Casdave’s point - even if you don’t agree with it - seems pretty clear: the USA gets doctors without having to pay for their training; the other countries pay for the training but don’t benefit as the trainees emigrate to the USA.
Well, that and women still tend to be primary caregivers, so even after maternity leave they are more likely to need time to take the kids to soccer practice and what not. I don’t really have a GQ explanation for that, though.
Radiologists in the US have to be physicians, so this at least is one area where we can’t borrow from abroad.
No, it burdens foreign health systems who pay to train those physicians only to watch them jump ship afterwards for a more lucrative career in the US.
It’s a brain drain, but it’s not a subsidy. Having the US market as a safety valve for doctors with high earning ability allows India to pay domestic doctors much less. If wanted to capture all of the doctors that it trains, it would have to either have to pay them more or forbid emigration (in which case many of the doctors with high earning potential would just switch to other, more lucrative careers). On balance, it’s probably more accurate to say that the US is subsidizing Indian medicine.
You’re joking, right?
Tom Tildrum
I believe your point is in error, or perhaps I have not grasped exactly what you are saying.
Please clarify the following to me,
Why would India have to pay more if experienced staff remained in their country?
If this is truly the case, then it is also logical to believe that this extra money would be found by saving on the total costs of training.
What we actually have is one of the worlds richest nations, which has a greater industrial capacity than any other nation on earth, taking hugely expensive resources from another country that finds it hard to feed itself. Who is subsidising whom?
Your superb medical service, that until recently did not provide adequate cover for over 30 millions of its own citizens, is provided with staff from other countries that need their skills far more.
Surely the US should pay for its own staff and its own training, in fact you might even argue that a nation as wealthy as the US should be leading by example and finding ways to relieve poverty rather than exploiting it.
Seems US citizens, or some of them, are very selective about immigration. Economic migrants who try to better themselves are often rewarded with poor pay and conditions, are given no security, living under constant threat of deportation, but when it comes to medical staff, well the US citizen does not want to pay the full cost of that, just wants to ensure they get theirs and everyone else can just go whistle.
US medical costs are high, but they would be significantly higher still if it had to pay to train all its own practitioners, and in that sense the US citizen is subsidised by the 3rd world resident.
Except in France you guys still only spend about 10% of GDP on health care. In the US it’s about 17%, and whereas France was ranked first for health care by the UN, the US was ranked 37th.
Well, India was subsidizing the NHS until quite recently, too, since an even greater percentage (46%!) of doctors certified by the GMC qualified outside the UK.
It would have to pay more in order to keep those doctors in the country.
Training costs don’t have to be an issue. India could require doctors who take a job outside the country to pay back the cost of their education.
India has fantastic medical training, assuredly. But as a consequence it produces highly valuable people. Some, probably most, of those people will be happy to work at the income level available to a doctor in India, out of love of country, feeling that they’re serving the greatest need, and so forth. But some portion of the class, particularly among the high achievers, is going to want to be compensated for their valuable abilities as highly as possible. To keep those people, India would either have to pay them more or forbid them to leave.
If they are forbidden to leave (i.e., if a US salary is not available), then future high achievers who are concerned with money will recognize that medicine in India cannot lead to a high-income position. Some portion of that group will decide that money is more important than becoming a doctor and will become lawyers or stockbrokers instead. Eventually, because somewhat fewer high achievers would be choosing to study medicine, the high reputation of Indian medical education would decline somewhat.
Basically, in order for India to provide the world-class medical training that it does, it has to produce graduates who can and do go out into the world.
I can’t disagree with that, our NHS does employ medical staff from other nations, to the detriment of those other nations, it is not something for us to be proud about, the only slight saving grace is that at least we don’t try to use this to deny treatment to our most vulnerable people - but it’s still wrong.
It’s actually wrong for us to do this, for very similar reasons to those of the US.
We have a medical association called the British Medical Association (BMA) which went to great lengths to ensure that uplift to the role of consultant was very stricly rationed, and was more about keeping the numbers of consultants down to ration their supply and hece keep up their prices in terms of income. It did not matter how well you practiced, or how well qualified, only the BMA could bestow consultant status.
They also used to defend against imported practiioners by requiring them to pass yet more exams, often at a level far below their knowledge - it was merely an obstacle rather than a check on medical competance, however this did not prove to be an effective barrier to UK practice.
This does not operate to the same restrictive extent, but all the same, it was not unusual for medical students to go through their entire course with good results and yet there would not be a place from them, they simply had to leave the UK to gain employment. The foreign practitioner did not face the same restrictions to reaching the level of consultant in their home nations, so they simply imported their qualificatios and knowledge with them - the result of the restrictive operating of the BMA actually led to more foreign national medical practitioners coming to the UK, whilst UK born and trained practitioners had to leave for the US and others.
