Considering how the average lifespan was about 41 years when Von Mises was born, the past century-plus of government intervention has been fantastically successful.
My bolding.
Government intervention into the market can cause problems, but von Mises was not an anarchist. He recognized that the government could and should provide public goods like courts, police, and the like. Public health falls neatly into that category.
A Canadian-style arrangement of privately-owned practices, equal before the law, in which patient care is subsidized, would not particularly offend von Mises, anymore than publicly-funded soldiers did - or at least not to any degree that I’m inclined to care about.
Have you ever been to a developed country that has a single payer system? You should visit one - turn off the fox news and garbage right wing websites (by the way, spoiler alert, they are lying through their teeth to you)
This is coming from someone that has relatives living in Western Europe and that is able to compare first hand the care they receive to the care my family receives in the US - here its a business, there its about “do no harm”…
There is evidence that physician burnout in the U.S. continues to trend upward.
And contrary to the impression some have that it’s relative nirvana for docs in countries with single-payer systems*, that doesn’t appear to be the case, at least in the U.K..
Some caveats: I think physician satisfaction surveys may tend to select for docs who are pissed-off/depressed, while the more satisfied ones are less likely to respond. And burnout-related issues are more commonly associated with primary care fields (not that that makes those issues less serious).
As long as living conditions remain relatively good in the U.S., we’ll continue to attract (or steal, depending on your viewpoint) physicians from other countries such as India, the Far East etc. to make up for any “looming shortages”. I suspect the worst shortage problems will be in primary care in rural areas with declining populations, and further incentives will be needed.
Unless you’re one of the many whose records get hacked/stolen/misused (I have a year’s free credit monitoring thanks to such records hacking by one practice where I was a patient, whoopee). Personally, I love electronic medical records as EMR relates to my job, since I can look up info quickly on patients that’s important for making pathology diagnoses, rather than spending hours navigating office phone systems and trying to explain what I need to receptionists, nurses and so on. But it’s a different story for those who have to mess directly with putting in the data, fixing electronic glitches and so on.
*much as I loathe medical insurance companies for personal and professional reasons, and sympathize with docs who have to fight them to get needed tests/treatments covered for their patients, it would not shock me if in the future, physicians coping with single payer government health care wax nostalgic about the “good old days” with Aetna et al.
Doctors in the US make more money. That isn’t a selling point for patients though, I’d rather work somewhere where I can make more money but if it means the products I provide aren’t affordable to large numbers of people, that doesn’t mean me pursing a higher paying job is in the best interest of the consumer.
Also here is a survey from Australian physicians showing high satisfaction. Australia has a public system that covers everyone, with the option of buying into a better private system on top of it. Also they only spend 9% of GDP on health care compared to 18% in the US.
There seem have been a lot of changes in the past few years in the healthcare market in the US, based solely on my observations. It seems like more and more doctors are either employed by or affiliated with increasingly larger hospital owned health care systems. I’m not in the health care Industry but I imagine the complexity of billing and patient record keeping is a big factor in this shift.
And the other trend is for insurers to affiliate themselves with either one or a limited number of these systems. I also believe some of these large healthcare systems offer insurance directly.
As a person living in a large urban area, I find these systems a little bit impersonal but incredibly efficient and fast. I recently had a situation , I made an appointment with my PCP, who drew blood and asked me to see a specialist in the same building two days later (the day the test results were due back)
The “doctors office” is an 8 story building with primary care services on the ground floor and specialist clinics on the upper floors.
Then based on the blood tests and the specialist visit, I had to see another specialist. All this happened in the same week. And while the offices were incredibly busy I never felt rushed during my consultations.
It’s a completely different experience than I would have had 10 or even 5 years ago. In a way it felt like fast food healthcare, but (like fast food) it was pretty good and , most importantly, really fast. But lots of copays, I’m really glad I splurged for a high end ACA insurance policy -0 deductible and 2K a year out of pocket max ( those copays can add up fast! )
So I think the markets will adapt. I think a lot of doctors, healthcare corporations and insurers are finding it hard to develop business plans going forward with all the uncertainties surrounding the legal status of the ACA and the AHCA.
