Fantastic job admitting you have nothing useful to say.
I think that Paul Krugman would strongly support a proposal like this, but I believe it is a terrible idea.
http://averagedoctorsalary.com/ The average doctor pulls down $280,400 . That is not starvation.
They will not be bankrupted by helping out the “little people”.
And how does this relate to the issue of licensure?
And we single-payer advocates will croon, ever so gently, “We told you so…”
In some states it used to be illegal for anyone other than a doctor to pierce ears. When that restriction was lifted did prices go up or down?
You’re now discussing scope of practice.
I get that, I do.
I am a nurse practitioner and my expanded scope of practice has overlap with physicians.
I diagnose and prescribe, among other things. I can also do some minor surgery.
However, I am never going to replace a physician in certain circumstances.
As I understand it, the proposed law in question does not only apply to the licensure of physicians, but other licenses as well. Nursing?
Nurse practitioners such as myself?
In principle, do you agree with the premise of the proposed law that a fully licensed physician, or a fully licensed RNP or PA or RN or EMT, could be denied licensure purely for economic reasons and NOT because of any malpractice or danger to the public?
If you do agree with that notion, in principle, then why not other professions that require licensure and continuing education to renew that license?
Physician salary aside, what do you think about the basic premise that licensure is dependent on a government entity basically saying you cannot open a private practice fee for service and determine for yourself how you want to run your business?
Why not expand that to attorney licensure as well?
Their license to practice law is revoked unless they work for certain clients the state determines they must accept, or lose licensure?
It is not about salary.
It is about licensure revoked when the public is NOT at risk.
It is about an individual’s freedom to peruse their work as they see fit.
Would that be OK with you, based on the same principle?
What if a licensed pilot could have his/her license revoked for reasons NOT involving competency or safety? That’s OK with you, because they too have a high salary?
I do not understand why you think this sort of terrible idea could be restricted to physicians.
Actually, your site implies that the average of the listed fields is $280,400–and all but one of those fields are specialties. You’ll notice, of course, that the closer one gets to primary care on that list, the lower the average salary. Your average internist makes a little over half of your cited figure, with very slightly lower numbers for family practice docs. Yes, that’s still well above starvation, but very, very few people are going to spend 11 years and $100-200,000 on education/training, work nights, weekends, and holidays, take phone calls about work during dinner/school plays/sex, and risk physical injury from aggressive drug-seekers without the expectation of doing quite a bit better than not starving.
And Medicare reimbursement is, well, weird. I’ve had multiple people try to explain it to me, and I eventually have to make them hush because the whole thing just gives me a headache. My rough understanding of it is this: Medicare pays by diagnosis, not by service. If a patient comes in with X diagnosis, you get paid the same no matter how much testing and treatment you do. A patient who gets an exam and a prescription gets reimbursed the same amount as one who gets an exam, a chest film, blood work, a breathing treatment, and a prescription. I understand why they do it like that, to keep people from ordering expensive tests and treatments that aren’t necessary. And I’m all for not doing unnecessary test and treatments, even the cheap ones. But the unintended consequence is that it’s entirely possible to lose money seeing Medicare patients. Depending on your patient population–the percentage on Medicare/Medicaid, average age, prevalence of treatment/testing-heavy conditions–those losses or even the paper-thin profit margins on Medicare patients can be the difference between getting new equipment/attracting good staff/keeping the doors open or not.
What’s the answer? I don’t know. I doubt there’s a one-size-fits-all solution to this, any more than there’s one to any other large, complex issue. But I think I’d feel a lot more comfortable with just removing the fig leaf of payment from the issue and just being honest about the reality that a lot of these services are being done at cost or a loss. Maybe requiring a certain number of hours volunteering at a free clinic or doing other pro bono work.
And, of course, requiring a corresponding amount of pro bono work from all other licensed professionals as a condition of licensure.
The EU isn’t in shambles.
All things considered, I prefer our Canadian system over the US one. If you need some care, yes, you usually wait. If it’s an emergency, you get it no questions asked and no bankrupting costs.
