Okay, but it’s not as if everyone who isn’t admitted to medical school isn’t qualified to be a doctor. Some are above the threshold, let’s say, but there are plenty of people who are qualified with respect to the standards, who are not admitted because there is just a limited number of spots.
As for the quality of medical care provided, even if it is decreased–and I do not think it will be–the greater availability of medical personnel available to treat patients would more than offset this in terms of outcomes.
Feeding tubes and other measures can be taken out of the picture with advanced directives, AFAIK, but not everybody has arranged for this. And of course I don’t know all the details pertinent to this particular case.
That said, the overall health must be considered, as you mentioned, and not just the age of the person in question. I wouldn’t want to see people cut off from care just because of chronological age. There are some folks I know in their 80s and even 90s who are still pretty good physically and mentally, while some folks half that age are in terrible shape and/or dying.
There is some support for your belief, but it is probably not a black and white issue - and it not fully the AMA. Over the past 30 years there have been predictions of physician surpluses and limits on medical school enrollment. This link says :
The marketplace doesn’t determine how many doctors the nation has, as it does for engineers, pilots and other professions. The number of doctors is a political decision, heavily influenced by doctors themselves.
As I understand it medical education must be accredited by the ACGME membership organizations (physicians and hospitals) and residency program funding is controlled by congress.
The good news is that the while the US only added 1 new medical school in the 1980’s, 5 in the 1990’s and 13 since 2000. Another 17 are under consideration.
Formulaic Opt-out Advanced Directives? Based on age, health etc… That way there’s a default ‘this is how you will be treated’ with the ability to change it if you want to.
Interesting. So you think medical schools are close to 100% accurate in accepting students? What about students rejected by school A and accepted by school B? If they hadn’t applied to school B, would they then not be qualified? What about students who do not even apply because they have heard of low acceptance rates?
The US has a low number of physicians per capita, 2.3 per 1,000 people.
France has 3.37
Germany 3.4
Israel 3.82
Canada & the UK have about 2.1 & 2.2
These are all wealthy, developed OECD nations by the number of doctors is 60% higher per capita in Israel & Germany than Canada & the UK.
I don’t buy the idea that a UK or Canadian (or US doctor) is better than a French or German due to the fact that there are fewer than them.
There are tons of intelligent, hard working people who get rejected from medical schools all the time. And there are people who get in who have good academic/technical skills, but bad interpersonal skills (which are extremely important in medicine). Adding an extra doctor per 1,000 people isn’t going to decrease quality any. It hasn’t in France or Germany.
It is a shortage of programs (med schools and residency programs), not a shortage of talent. We have as much talent as France, Germany or Israel. We just don’t have as many openings.
I guess it is more that we don’t have enough residency programs.
But some specialist docs earn enough to buy small islands, and that makes it all worthwhile. :rolleyes:
As someone who was recently accepted to med school, I certainly hope that the number of spots is increased for future applicants, and a system is created where everyone is able to obtain medical care without going bankrupt.
I don’t know tons about the Sustainable Growth Rate, but it sounds like the ‘starving the beast’ concept among the GOP.
If you keep cutting medicare reimbursement rates, doctors won’t take medicare patients. And soon only bad doctors or no doctors will be left. Then you can eliminate medicare by pointing to how few or how bad the doctors left are because all the other doctors will have abandoned the program.
Thomas Frank claims conservatives have been doing this for a while. If you cut wages and benefits for those who work under public systems, then you can eliminate people who will take those jobs, or get people who are lower quality to take those jobs. Then you can point at those ineffective programs with lower quality workers and say ‘see, government doesn’t work. Lets eliminate XYZ’.
Its like FEMA under Bush. Put incompetent people in charge, then use their incompetence as an excuse to bash government intervention and laud the private sector. Except it is intentional.
Only 1 republican voted to replace the SGR program in 2009 in the house.
So I don’t believe that the program is designed to keep medicare solvent, it sounds more like a tool used by conservatives to destroy entitlement programs.
Peter Orszag claims about $800 billion in medical spending goes to interventions that do not make people healthier. Targeting those (which would probably include targeting tort reform designed to block defensive medicine) would probably be better to keep costs down.