I have! I’ve also heard of Marx, and Rawls, and Piketty!
Maybe you’d like to look at actual empirical evidence some time, instead of relying entirely on a generalized interpretation of Mises’s thought experiments. And after so much of the thread had spent a lot of time on specific data about this particular sector, your vague generality is a joke.
I hate even to waste a post responding to it, but come on, man!
Sorry, everybody.
It’s not all roses for MDs down under, despite the wonders of single payer care.
Note also that physician burnout is not a phenomenon confined to grumpy older doctors - it’s affecting recent grads who often work the longest hours.
I knew that it would inevitably come to this right-wing mantra. It is, however, pure myth that is not only completely false but the exact opposite of the truth. The high costs and complexities of dealing with a myriad of insurance companies are bad enough that most doctors need a dedicated accounting staff just to keep up with it and then to chase down insurance companies and/or patients to actually get paid. In return, the insurance companies constantly meddle in the doctor-patient relationship, telling the doctor what they will and will not pay for and blatantly interfering in clinical practice to a degree that would be totally unacceptable to doctors and patients alike in any country with a civilized health care system. It’s so bad that these factors have been cited as a major disincentive discouraging young people from going into medical practice. This clinical meddling between doctor and patient is inherent to private insurance and completely absent in single-payer, a phenomenon so counter-intuitive that it even has a name, Reinhardt’s Irony, after Princeton health care economist Ewe Reinhardt:
In contrast to the United States, France, Germany, and Canada have virtually no government or payer intrusion in clinical practice. This observation supports what may be called “Reinhardt’s irony”:
The less tightly society controls the overall capacity of its health system and the economic freedom of its providers to practice as they see fit and to price their services as they see fit, the more direct appears to be the private or public payer’s intrusion directly into the doctor-patient relationship – the less clinical freedom at the level of treatment will payers grant providers.
https://www.nyu.edu/projects/rodwin/payment.html
The introduction of “managed care” networks in the 70s made a bad problem even worse:
Rising costs in the 1970s were the catalyst for “managed care”—basically, our current system, in which insurance companies like Aetna and United Healthcare negotiate with networks of doctors to determine how much care patients get, whom we can see, and at what price. But along with new checks and balances came added bureaucracy, and frustrated doctors and patients.
I don’t “think” government will breathe down doctors’ necks less, I know it for a fact, because I live under a single-payer system and some of my friends and family practice medicine in it. The doctor is considered the trusted gatekeeper to the medical system, there is no insurance adjuster to challenge or second-guess the doctor’s treatment regime – essentially anything deemed medically necessary is covered, and the doctor’s fees are submitted electronically and paid in full electronically on a regular basis through a single unified system. It’s incredibly streamlined, and it’s a good example of why these myths that are constantly promulgated by single-payer opponents may sound plausible because they appeal to traditional beliefs about free-market principles, but they’re totally wrong because health care economics is subject to completely different principles that are very different from free-market consumerism – hence, for instance, Reinhardt’s Irony above.
No, they don’t earn “about half”. It’s actually hard to get accurate and reliably meaningful numbers but according to this table, doctors’ income in Canada averages about 70% of the US average, on a par with doctors’ incomes in countries with a similar cost of living (France, Germany, Australia) and more than doctors in the UK or the average of non-US major countries. Indeed high doctors’ incomes in the US are partly justified by the aggravations mentioned above, by bizarre risks and costs related to medical malpractice and insurance thereof, and various other complexities and frustrations of the profession which are lacking in more sane and unified health care systems. Arguments have indeed been made that average US doctors’ incomes are too high, but in any case they are among the many contributors to the extreme and outlandish cost of health care in the US.
And wrong again, for a perfect record of wrong. If you don’t think there’s a negotiation you don’t understand how single-payer works. What is fixed and uniform throughout the system is the fee for any specific service, which is paid in full without question by the single payer, but the schedule of services and the associated fees are negotiated up front on a periodic basis between the doctors’ medical associations and the health care ministries. What is notably lacking is constant meddling and second-guessing and challenges by the insurer on individual clinical cases, which is the plague of private insurance and always will be. I know the penny-pinching and weasely tactics that go on when I have to make an auto or home insurance claim, and I sure as hell don’t want my health care treated like that!
