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For starters....people have to become more conscientious about their health. Physicians have to stop doing unnecessary tests because they're afraid of being sued.
Physicians can't come out of medical school $100,000 in debt and still need to go through residency (# of years varies by specialty) and then fellowship (# varies again).
Medicine in the US had always been "lucrative", until HMOs came around and even so, it still is. Somebody has to pay for the luxury cars, the mansions, the private schools, the travel, etc.
There are so many reasons why healthcare here is expensive and basically it is unmanageable at the rate we're going.
So now you have Nurse practicioners, physician assistants, nurse anesthetists, therapists....taking the place of your "family" doctor. These people still make over $200K/yr but they are replacing physicians who no longer want to deal with the bureaucracy for the pay.
Just thought I should hit a few points here. You are right, medical education is expensive, the average debt now a days is 150K and climbing. Interest rates on these loans are ~7%.
These Nurse Practicioners, Physician assistants, and the likes are NOT making 200k a year. The average family doctor makes about 140K a year. This is after 4 years of undergrad, 4 years medical school, and at least 3 years of residency. Don't forget the debt. So they lost earning power in their 20s, lost ability to invest, and actually payed since they are going to school for the privelige of practicing medicine at the rip old age of at least 30. Plus they are working ~60 hours a week, deal with insurance that doens't want to pay for the best treatment for their patiensts, paper work, pay malpractice insurance, debt loans, ect, so the 150K a year isn't so much to ask for.
Yes, part of the cost of healthcare spiraling out of control is malpractice. The US is sue happy. Canada is not like that. Canada pays for med school and for malpractice insurance. Also they just aren't a sue happy culture like ours. In Miami, the premiums for an OB doctor is higher than anywhere, because Miami is extremely sue happy. For these reasons, doctors order more tests, even though there diagnostic skills using physical exams are going to lead to being correct 95% of the time, they do not want to miss that 5%.
Also, in the US we have access to the best and newest technologies. Almost every hospital has an MRI. Ask Natasha Richardson if there are abundant MRI's in Canada... there aren't, which is why she sadly died. In the US that wouldn't have happened, because MRI's and specialty surgeons like neurosurgeons are more available than Canada. This is why Canada is spends less on healthcare, and we spend more.
The uninsured cost a lot. They use ER facilities for minor complaints which could be easily dealt with at a Family Doctors office, but they don't want to pay the bill. ER's cannot refuse the right to treatment regardless of ability to pay. ER's cost a lot because staffing requires having specialists and nurses available 24hrs a day. So that ear infection that could have been diagnosed and treated for less than 100$ at the family doctor clinic will cost $2000 in the ER.
Finally, the US has a much greater obesity epidemic then Europe, Japan, and other industrialized countries. We are extremely unhealthy as a nation. Obesity is linked with heart disease, diabetes, hypertension, and a host of other morbitities.
Physicians in latin american countries are not nearly as glorified as they are in the US and are much more accessible BUT there is a social tiers structure.
Doubt that they are glorified here either. In Latin America, the best care is for people with MONEY. If you have the money to pay for treatment, you get it. If you don't... tough luck.
In countries like Australia, they have a two tier system, kinda like public and private schools here. You pay to send your kids to the better schools, and we all know about the shape of many public schools in our nation. So same thing in Australia. Most doctors work for the government, get paid less, work less, and are essentially clock punchers because there is no incentive to work hard. Some doctors in Australia are in the private tier, where treatment is better, but obviously your pay for it.
United States spends more money in Public Healthcare per capita than any European country. Problem there lies with AMA and Insurance Lobbies.
In Europe, doctors are just professionals without so much ado. Some complain, in Spain, that they are treated almost as blue collars.
I don't see AMA allowing a Univ. Healthcare there.
The AMA has very little political clout these days. The biggest players against universal insurance is the Insurance industry and Big Pharmaceutical industry. They are at stake to lose the most money. The Insurance industry has completely squeezed doctors and patients completely.
Just thought I should hit a few points here. You are right, medical education is expensive, the average debt now a days is 150K and climbing. Interest rates on these loans are ~7%.
These Nurse Practicioners, Physician assistants, and the likes are NOT making 200k a year. The average family doctor makes about 140K a year. This is after 4 years of undergrad, 4 years medical school, and at least 3 years of residency. Don't forget the debt. So they lost earning power in their 20s, lost ability to invest, and actually payed since they are going to school for the privelige of practicing medicine at the rip old age of at least 30. Plus they are working ~60 hours a week, deal with insurance that doens't want to pay for the best treatment for their patiensts, paper work, pay malpractice insurance, debt loans, ect, so the 150K a year isn't so much to ask for.
