Here is an article by a doctor suggesting the entrenched positions of the AMA have been costly for all concerned.
That’s a demand-side solution. But you won’t get more doctors so long as the AMA & the government block resupply of physicians. We need more doctors & nurses, the most direct solution is increasing medical & nursing training. Some new schools have been opened up in the last eight years, but it’s too soon for them to have made a dent.
BlinkingDuck said:
According to Merriam-Webster:
“Greed” carries with it a value judgment. It implies not merely looking out for your own best interests, but doing so regardless of the impacts to anybody else. So no, mere self-interest is not greed, and greed is typically considered a bad thing.
Ruminator said:
Yes, there is some subjectivity in the word. Welcome to the English language.
foolsguinea said:
I’m going to assume this is a simple mistake and not an accusation of anything.
That is inappropriate. I’m tempted to report this to the mods.
I’m aware this is America. That doesn’t change that people have different attitudes within this country about what the best solution is, about the status of Health Care as a necessity/right, and about the government’s role in ensuring health care for all people.
I listed it as an explanation, I did not advocate it. But I challenge you to counter any of the three specific statements I made as positions that are possible under a liberal leaning government. I consider them likely proposals.
Chances are there are simply not that many high-IQ people who are interested in medicine rather than a more lucrative profession. When you consider how difficult medical school is, and how the former incentives to go into medicine (independence, public esteem) are eroding, it’s almost a surprise that we fill classes every year at all. Yes attrition rates at medical schools are low, but this seems to me more of a case of trying to make sure everyone gets through to make the school look good, rather than a case of having pent up supply of people wanting to be doctors.
Nurses are another story, though, and there are probably plenty of people at clerical jobs who would be willing to switch over if the financial incentives shift a little. There’s an argument to be made that what we need is not more doctors but more nurses, but the perennial complaints of nursing shortages seems to indicate that people are already taking that into account.
Like what more lucrative professions? There are only 12 job categories in this country that have a median wage of over $145,000. 10 of them are in healthcare-related fields (2 of those are dentistry-related).
Plus, you don’t need genius-level intellect to do a good chunk of doctoring. Of course, the AMA would rather chew glass than admit that…
As with most of post-undergraduate professional education, the hard part is getting admitted past the supply barriers that have been erected by those who have a vested interest in keeping the supply low relative to demand.
But sure, not everyone can be a heart surgeon. But alot of people can be trained with rudimentary medical skill; enough to diagnose and prescribe the 90% of basic, recurring human ailments that most people go see doctors for (or know that they don’t know enough to send it up the medical services ladder). Despite what you watch on House, not every third person that walks into a doctors office presents with a century-dormant mutant strain of Japanese encephalitis or some other weird ass disease.
Indeed:
If you believe that there are artificial barriers to entry, then you must argue that for the median medical student, indeed, for the worst-qualified medical student, the so-called rigors of medical school and residency are far below the limits of their ability. Are you prepared to defend calling medical education an intellectual cakewalk for the least qualified applicant?
Nobody is calling medical school a cakewalk. I’m sure the academic regimen would kick my ass. Rather, there are a lot of smart people who can handle the rigors that aren’t being let in because the AMA keeps artificially low the number of medical schools.
Well, again, since the rate of acceptance to medical school is about 50%, “keeping the class size low” implies that they get to pick students who are much better than they actually need to be to be a good doctor. Thus, medical education (as opposed to non-intellectual screens like grueling residencies) should be easy, even for the least qualified applicant. This appears to me not to be the case.
Regarding the supposed greed of doctors – there are a lot easier ways for an intelligent and hardworking person to make $150K a year than in primary care medicine, when the cost and duration of training are taken into account. If you thought government-run health care was going to cut your pay back to $100K a year, you’d probably be pretty strongly opposed to it unless you were a real hardcore left-winger (and some docs are).
I don’t know how much the AMA emphasizes this, but there are professional reasons to be against government-run health care that are just as important. Docs have had a taste of insurance companies telling them what they can and can’t do, and that’s only going to get worse if the gov’t takes over - especially considering the Obama administration’s proposal to have the government rate the efficacy of various treatments and set up incentives to promote the ones they like. I’m not taking a position on whether this is good or bad for society, but clearly it’s bad for the professional image of doctors.
Well, there’s no reason to think it’ll get worse.