Extra! Extra! Read all about it! Single payer system not a nirvana of roses! It’s only more efficient and doctors have higher satisfaction levels! Extra! Extra!
I regret that it upsets you to hear the other side of the story.
I cannot fathom what the purpose is of this meme you’ve seen fit to introduce here that “it’s not all roses with single-payer”, since no one claimed that it was. Get back to us when the majority of NHS patients start lobbying to abolish the NHS and give them private insurance that they and their employers have to pay for and get screwed by; until then, these digressions of yours are a pointless waste of time. Likewise in Canada; if there’s one thing that federal and provincial liberals and conservatives alike can agree on, it’s that it’s political suicide to meddle with the basic structure of the single-payer health care system because it’s more than just enduringly popular, it’s considered to be one of the pillars of basic national values. Canadians know it’s not perfect – few things are – but they have only to look south of the border to see what the appalling alternative is.
To your other pointless links, most of us recognize that being a doctor is a high-pressure demanding profession anywhere. Which is a good reason that they don’t need any more hassles from unproductive insurance companies that meddle with their clinical judgments, make their practices complicated and expensive, make it difficult for them to get paid, and subject them to being stiffed by insurance and deadbeat patients alike. At least in other countries doctors can focus on practicing medicine instead of bullshit.
I am not sure why that is the other side of the story?
I mean, what is your point?
No-one has argued that being a physician is not stressful, or that you are not subject to overwork or burnout.
Only that you are subjected to far more bureaucracy and stress in the US compared to developed UHC countries. What exactly are you arguing by posting links that show that yes, doctors get stressed in all countries?
My father was a practicing physician in Canada. I don’t need your cities to realize he didn’t think it was a rose filled nirvana. I never heard him long for an American style system though. Quite the opposite.
The fact that survey results vary according to various factors including the question asked and of overlapping but different time periods notwithstanding, the fact remains that describing a specific survey as showing “an alarming growth in burnout and dissatisfaction among practicing physicians” when the survey actually shows decreasing rates of each, is still at best demonstrative of someone not actually looking at what the survey’s results were, and at worst much more scurrilous. The survey they said showed X actually showed not-X. That’s inexcusable.
To be honest neither of survey’s are all that impressive as sources. The one cited in by the article cited in the op (again with them completely misrepresenting what it found) at least shares their methods, the return rate (horribly low), and some source that claims some error bars to be likely. The Medscape one does not even do that.
For funsies let’s assume that both are well designed. Can both be true despite superficially being contradictory?
Yes. In overlapping periods more doctors can endorse one of the markers for burnout (low enthusiasm for work, feeling cynical, and a low sense of personal accomplishment) and also be increasingly more likely to endorse statements expressing optimism about the present state of and future of healthcare, expressing more willingness to make the same career choice, and more likely to advise their child or another young person to choose medicine as a career.
Of course one or the other or both could just be sloppy surveys.
By the way the use of the word “continues” there is a bit disingenuous unless you have data that supports a long term trend of increasing amounts of “burnout”. Medscape only has three years of asking the question.
Meanwhile while I personally remain very highly satisfied, optimistic, etc., I am a bit surprised that the data does not more conclusively show increasing levels of dissatisfaction overall. My impression is that job satisfaction often tracks with how much control a person feels they have over their circumstances, and how much they feel they are part of a grander goal. Doctors are increasingly employees with little control over their circumstances and no longer as commonly equity stakeholders in their businesses. Perceiving yourself as a cog rather the master of your own fate is dissatisfying. This increasing trend of coggification … the corporatization, McDonaldification, of medicine well predates the ACA. And would be no worse under single payor I don’t think.
Overall I think you are correct (although maybe having to go to two specialists when maybe the primary doc could have made the right referral in the first place if they had jus waited to get the result first and maybe even made a call if they had to was not all that efficient … although I’ll cynically note that it did generate their group more revenue).
There are lots of new models out there and in the business parlance a market of providers that is still very fragmented. “Adapt” was a good word to use because this is a system undergoing a rapid evolution to a rapidly changing and difficult to predict environment. Some models will be more fit than others and some may end up going extinct. Which ones will do what? Check back in ten or so years!
