I’ve never once gone to my doctor and asked about a drug I heard about in one of those ads, but I must be rare in that regard. I expect my doctor to know about whatever the latest treatments are and make those suggestions to me, not the other way around.
How do doctors feel about UHC, I wonder. I know we have a few doctor dopers, but I can’t recall any of the ones I know are doctors, weighing in on this topic.
Doctors are almost invariably going to be against it on the basis of self-interest; their earnings would be cut dramatically. I suspect that most of them would be for it on a purely theoretical basis.
Could you finesse that by the government taking over their student debts? So that while their earnings might be lower, their incomes would remain the same.
Quite possibly. That’s one of the largest concerns among the younger physicians I know. Unfortunately, we already have a large shortage of doctors because the AMA and the federal government have depressed the number of med school places to fend off what they thought would be a glut of doctors in the 80s.
If earnings come down, the US will be a less attractive place for the Indian and Chinese doctors who come in droves and keep our system afloat (since their educations have generally already been paid for by their own governments.) That will make it easier for the NHS to recruit, though.
Correct. When Britain introduced the NHS, the British Medical Authority (i.e. main body representing doctors) campaigned heavily against it. They had to be given huge incentives before they eventually acquiesced.
Woah! I don’t think i’ve ever seen prescribed drugs advertised to the general public - I mean, what do I know that a GP doesn’t.
I remember some low grade scandal a few years ago to do with drug companies approaching doctors directly but that’s all - in the UK, btw.
US drug adverts are one of the most darkly amusing things you’ll ever see. 45 seconds of cliched imagery, inevitably starting with someone all glum about something, then changing to them being dead happy and usually playing with their loved one and/or family. Then a 5 second “Ask your doctor if [whatever] may be right for you” Then 30 seconds of the voiceover guy listing possible side effects, many of them horrible. It’s truly bizarre.
And the drug companies spend more on the adverts than they do on R&D.
Not really to the extent of “almost invariably” – for instance, there’s a fairly significant organization called Physicians for a National Health Program, and in these types of discussions elsewhere I’ve come across doctors both for and against single-payer type programs. As with the general population, it varies and is often driven by ideology. AFAIK, the AMA took a definite stance against such programs some years ago when they elected a fairly extreme right-winger as president, and there’s at least one extremist “medical” organization whose name escapes me that is seemingly dedicated to fighting it tooth and nail, though I suspect it’s just another fake astroturf front group for the insurance industry.
In Canada, doctors in Saskatchewan were so strongly against it when the legislation was first proposed that they went on strike. Some aspects of the program were modified in response, and in later years the attitude seemed to be a combination of acceptance and occasional dissidents opting out of the program. Today I get the impression it’s pretty much accepted throughout the medical profession that single-payer with no extra-billing allowed is here to stay. I’ve seen various articles in Canadian medical journals about improving faults in the system, which is of course an ongoing and desirable initiative, but none that I’ve seen are arguing for revolutionary change. Among other things, after decades of experience doctors have come to appreciate the benefits of always getting paid in full for everything they do.
PNHP has 19,000 members, many of whom are not physicians. The AMA has over 200,000 physician members and there are at least 800,000 currently practicing doctors in the US. That doesn’t include chiropractors, whose practices would be even more badly affected by UHC (because they’re flim-flam artists.)
And always, moving and playing in slow motion.
That’s incorrect. Some drug companies spend more on marketing than they do on R&D. But marketing is a lot more than “the adverts” that you’re talking about.
Yeah, there’s also the short-skirted hotties they send to doctor’s offices to shill their latest products.
“some”
Hell, I even gave you a link analysing it. Only one company claimed to spend more on R&D than marketing, and that was Swiss company Hoffman La roche. All the others spent significantly more on sales and marketing.
And yes, the bulk of that is on US adverts. A full page spread in the lancet is a lot less than 90 seconds of primetime on a Friday.
Marketing is more than advertisements, in either Lancet or on TV.
