. make something like five to eight times as much as Swedish doctors (depending on field, etc). Do you really think that's because of their hard work and expensive schools?

American exceptionalism.
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Old 20th March 2017, 03:01 PM   #1384
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Originally Posted by blutoski View Post
  • the MD's grades, reputation, and references are terrible (eg: had to repeat two years in medical school, is a registered sex offender, all his references are from people who are not medical, such as priest or personal psychotherapist)
  • the student wants to get into exactly one specialty and is not applying to others; my friend really wanted to be a surgeon and applied to all the surgery residencies in Canada when he graduated from medical school; non accepted him; he had to wait a year for the next round and expanded to other specialties, and is now an obstetrician.
  • the MD did not graduate from an accredited domestic institution; very few residency programs will accept an MD from a disreputable school
A quick scan seems to indicate that the biggest problem is applying for one hot speciality or too few programs, and apparently a high percentage of first-round failures get accepted in a second round, or reapply successfully the next year.

I would think somebody with bad grades and references would wash out earlier. Somebody applying for a residency has already graduated from medical school, completed an internship and been licensed.

I don't think the U.S. has any "disreputable" med schools. Med schools are all university affiliated and closely regulated by accrediting organizations and other entities. There used to be (and may still be) unaccredited fly-by-night law schools. But not in medicine. (That's different from somebody going to a school in the Caribbean, and being at a disadvantage against U.S. graduates.)
https://www.usnews.com/education/bes...idency-matches

Interestingly, apparently residencies are funded by Medicare, and the number hasn't increased since 1997.
http://www.post-gazette.com/news/hea...s/201405260083
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Old 20th March 2017, 03:12 PM   #1385
blutoski
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Originally Posted by Bob001 View Post
A quick scan seems to indicate that the biggest problem is applying for one hot speciality or too few programs, and apparently a high percentage of first-round failures get accepted in a second round, or reapply successfully the next year.

I would think somebody with bad grades and references would wash out earlier. Somebody applying for a residency has already graduated from medical school, completed an internship and been licensed.
Well, the joke is: "what do you call the medical school graduate at the bottom of his class? Answer: Doctor."

A lot of MDs graduate from medical school, completed their internship, are fully licensed, and had to repeat years, and some have criminal backgrounds. You don't get expelled for date rape.


Originally Posted by Bob001 View Post
I don't think the U.S. has any "disreputable" med schools. Med schools are all university affiliated and closely regulated by accrediting organizations and other entities. There used to be (and may still be) unaccredited fly-by-night law schools. But not in medicine. (That's different from somebody going to a school in the Caribbean, and being at a disadvantage against U.S. graduates.)
https://www.usnews.com/education/bes...idency-matches
It comes and goes, is the problem. It also depends on how far down the disreputable classification you're going to go. When my wife was in the US a few years ago for a gospel choir tour, one of the churches she performed at had an unaccredited correspondence school offering MD degrees, for example. Sort of like Kent Hovind's self-awarded PhD granting institution. I doubt they make any real blip on the residency radar.


Originally Posted by Bob001 View Post
Interestingly, apparently residencies are funded by Medicare, and the number hasn't increased since 1997.
http://www.post-gazette.com/news/hea...s/201405260083
Yes, although that's the institutions' choice. In Canada, they're funded through the same hospital budget as medical staffing (since they fill that role, albeit with supervision). The attending physician is also sometimes paid teaching stipend if they've been given faculty status at a nearby teaching hospital. For example, my wife acts as faculty at UBC while supervising/training residents at VGH.
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Old 20th March 2017, 03:43 PM   #1386
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Originally Posted by xjx388 View Post
But they aren't because a long time ago we decided that teachers should be a government job. Don't think the doctors haven't noticed that . . .
I just note that teachers in large public systems usually make much more than they could earn in most private schools, even if they don't get rich. Somewhere along the way we decided that education benefits the society and should be universally available, rather than be treated as a scarce luxury. And doctors in the VA -- the U.S. system that most closely resembles UHC -- are well-paid, and they enjoy a level of security and professional support -- including benefits and malpractice coverage -- that private docs have to pay for themselves. "Government" is not the enemy.
https://www.glassdoor.com/Salary/US-..._D_KO34,43.htm
http://www.vacareers.va.gov/why-choo...e-salaries.asp
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Old 20th March 2017, 03:58 PM   #1387
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Originally Posted by marplots View Post
How are there private practices if heathcare is universal and publicly funded? Who is paying the private docs and why?
Often it's a perk of senior executives and partners, the benefit being that non-emergency procedures can by scheduled by the patient/client. Private hospitals don't do ER or intensive care : if things go pear-shaped they ship you off to the NHS. And charge for the ambulance-trip, naturally.
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Old 20th March 2017, 04:09 PM   #1388
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Originally Posted by marplots View Post
How are there private practices if heathcare is universal and publicly funded? Who is paying the private docs and why?
That doesn't mean everybody gets everything he wants whenever he wants it. Even in the U.S., people with great insurance will still have to pay for their own Lasik, cosmetic surgery etc. In UHC systems, everybody is covered for specified essential services, and doctors agree to accept the payment provided. It doesn't usually (I'm not sure about everywhere) prohibit people from making private arrangements for extra services at their own expense.