Oh please. There have been several posts in this thread alleging that physicians in other countries are happier because of single payer systems. While it should not be the goal of a health care system to fill MDs with joy, physician satisfaction/alleged impending physician shortages is (or was) supposed to be the subject of this thread.
For the record (and I think I’ve mentioned it elsewhere on this board, as well as reiterating my disdain here for medical insurance companies), I think a single payer government health care system is inevitable and more desirable than what we have now. But one would be foolish (or to use an ironically misplaced DSeid adjective, disingenuous), to suggest that a cure for physician burnout is something like the NHS, or that virtually everybody else in the U.S. will be more satisfied with health care delivered by Uncle Sam (going into this further is beyond the scope of the present discussion, but rest assured there will be plenty of expensive messes to clean up, plus delays and wrangling that will make some current insurance company hassles seem like quaint inconveniences)*. I can afford not to care from a professional standpoint, since I should be retired from full-time practice by the time the mess arrives. From a patient standpoint, my options will be squeezed and payout jacked up like lots of others, but I should be able to find care of some sort - again, thanks in part to imported physicians.
I’m having difficulty fathoming how NHS physicians repeatedly going out on strike constitutes a “focus on practicing medicine”, or why contented NHS nurses, midwives, ambulance staff and other health care workers have also gone on strike (nurses this year have been threatening to strike again. Probably they just don’t know what’s good for them or are being brainwashed by people trying to sabotage their idyllic existence. :dubious:
*I’m pretty sure that lying to Americans about how great things will be under nationalized single payer is not the way to get them to buy in. That way leads to election of politicians like the current disaster in the Oval Office.
As a soon to be retired geologist in the O&G field let me commend your son’s career choice and introduce
him to the great crewchange. I trust his career will be as interesting as mine has been.
So let’s break down the premises and claims of the op into its bite-sized bits.
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There is a looming physician shortage. Certainly one is predicted and is existing to some degree now, especially of primary care and some specialties, and especially in rural areas and in poorer urban areas. There is however no shortage of qualified individuals wanting to become doctors. The bottleneck for increasing supply is mostly residency spots, which are increasing but at a rate modest compared to the projected increased need. But it is also of note that supply is impacted by when docs retire and “over one-third of all currently active physicians will be 65 or older within the next decade. Physicians between ages 65 and 75 account for 11% of the active workforce, and those between ages 55 and 64 make up nearly 26% of the active workforce …” Moreover Millennial physicians are predicted to work fewer hours than the older generation typically clocks.
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Physicians are, as a group, burned out. Also indisputably true that survey after survey documents high rates of answers to questions that correlate with “burnout” with a common complaint being the paperwork requirements and the lack of feeling like they have meaningful input into their work conditions. Are more more burned out than they were over the past eight or so years? Depends on the survey and the questions asked.
Fewer physicians are self-employed than previously and many newer docs going into the employed physician model. The advantage of the employment model is often more help built in for dealing with the paperwork and the business side of practice which frustrate the self-employed greatly. The disadvantage is less autonomy or even meaningful input into processes. That said the stress of dealing with the changing nature of the business of medicine today (a process that was occurring before the ACA) is huge on the small to medium group self-employed independent physicians. Maybe more more older docs will decline to keep working past 65 for the love of the job given those stresses. And inadequate numbers of docs will mean that employed physicians will be told to see more each hour to service the demand.
- “Single payer” would make physician burnout and dissatisfaction worse. Very little evidence to support either that claim or that it would make it better. Depending on how it was implemented it could go either way, IMHO.
I know a lot of physicians - family and friends. In Australia. All would recommend to any kid to become a physician today, and none are considering retiring early. It’s a great job. My Mother and her friends tailed down and relinquished registration (and insurance) in their 80’s.
The USA has a recent record of trashing initiatives and non-co-operation, so who knows what a “single payer” system would look like after you got through with it. Most of the rest of the world has less paperwork and regulation than the USA, parhaps that’s something American doctors don’t like?
It’s never easy for a doctor to migrate, and it’s become even more difficult, but if retirement is an option, perhaps migration to Aus would be an alternative?