The shortage of doctors is not due to a shortage of qualified applicants (although that’s an issue which concerns me – there are already some crappy doctors out there), nor is it primarily due to a shortage of medical school slots. The Liaison Committee on Medical Education (LCME), THE accrediting body for US medical schools, is overseeing a 30% expansion in med school capacity. They’re a lot more worried about a shortage of slots in residency programs. In an opinion piece in the Wall Street Journal, the president of the Association of American Medical Colleges blamed Congress for putting a “cap” or “freeze” on funding for residencies. The AAMC and the AMA pretty much run the LCME, so they deal directly with the conflict between the financial interests of doctors, and the policy interests we’ve discussed, but right now everyone agrees there’s a shortage, and that it’s going to get worse.
In other news: there’s no point in comparing Medicare to Social Security; there is no SSI-style cap on the Medicare tax. To fund Medicare from income tax, the rate would have to increase to account for exemptions and deductions. I have no problem with that, but there’s no inherent funding benefit from it like there would be for SSI. Similarly, SS spending would go down a lot if no one with an adequate retirement plan drew benefits; I don’t think Medicare would experience similar savings, as private medical insurance is, well, not at all like an IRA.
I really think we need to suck it up and raise taxes; even George Will has said that Americans are undertaxed, compared to the level of services they (we) receive. Perhaps people would finally decide one way or the other.
My point is that they haven’t made the cuts at all.
What I keep asking is, if there is $800 billion in cuts that could be made without affecting the health of Medicare patients, why haven’t they been made for the last seven years?
Politicians always talk about “waste, fraud, and corruption” and how eliminating it will magically make money appear. (Remember the $200 Pentagon hammers?) The trouble is, whoever is now benefiting from the waste is going to scream bloody murder, and will hire a bunch of highly educated folks who will make a very plausible case that “grandma will be kicked out to die in the street because no doctor will treat her at a loss if we cut Medicare”.
For instance -
Notice what they are saying - preventative measures add to health care costs. Now suppose we want to cut $55 billion so as to save money. Can you imagine the screaming? “You want to force diabetics into the hospital! You MONSTER! You are trying to starve the beast and ruin entitlement programs!” Etc., etc.
Yes, tort reform could help, in the sense even of reducing costs rather than merely slowing their growth. Given the amount of contributions that trial lawyers give to Congress - good luck with that.
Tort reform includes things like reductions in defensive medicine and malpractice insurance, not just lawsuits. Cite - PDF. Although you are correct, it is not a panacea. On the other hand, it does not involve cuts in reimbursements or tax increases, and it decreases one of the upward pressures on costs.
It makes for fewer John Edwards types, but I consider that a benefit.
“Health Spending In The United States And The Rest Of The Industrialized World”
Anderson et al.
Health Affairs, 24, no. 4 (2005): 903-914
The 0.46% includes malpractice claims. As for the costs of defensive medicine, they are somewhat more difficult to gauge. Presumably, more and higher lawsuit settlements would prompt more tests, but they are not the only factor in this. Doctors also order additional tests just for the reimbursement, as well as for a defense against complaints that do not involve monetary compensation (e.g., board sanctions).
I’m all for rendering this question moot by establishing single payer healthcare. If doctors are federal employees, they can’t be sued. At the same time, patients don’t have to worry about the financial burdens inflicted on them by incompetent doctors, since their health bills would be covered (though they would still have the health effects).
But I would not support “tort reform” without a guarantee of the provision of healthcare for everyone.
Medicare could be partailly saved by eleimating Medicare Fraud. They have a device that scans your finger to show you signed for those services. This would be a huge help because now all they need is your Medicare card to bill for services.
It would not cost 60 Billion. It would pay for ityself. I’ll see what I can find out how much they cost. The government has saved Billions converting from paper food stamps which were sold for cash, to government atm cards for food.
This is what I think is the most important thing. Doctors who don’t take Medicare do this because they can be paid more–that is, charge more–in the private market. Competition will act as a counter to that.
Funny how people complain about Medicare being so expensive, but are horrified at the idea of paying doctors less.