Last edited by Bob001; 20th March 2017 at 04:22 PM.
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Old 20th March 2017, 04:14 PM   #1389
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Originally Posted by xjx388 View Post
So what's an average? The average Family Medicine doctor in the US makes about $225k/year. According to this, the highest pay grade for NHS consultants is about $126K which kicks in after 19 years of service. I can't find any good information on what doctors who have private practices in the UK make.
If payment was switched to a "number of patients" plus "procedures" system that paid a fair rate for these things, then would you be willing to acknowledge that there is a possibility that if Doctors pay went down under such a system then they are currently being overpaid for what they actually do?
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Old 20th March 2017, 04:18 PM   #1390
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Originally Posted by TragicMonkey View Post
What do you want from me? An official retraction of the clause "it's just part of the cost of doing the business"? Fine! Jesus! I APOLOGIZE for sloppily wording something. Anything to stop you talking.
Wow. That seems unnecessary.
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Old 20th March 2017, 04:19 PM   #1391
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Originally Posted by blutoski View Post
.....When my wife was in the US a few years ago for a gospel choir tour, one of the churches she performed at had an unaccredited correspondence school offering MD degrees, for example. Sort of like Kent Hovind's self-awarded PhD granting institution. I doubt they make any real blip on the residency radar.
.....
It's very hard to believe that wouldn't be an outright, straight-to-jail fraud. I can't imagine that a "graduate" of a correspondence "medical school" would be dumb enough to apply for a residency.

Of course, that doesn't mean that scams don't exist.
http://abcnews.go.com/Business/Perso...ory?id=8322412
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Old 20th March 2017, 04:29 PM   #1392
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Originally Posted by Emily's Cat View Post
Wow. That seems unnecessary.
Exactly what I thought about your pointless picking on one part of one remark.
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Old 20th March 2017, 04:32 PM   #1393
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Originally Posted by TragicMonkey View Post
Exactly what I thought about your pointless picking on one part of one remark.
I thought we were having a discussion. You seem to have taken it personally.

At the end of the day, that waste ends up being part of the cost of care. It contributes to the underlying cost mechanism. It's not something to be ignored. I understand why it occurs, but you can't just brush it aside either.
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Old 20th March 2017, 10:03 PM   #1394
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A Medicaid success story by a Washington Post editor and columnist:
http://www.washingtonpost.com/busine...=.acf5da55e9ce
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Old 21st March 2017, 12:53 PM   #1395
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Originally Posted by jimbob View Post
There are reasons - in a previous thread, Rolfe said that she went private because she wanted to get some not-very-urgent condition surgically treated quicker. I can't be bothered to search for the details.

If you look at my signature, you'll see that about 17% of healthcare spending in the UK is private.

The NHS is very cost effective, but it isn't perfect.
Also most family practices (GPs) are small businesses run by doctors. What they have is a contract with the NHS to provide care to patients. The NHS is the sole contractor, but the doctors are self employed partners. Some things like travel medicine, some occupational health issues are not reimbursed by NHS and the GP charges the patient. The partnership may have a contract to provide health care to e.g. nursing homes, factories, schools outside of the NHS.
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Old 21st March 2017, 02:23 PM   #1396
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Originally Posted by Bob001 View Post
That doesn't mean everybody gets everything he wants whenever he wants it. Even in the U.S., people with great insurance will still have to pay for their own Lasik, cosmetic surgery etc. In UHC systems, everybody is covered for specified essential services, and doctors agree to accept the payment provided. It doesn't usually (I'm not sure about everywhere) prohibit people from making private arrangements for extra services at their own expense.
This last bit is the subject of a [constitutional challenge] in Canada that's taking place as we speak.

Basically it works like this... public healthcare funds a list of medical services.

1. If an MD wants to provide a procedure that's not on the list (eg: cosmetic surgery, acupuncture, homeopathy, Rolfing...) he will need to obtain private funding.

2. If an MD wants to provide a procedure that IS on the list (eg: cataract eye surgery) and charge patients directly, it's illegal.

That #2 is being challenged. Basically, a doctor ("Cambie Surgeries Corp") in Vancouver billed his patients AND billed the public healthcare system for the same procedure, feeling that this remuneration was fair compensation for his labour and skill. His challenge of the law is that he should be allowed to charge outside the public system for any legitimate procedure he performs.
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Old 21st March 2017, 02:28 PM   #1397
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Originally Posted by blutoski View Post

That #2 is being challenged. Basically, a doctor ("Cambie Surgeries Corp") in Vancouver billed his patients AND billed the public healthcare system for the same procedure, feeling that this remuneration was fair compensation for his labour and skill. His challenge of the law is that he should be allowed to charge outside the public system for any legitimate procedure he performs.
Isn't he charging the patient for something he's already paid for with taxes? That seems like a some double dippage to me
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Old 21st March 2017, 02:32 PM   #1398
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Originally Posted by twinstead View Post
Isn't he charging the patient for something he's already paid for with taxes? That seems like a some double dippage to me
Sounds more like he's offering a two tiered system from this article. Pay out of pocket and skip the queue or let the government pay and wait in the queue.

Quote:
Dr. Day is the medical director at the Cambie clinic, which specializes in anthroposcopic surgery and allows patients to pay out-of-pocket rather than wait for care in the public system. The provincial government has previously audited the clinic and alleged its billing practices were illegal, though for years it did little to actually intervene. Dr. Day and his patients argue that restrictions on private care are unconstitutional.
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Old 21st March 2017, 02:45 PM   #1399
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Originally Posted by twinstead View Post
Isn't he charging the patient for something he's already paid for with taxes? That seems like a some double dippage to me
Yes, it does feel like double dipping, but the criminal charges he's challenging were strictly for the private billing portion, whether or not he had applied for the public fee.

But the patients who joined his lawsuit are fine with it, so in that sense I don't want to say they were defrauded. He would have refused service at the public funding only pricepoint, and they feel this means they got the best care they could offord because they were willing to top up his publicly funded fee.
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Old 21st March 2017, 02:48 PM   #1400
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Sounds like you can jump the queue for a little extra cash. Seems like at least a potential issue
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