Yes, part of the cost of healthcare spiraling out of control is malpractice. The US is sue happy. Canada is not like that. Canada pays for med school and for malpractice insurance. Also they just aren't a sue happy culture like ours. In Miami, the premiums for an OB doctor is higher than anywhere, because Miami is extremely sue happy. For these reasons, doctors order more tests, even though there diagnostic skills using physical exams are going to lead to being correct 95% of the time, they do not want to miss that 5%.
Also, in the US we have access to the best and newest technologies. Almost every hospital has an MRI. Ask Natasha Richardson if there are abundant MRI's in Canada... there aren't, which is why she sadly died. In the US that wouldn't have happened, because MRI's and specialty surgeons like neurosurgeons are more available than Canada. This is why Canada is spends less on healthcare, and we spend more.
The uninsured cost a lot. They use ER facilities for minor complaints which could be easily dealt with at a Family Doctors office, but they don't want to pay the bill. ER's cannot refuse the right to treatment regardless of ability to pay. ER's cost a lot because staffing requires having specialists and nurses available 24hrs a day. So that ear infection that could have been diagnosed and treated for less than 100$ at the family doctor clinic will cost $2000 in the ER.
Finally, the US has a much greater obesity epidemic then Europe, Japan, and other industrialized countries. We are extremely unhealthy as a nation. Obesity is linked with heart disease, diabetes, hypertension, and a host of other morbitities.
I agree with most of this, apart from the "bolded" part. "don't want to pay the bill" is a common misconception -- what about "can't pay the bill"? Without insurance, even a doctor's visit is out of reach to most. I have nothing but sympathy for these people, especially those who have found themselves unemployed as a result of this particularly bad recession.
I do agree with the obesity issue though, but that's also a complex issue in itself. Personal responsibility plays a role, but equally, we have to try to change the "fast food, fast living" culture that has allowed us to become extremely unhealthy, car-centric and in many cases, obese.
Location: Lots of sun and palm trees with occasional hurricane :)
8,293 posts, read 16,158,308 times
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Quote:
Originally Posted by vdy1985
Just thought I should hit a few points here. You are right, medical education is expensive, the average debt now a days is 150K and climbing. Interest rates on these loans are ~7%.
These Nurse Practicioners, Physician assistants, and the likes are NOT making 200k a year. The average family doctor makes about 140K a year. This is after 4 years of undergrad, 4 years medical school, and at least 3 years of residency. Don't forget the debt. So they lost earning power in their 20s, lost ability to invest, and actually payed since they are going to school for the privelige of practicing medicine at the rip old age of at least 30. Plus they are working ~60 hours a week, deal with insurance that doens't want to pay for the best treatment for their patiensts, paper work, pay malpractice insurance, debt loans, ect, so the 150K a year isn't so much to ask for.
Yes, part of the cost of healthcare spiraling out of control is malpractice. The US is sue happy. Canada is not like that. Canada pays for med school and for malpractice insurance. Also they just aren't a sue happy culture like ours. In Miami, the premiums for an OB doctor is higher than anywhere, because Miami is extremely sue happy. For these reasons, doctors order more tests, even though there diagnostic skills using physical exams are going to lead to being correct 95% of the time, they do not want to miss that 5%.
Also, in the US we have access to the best and newest technologies. Almost every hospital has an MRI. Ask Natasha Richardson if there are abundant MRI's in Canada... there aren't, which is why she sadly died. In the US that wouldn't have happened, because MRI's and specialty surgeons like neurosurgeons are more available than Canada. This is why Canada is spends less on healthcare, and we spend more.
The uninsured cost a lot. They use ER facilities for minor complaints which could be easily dealt with at a Family Doctors office, but they don't want to pay the bill. ER's cannot refuse the right to treatment regardless of ability to pay. ER's cost a lot because staffing requires having specialists and nurses available 24hrs a day. So that ear infection that could have been diagnosed and treated for less than 100$ at the family doctor clinic will cost $2000 in the ER.
Finally, the US has a much greater obesity epidemic then Europe, Japan, and other industrialized countries. We are extremely unhealthy as a nation. Obesity is linked with heart disease, diabetes, hypertension, and a host of other morbitities.
We're saying pretty much the same things. I just didn't say it as well as you. I do disagree slightly on a couple of points. NPs, PAs, and the like DO make over 200K - the ones I know.
A "family" doctor, or a GP does not really need a residency/fellowship. If you go to a internist for your earache, well, that's different.