So anyway, the R&D argument is on the resuscitator.
What else makes US healthcare a beacon of hope for the rest of the world?
Can you give some examples of incentives given? Are they something we could do here in the US.
I’m not at all offended by being called a socialist, so keep that in mind. I’m all for making education as close to free as we can get, but would that be enough?
I think we’re in agreement on most of the major issues here, and for the record, I believe those numbers are more or less correct. I think there are a few things worth pointing out here, though. One is that the same thing applies to the AMA – that is, some of its members are not physicians, but are medical students and other parties. Another point is that since the PNHP is an advocacy organization pushing for revolutionary change in the US health care system, namely the adoption of national single-payer, one can conclude that its membership consists of those members of the medical profession who feel strongly enough about the issue to lobby for it. There are no doubt much larger numbers of the medical profession who support the basic principles of UHC.
Surely every doctor must support the idea of always being paid in full for services rendered under a simple and straightforward billing system, and that this can be a fair compromise with lower fees. This is one of the foundational principles of single-payer and why it’s a win-win for all concerned. It’s one of many reasons that the private health insurance industry is essentially useless and counterproductive, and is basically an illicit, immoral business on a par with racketeering. Here’s the kind of news story the health insurance industry doesn’t want anyone to see:
Canada has more doctors, making more money than ever
The number of doctors in Canada and the amount they get paid by government health plans hit record highs in each of the past several years – and 2012 was no different.
Canada had more than 75,000 doctors working last year, an increase of 4 per cent over 2011, and governments paid them $22-billion for their services, about 9 per cent more than the previous year, according to new data released Thursday by the Canadian Institute for Health Information.
The hospital doctors and managements broadly accepted the NHS fairly quickly, because WW2 had left a huge backlog of repairs and improvements that could only come from public funds anyway; the senior consultants who managed the different teams of (salaried) hospital doctors were allowed to spend a certain proportion of their time (if memory serves, two-elevenths) on work for private fee-paying patients and their own research.
The big issue was the general practitioners (family doctors), represented by the British Medical Association. An early proposal from the wartime minister (who was not, actually, a socialist) was that they should all be salaried employees of local government, and that went down like a cup of cold sick. So it was accepted they would remain self-employed and contract individually or in partnership with the NHS, and it all came down to the contract terms. The BMA leadership was ideologically opposed to government intervention of any significance and was worried about the potential for government interference in what they did, but the rank-and-file gradually accepted the contracts on offer in time for the service to start as planned. The Labour minister who brought the NHS into being famously said he “stuffed their mouths with gold”, though I suppose the amounts of money involved in 1948 would look trivial now.
Over the years, there have been changes, with GPs, like everybody else in the NHS, complaining from time to time that there wasn’t enough money, and occasionally threatening to pull out of their contracts altogether (at one time, a substantial number of dentists did and made it difficult to get NHS dental treatment in some places).
Bear in mind that an important part of GPs’ work before the NHS had been the power of referral of their patients to specialists in the hospitals: that function was carried over into the NHS, and now survives as a cost-controlling gatekeeper function (indeed, this government’s latest reorganisation devolves the bulk of financial power within the NHS to local groups of GPs so that they commission hospitals and other providers on bulk contracts for the different services). They mostly remain self-employed or employed within independent group practices, but they are overwhelmingly committed to the principle of the NHS. The current issue is whether or not the government will properly fund them to provide longer opening hours, and longer-term whether or not there will be enough people in general practice to cope with increasing demand and demographic change.
You can get a general indication of current pay rates at
http://www.nhscareers.nhs.uk/explore-by-career/doctors/pay-for-doctors/
I think a big problem would be the same as you have in Europe where you have private for profit medical care alongside the government run ones and the rich will have their own while the rest of do with the government run system. Already here in the US you have the “charity” hospitals, usually located in downtown areas that help those without insurance and many are quite good but others not so.
Thing is though under the present system even many people of lower classes often have excellent insurance giving them top medical care.
Thank you PatrickLondon.