The Canadian system like most politically guided funding bounces betwen starving the system to control costs and then throwing money at it to get rid of “hallway medicine” and backlogs of waiting patients. Similarly, doctors alternate between participating and moving to other locations (notably the USA) because the pay is too small.
Canada does not refuse to license physicians, but they do have a simple system - either you’re in or you’re out. A dotor takesUHC (Medicare) patients, or they charge the patient for the treatment. If the doctor is not “in” the system, the patient does not get reimbursed for the treatment either. Since no employers have plans that cover costs that medicare should pay for, the doctor is limited to cash customers.
A doctor in the system cannot charge more than the schedule for services in the system. (No “extra billing”).
There may be a few “boutique” physicians and dotors to the fabulously wealthy, but almost every physician is “in”. Even a plastic surgeon - the items not covered by Medicare are not relevant - you can do vanity face-lifts for cash, and still do plastic surgery for burn victims under Medicare, although face-lifts probably pay a heck of a lot better.
The other glitch is that the medicare system will reimburse costs for work done out of province to the amount the province would normally pay… and if they have to send you out of province (because there is no service available locally) they will pay what the market costs. Newfoundland was about to lose their 5 specialists in one field (cancer?) becuse they would not raise the rates; yet due to a shortage of these specialists, they would pay to fly some patients to Halifax for a similar specialist, and then pay the much higher Nova Scotia medicare rate for the same specialist service.
So there are glitches, but the system has a way of evening itself out. Either they match Nova Scotia’s and other provinces’ rate or all their specialists leave. If the Canadian rate is too low, doctors head for the USA. We can’t be too bad - doctors from South Africa and Asia are lining up to get in here, and we’re taking tehm.
The problems with the USA UHC system, IMHO, lie with the right and their objection to UHC. To appease them and win necessary votes, you now have a messed up multi-participant partly-for-profit health care system. Instead of a standard schedule by state - “this is what the state covers, medically” it’s still a confusing mash-up of different providers with different rules, different forms, different rates and all the overhad required to fill this. Almost everything Canadian doctors do, is billed with one form to one agency against a list of known services.
Thank you for your post.
It is my understanding that the Canadian system also has a completely different malpractice senario which effectively eliminates frivolous malpractice law suits. The “loser” in a suit pays the attorney costs for the “winner”.
That is what I have read.
Yeah, you guys should import our legal rules along with our health care system.
Actually, we are significantly less litiginous because that applies to EVERY lawsuit. Generally, unless there’s a really good case, the loser pays the winner’s legal bills. IIRC, in some cases, if the one side argues the other side’s case is too tenous and unlikely to succeed, the judge may demand the party suing must put up a bond showing they can reasonably cover the other side’s legal bills. (In the USA, it’s a real fight and significant difficulty to recover legal costs)
Plus - a lot of the things people sue over are the medical expenses - well, if you have no significant out-of-pocket medical expenses, what are you suing for? Pain and suffering and punitive damages are much more significantly limited; and IIRC the party sued can decide if they want a jury or just a judge to hear the case; so there goes the “appeal to emotions” gambit. Most provincial law societies strongly discourage (if not outright ban) contingency suits, and IIRC also dislike high-percentage contingency payouts, so such speculative “free-enterprise” lawsuits are rare.
As a result, medical malpractice usually applies to REAL malpractice, gross negligence and stupidity - not because the patient is not happy with the outcome. With the winner getting legal bills covered, frivolous suits are discouraged and settling just because “fighting it is more expensive” is less of an incentive.
The difference with the Massachusets law is that in Canda, with only one player in the provincial medical insurance game, it’s either take it or leave it - so they don’t have to revoke licenses; if too many doctors opt out, it will be hard for any to make a living. In MA, if Blue Cross, Medicare, or whoever says “fine, we refuse to reimburse you if you go to this doctor” then the doctor will still have paying patients from 100 other insurance companies. The 500lb gorilla wins a lot more easily than one of 500 chipmunks.