You have to account for how much of the money they are paid goes back to the home country in terms of remittances. I am from Pakistan and two of my cousins are doctors who were trained in Pakistan but practice in the US and Australia. Both send a significant proportion of their income back to Pakistan to support various family members. For a while at least, it is not much different than exporting labor of any other kind.
Actually in Pakistan we do have some kind of bonding scheme, or we used to. The government subsidizes the education of doctors, but on the condition that they post a large bond. If they don’t work in a government hospital for some number of years they forfeit the bond, which repays the government for the cost of the education. But if a doctor moves emigrates to the US it is easy to pay the bond, at least after the doctor completes his residency.
The fundamental problem in Pakistan is that the vast majority of people cannot afford to pay a doctor’s wages in Pakistan, as that wage is determined in a global free market. The private sector wages are driven up by the threat of emigration of doctors, and the public sector wages are driven up by competition with the private sector. The government hospitals are not funded enough to pay the doctors the prevailing private market wage, so they are chronically understaffed, or the doctors working there are collecting bribes from the patients, effectively making up the differences.
I don’t believe it will benefit the economy at all, and even if it does, that’s an incidental benefit. The point is not to save the economy; it’s to provide one of the (IMHO) legitimate functions of government.
A friend of mine is crippled due to his hip, he broke it in high school and its been slowly degrading since. (about 20 years now) The guy is collecting food stamps and can barely work at all. Hes been living off the rest of us for a couple years now and needed assistance for a few years before that.
If he could get hip replacement surgery he would be back to 100% in 6 months or so (according to a doctor he saw)
which of these situations makes the most economic sense to you? (the general you) if we had paid for his hip replacement with tax payer dollars 15 years ago when he needed it the money would have long since been put back into the system by him. as it is the longer it takes the more hes removing from the system with less and less hope of ever getting it back.
the current system is broken and stupid from any point of view that isnt wealthy or involved in health insurance.
Not entirely sure that’s a good example. Hip replacement surgery and rehabilitation can cost several hundred thousand dollars. Depending on his qualifications, he might never have made that much money even if he had been working all this time.
Only in the US. Elsewhere health costs are much more affordable… even paying out of pocket with no insurance. No money is wasted on marketing drugs and insurance to consumers, nor is money wasted on underwriting.
Either way, though, someone’s paying for him. The losses incurred aren’t just tied to what he could earn if he were working–you also have to factor in the cost of social services that he’s using that he wouldn’t have to use otherwise. Over the course of a person’s lifetime, that adds up.
Also, if he needed help with day-to-day life, likely a family member would wind up taking care of him, and then you would have two people not working who could be–the ill person, and the person taking care of him.
Really? Maybe in very exceptional cases, but my mother in law had hip replacement and shoulder replacement surgery after a fall, at well over 80, and it didn’t cost anything like that.
In computing the savings, you have to add in the reduced welfare cost as well as the tax revenue. I suspect the welfare cost might dominate. There is also a harder to quantify social cost of losing a possibly talented contributor to society.
I have never seen an ad for a hip replacement. And the truly outrageous costs are for private payers with no insurance, so they aren’t recovering those costs either.
It’s not the overhead costs or the marketing costs, people. It is the perverted market. The providers can set any price, and either the consumer demands that the insurer pay the cost (in which case there is some bargaining) or has to pay the cost himself…
In the uninsured market, if the surgeon can charge $200k for one surgery, he is better off than if he did 20 at $6000 each. As the 20 write in agony, they become more willing to pony up the $200k, or at least whatever it takes for them to qualify for medicaid.
Hip replacements are really a bad example. The vast majority are done for people covered by medicare.
Does not matter. Look at where they are making their [obscene] profits. If it was more cost effective to do the research, they would do it in Bangladesh. It wouldn’t mean that they are developing the products because of the profit potential in the Bangladeshi market.
Some bargaining? The statements from my insurer give me the “list price” of the procedure, what they paid, what I have to co-pay, and what the doctor has to eat, in other words the discount they got from my medical group. Doctors have to eat also - if one of the big insurers says charge this price or you are not on the approved list, they listen.