Take a look at how restrictive practices can drive up the cost of non NHS treatment in the UK.
This is a view of the recent past,
Things have changed dramatically, but the oversupply of graduates compared to posts does mean theat UK doctors wil often have to choose between remaining in the UK or leaving for other countreis, yet even so, we stil import medical practitioners - se we pay to train them, they leave and we import Indians or others from places where their skills are needed so much more.
NPRs Planet Money podcast had several episodes about this. One of them had this analogy which made alot of sense to me. Imagine instead of getting out health care through our employer, instead we good our food through our employer. We pay a few bucks a month in “food insurance” and in exchange we can go to the supermarket and buy what we want with just a tiny “co-pay” (that doesn’t have much relation to that actual cost of what we are buying).
Are you going to choose to eat Ramen and corned beef ? No, you’d choose Fillet Mignon and lobster every day. Soon enough we’d all be paying a butt load more for our food than anyone else, and people who didn’t have “food insurance” from their employer would be royally boned.
Does this analogy really work, though? What if the Government supplied your food out of general tax revenue, and when you went to the store you paid nothing? What would you choose, and how much?
To clarify: I think you’re correct that people in the US would spend less on health care if they were paying for it all out of their own pocket. However, people in UHC countries don’t pay anything out of their own pocket, and yet they still spend less than we do.
We’d all be paying a buttload more for filet mignon and lobster. We’d be paying less for bread and cheese.
In any case, that is an almost stupidly simplistic analogy. Most health care costs are not choices; people don’t find out they have cancer and then seek treatment based on their ability to pay.
The analogy vaguely approximates the cost of things like MRIs and cosmetic surgery - procedures which are generally elective, in other words.
I am sorry but I think Whack-a-mole’s article makes more sense. The problem with the food analogy is that purchasing food is nothing like purchasing health care. I don’t go to the doctor and ask for an MRI, and seeing that it costs more than I am willing to pay opt for the cheaper X-ray or say, fuck it, insurance will pay so I don’t care what it costs. Instead I go to the doctor with a complaint. She then decides I need an MRI or an X-ray or antibiotics or whatever and I go and do what she says.
The New Yorker article referenced by Mr. Mole compares McAllen, TX to El Paso among other places. Medicare costs (which are a broad indicator of overall health care costs according to the article) are significantly greater in McAllen (which has the dubious distinction of having the highest costs in the country). El Paso’s are lower than average. Why? It isn’t litigiousness. Texas has a tort liability cap. It isn’t a relatively unhealthy population needing more care. Both regions have similar demographics and similar rates of health problems. According to the article, it is sort of an entrepreneurial spirit in McAllen which hasn’t made it to El Paso (but will). Doctors in McAllen, especially in cases where the course of treatment is uncertain, will tend to prescribe more and more expensive interventions than their colleagues up the river. They are more likely to do things like invest in their own MRI or ultrasound machines and therefore have an incentive to order scans where doing so would be a toss-up, diagnostically speaking.
I don’t really feel I am doing the article justice with my paraphrasing, so hopefully everyone will read it.
Well then you have the case that the government-run supermarket, and the fillet-Mignon and lobster are pretty strictly rationed. Though this is where the analogy falls down, the interesting thing about healthcare is that in alot of cases the “fillet Mignon and lobster” is no better for you than the “Ramen and corned beef”. And in fact in some cases can be worse for you.
The classic case of this in the in case of tests and scans, contrary to what you might think, always doing the latest greatest test or scan for some condition (which happens alot in the US healthcare system), in people that may not need it, will not make people more healthy. In fact due to the likelihood for false positives
and the unnecessary treatment that results, doing so will end up being detrimental the health to the patients.
Why would the supermarket even bother stocking bread and cheese at reasonable prices ? They make far more money on filet mignon and lobster. And the vast majority of their customers have “food insurance” that foot the bill.
Because healthcare spending doesn’t work that way. Nobody says, “ooh, I think I’d like to have a cardiologist do my physical this week!”
In any case, since we’re talking about employer-based care, your food insurance covers you, but it’s a shit ton extra to cover your spouse and crotchfruit. In fact, you might not be able to add them to your policy. Are you going to eat lobster while they eat ramen?
Oh, and I invite you to try eating lobster and filet mignon for a week, and then tell me how long you’d like to continue doing so. You’ll be surprised.
But they do have choice over bugging their doctor over particular drugs or tests they want done.
Though obviously there are other factors at work. To stretch the food analogy a bit more its as if everyone actually had a shopping list from their personal chef (who gets a cut of the food you buy).
Hi!