ERs only have to stabilize the patient. After the patient is stable, then you may ask for financial information. You do not have to provide any treatment in the ER after the patient is stabilized and you just give them a management plan. Many of these people have Medicaid, many have nothing. Those who have nothing are the ones who will end up in the ER again with the next earache. They fill up our ERs and use our resources - in Dade county. You don't have a Jackson Public Health Trust outside of Dade.
I did mention that Canadians cross the border all the time because we have the doctors, the technology, and the opportunity.
Doubt that they are glorified here either. In Latin America, the best care is for people with MONEY. If you have the money to pay for treatment, you get it. If you don't... tough luck.
In countries like Australia, they have a two tier system, kinda like public and private schools here. You pay to send your kids to the better schools, and we all know about the shape of many public schools in our nation. So same thing in Australia. Most doctors work for the government, get paid less, work less, and are essentially clock punchers because there is no incentive to work hard. Some doctors in Australia are in the private tier, where treatment is better, but obviously your pay for it.
Doctors in countries with socialized systems can still make a good living, trust me. As they don't have the burden of hundreds of thousands of dollars' worth of student loans + the burden of having to carry malpractice insurance (to prevent getting sued for anything and everything), the reality is that most are probably no worse off than the average US doctor.
Britain has only one-fourth as many CT scanners per capita as the U.S., and one-third as many MRI scanners. The rate at which the British provide coronary-bypass surgery or angioplasty to heart patients is only one-fourth the U.S. rate, and hip replacements are only two-thirds the U.S. rate. The rate for treating kidney failure (dialysis or transplant) is five times higher in the U.S. for patients between the ages of 45 and 84, and nine times higher for patients 85 years or older.
Overall, nearly 1.8 million Britons are waiting for hospital or outpatient treatments at any given time. In 2002–2004, dialysis patients waited an average of 16 days for permanent blood-vessel access in the U.S., 20 days in Europe, and 62 days in Canada. In 2000, Norwegian patients waited an average of 133 days for hip replacement, 63 days for cataract surgery, 160 days for a knee replacement, and 46 days for bypass surgery after being approved for treatment. Short waits for cataract surgery produce better outcomes, prompt coronary-artery bypass reduces mortality, and rapid hip replacement reduces disability and death. Studies show that only 5 percent of Americans wait more than four months for surgery, compared with 23 percent of Australians, 26 percent of New Zealanders, 27 percent of Canadians, and 36 percent of Britons.
Doctors in countries with socialized systems can still make a good living, trust me. As they don't have the burden of hundreds of thousands of dollars' worth of student loans + the burden of having to carry malpractice insurance (to prevent getting sued for anything and everything), the reality is that most are probably no worse off than the average US doctor.
Oh, I agree. But like I said, they are doing well because, as you said, they don't have the student loan burden or the constant threat of being sued. The government takes care of that.
Location: Lots of sun and palm trees with occasional hurricane :)
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I agree that the biggest obstacle is probably the insurance companies. The red tape is unbelievable. There are umpteen different plans, by payor, by employer, by individual contract. It is almost impossible to decipher who pays for what when. Even for those who have employer sponsored insurance, the out of pocket share is increasing every day. Deductibles, co-pays, specialist co-pays, covered vs non-covered, HMOs, PPOs, Choice +, Open Access, all this costs money out of pocket, in addition to your monthly premiums. Healthcare is not affordable, even with insurance.
The insured avoid going to the doctors because of all the out of pocket costs, which then leads to bigger problems in the long run. It's a vicious circle.
I have a problem with where my tax money goes and how it's used and ON TOP OF THAT I have to pay a small fortune everytime I have to see a physician.
We're saying pretty much the same things. I just didn't say it as well as you. I do disagree slightly on a couple of points. NPs, PAs, and the like DO make over 200K - the ones I know.
A "family" doctor, or a GP does not really need a residency/fellowship. If you go to a internist for your earache, well, that's different.
ERs only have to stabilize the patient. After the patient is stable, then you may ask for financial information. You do not have to provide any treatment in the ER after the patient is stabilized and you just give them a management plan. Many of these people have Medicaid, many have nothing. Those who have nothing are the ones who will end up in the ER again with the next earache. They fill up our ERs and use our resources - in Dade county. You don't have a Jackson Public Health Trust outside of Dade.
I did mention that Canadians cross the border all the time because we have the doctors, the technology, and the opportunity.
Again, about the PA, NP issue, sure you may know some outliers. But the average PA is is making 80K, and the average NP is making maybe a little more or about the same. Google it.
And the Family Doctor, unless you are working for the military overseas or an extermely rural community, you will NOT get hospital privalidges nor will you get malpractice insurance if you are not Board Certifed (this requires doing a residency, which for Family practice is 3 years).
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