Comparative effectiveness research has been around for decades. However, there is a difference between clinical guidelines (which basically tell the doctor what ought to be the appropriate course of treatment for a given diagnosis), evidence-based medicine (which is the recruitment of medical research literature for the purpose of making a clinical decision), and medical decision making (which involves probability diagrams and such). These overlap to a certain extent, of course. Some doctors don’t like guidelines, as they feel they have to cede too much of their authority. But most at least support EBM, because they realize that the information could potentially be useful to them.
But, in terms of patient outcomes and cost-effectiveness, clinical guidelines coming from a centralized office are extremely important.
But it depends on the motivation of the centralized office. If it’s the government, and it wants to save $1 billion per year by deciding that a treatment is no longer worthwhile, it can do it, regardless of the opinion of the medical community. Sure, the same thing could happen with an insurance company, but then you have 100,000 doctors versus a single insurance company (among hundreds of insurance companies).
Truly, the only logical outcome is rationing. Of course, under the current system, the only logical outcome is continued, skyrocketing costs. The compromise, of course, is to allow private insurance above and beyond some government, welfare scheme. Ration the people who can’t pay. Yeah, they may die early, but we all die eventually, so it’s a wash. It’s not much different from my ability to buy a Lincoln while a poor person would have to live with a Hyundai; we all get there.
So you think the AMA has some influence now, presumably, which is why you’re participating in this thread - but you don’t think it will have any influence if we get single-payer healthcare?
Nonsense. The AMA will still be able to throw its weight around - such as when the AHS (or whatever it gets called) decides to stop paying for Drug X.
In any case, you’re still ignoring the fact that insurers do this all the time. Remember the furor about how they were covering Viagra but not various forms of birth control?
How do you know? We’ll never be able to agree on this, you know. We’ll just have to wait and see. Some of Canada’s provinces are in trouble, because they have to ration healthcare, despite what anyone says is good or bad care. If you want it now, you come to the United States. Mexico does the same thing, but at least you can still get medical care because private insurance wasn’t outlawed.
Only vaguely; it wasn’t important to me. How’d it come out? Erectile dysfunction is a medical condition, and birth control isn’t a medical condition (except in limited circumstances), and I’m affected by neither, so don’t care. But government rationing will most definitely affect me. And I care a lot.
The chances that any American single-payer system will outlaw private healthcare are about the same as the chances that Rush Limbaugh will become a nun.
Birth control is frequently prescribed to address medical conditions - severe menstrual cramps, hormonal issues, and so on. It wasn’t covered then either. Anyway, the point is not that you might need the pill or help sustaining a boner, it’s that private health insurers pick and choose what they’ll cover and what they won’t just as the government would.
For example, they won’t cover Chantix (the anti-smoking pill), even though it’s at least 50% more effective than the next most effective anti-smoking therapy (Wellbutrin + NRT). You’d think health insurers would be over the moon about effective anti-smoking medications.
When doesn’t any entity footing the bill for something not approach making the payment in a cost-saving manner?
I kind of find it amusing how it’s the same people who hate government bureaucracy for spending without restraint are now upset that… the government bureaucracy would not spend without restraint?
If you want the oddball procedure that medical consensus doesn’t support (and any insurer would not provide, regardless of a private or public insurer), you can always pay for it yourself. It’s almost as if there is a belief that the insurance company doesn’t have even more of a reason to not spend the money?
(edit: i’m equally baffled by the notion that a publicly-run healthcare insurance program that denies a procedure that is considered so normal by medical consensus would actually survive a democratic review of it’s operations. yeah, the evil pinkos are really going to decide to cut the chemotherapy benefit of their state-run insurance just to save a few bucks. get real.)
No, we still don’t want the government to spend without restraint, and we know that government medicine will either (a) have to spend without restraint, or (b) ration what’s available. We can avoid both (a) and (b) by not having government-mandated health insurance for those who don’t want it.
Who is this we of whom you speak? And how do these we people (sorry about the pun) know the future?
One wonders how pleasant it is to live in a world where complex issues are easily reduced to a or b.
We already ration care in the US. We ration it by pricing 15% of the country out of it. We ration it by allowing insurance companies to decide what to cover. Still rationing, just with the soothing analgesic of complexity.
'Snot soothing at all. It makes my head hurt.