The poor sap who has to pay for himself has no such power, and pays list. In a UHC system the government has even more power, like in Medicare - that is if the government is allowed to negotiate, unlike the case of the Medicare drug plan.
Look, as part of the New Deal, FDR implemented Social Security. It did not “save the economy” and was not meant to. It had no immediate Keynesian stimulative effect. It was simply something worth doing and that was a politically opportune time to do it.
I think there is a point missed by everyone. Everyone knows how Iceland has essentially gone bankrupt. I have a friend whose family was from Iceland and he has many relatives there (he himself was born in Gimli, Manitoba, described as the second largest Icelandic speaking community in the world, although he grew up in Winnipeg). When I asked him about how his relatives were coping, eh explained that the situation meant they could no longer import goods, mainly luxury goods, from abroad, but with free health care, generous unemployment (all paid for in Icelandic crowns), and generour welfare when needed, the average person just went on living much as before. I have seen the same point made about France and Germany, why no matter how bad the economy, life goes on must as before. Only in the US are layoffs so frightening, since with a layoff you suddenly have no medical insurance, unemployment is small and runs out quickly and welfare is severely limited. The lack of decent public transport in most of the US is also a serious problem. I know two people who have been laid off. A first cousin who is a lawyer in Richmond and a Canadian software engineer in San Fransisco. The latter could move back, although he is reluctant, considering how hard it was to get a green card.
So health care reform would not fix the economy, but is even more important in the straitened times.
The bailouts are supposed to fix the economy . Medicade and Medicare are i supposed to be able to take it down again. They will have to be fixed too. We can not compete with other nations if we have to wrap health costs into every product we make. Of course we have to lower our wages to third world rates too.
I live in a state that has had socialized electric power since 1947.
We have large public power districts that both produce and distribute power. In most communities, the customer deals directly with the PPD.
Some communities have opted-out of the PPD system, except for the purchase of PPD power during peak periods and power plant maintenance ,and own their own plants/distribution.
Others own distribution and small “peaking plants” but get bulk power from the PPDs.
We pay considerably less for power here than our Iowa neighbors do. No Warren Buffett profiting handsomely from Mid American Energy so he can ostentatiously send our money,via the Gates Foundation, to benefit African dictators in the name of “fighting poverty” or “fighting AIDS” is but one advantage.
And yet, with socialized power a proven success, most Nebraskans balk at socialized medicine.
I don’t know that UHC=economic prosperity but I do know that we currently project health care costs to swallow our economy and federal budget unless we do something about it.
Wow, there is so much to respoond to in one post that I have to take it in small bites. Medical malpractice awards amount to less than 1% of all health care costs. The CBO reckons the total cost of medical malpractice lawsuits (including defensive medicine that would not exist if we had limits on special damages) is about 2%. I am all for saving that 2% but when half the country seems to think that it is going to be some significant element of the answer to our problem it worries me. Its like taking your oveweight kid to an all-you-can-eat bacon restaurant and insisting that your kid order the diet soda so he can lose weight.
Oddly enough medicare runs at about a 3% overhead while private insurance comapnies run at about 20%. In fact Medicare part C (where you get your insurance fdrom a private insurer and the insurer gets reimbursed by medicare) costs 12% more per insured (on an apples to apples basis) than the government run medicare.
I don’t have a problem with anything else you say, because its mostly opinion but you seem to have a distorted view of the impact of tort reform and the efficiency of government.
Most small medical practices farm out their accounts receivable to companies that are experts at dealing with insurance reimbursements. These reimbursement companies typically charge 10% of amounts collected, if your practice is alrge enough you might be able to hire your own people and pay a littel bit less but not much.
Lets not forget pharmaceuticals and medical devices. If there is any argument for keeping health care out of government control, it is the reimbursement rates paid to drug companies and medical device companies by medicare. We consistently pay significantly more for these things than the VA, private insurance companies, or other UHC in other countries.