I wonder what percentage of work in the US healthcare system is completely unnecessary from a general perspective but made necessary deliberately to justify the unethical system that allows millions to die unnecessarily.
Why that article points out the US spends $12k/capita on healthcare the singles out administrative costs at $1k/capita while ignoring all the other relevant factors is beyond me. They then use the misleading infant mortality stat, ignoring that the US considers vastly more babies viable than any other country, meaning we try to save infants that other countries write off, thus they count against the US when it fails, but not against the other countries that don't count them as viable. It's a really poor article ignoring important nuance in what it presents.
The US pays about twice per nurse or doctor in the system, and part of that is because the US pays nearly twice for most skilled work. So, to get prices like most other developed nations, we would be forced to cut nurse and doctor salaries, which would likely lower quality of workers as future workers went to more lucrative fields, which would likely lower outcomes.
The US can have higher cost or lower quality. How would you make this tradeoff?
> So, to get prices like most other developed nations, we would be forced to cut nurse and doctor salaries, which would likely lower quality of workers as future workers went to more lucrative fields, which would likely lower outcomes.
Why are you ignoring all of the costs that go to people besides nurses and doctors? I know very rich people whose entire careers are built around selling overpriced products to hospitals. These people are leeches that provide no value other than profiting off of dumb compliance laws. If you can buy the same product at any store for 1/10 the price, there is no benefit to requiring it be gatekept by people whose sole incentive is squeezing blood from a stone.
Get rid of graft. The problem is the system and the incentives it creates. US healthcare is dictated primarily by insurance companies who care more about maximizing profit than providing healthcare.
To fix the system you start with increased transparency, then you focus on accountability. Why do we allow such blatant corruption? Let's get rid of all the leeches first, since they provide no actual value while jacking up prices. There are so many areas we can improve results and cut costs before we address the salaries of doctors and nurses.
> The US pays about twice per nurse or doctor in the system, and part of that is because the US pays nearly twice for most skilled work.
which is in turn because in the US an average GP comes out of medical school with $200k-300k of student debt that has to have interest serviced and paid off within some 10-20 year timespan. That cost ultimately ends up being borne by the patient and their insurance.
unfortunately the US is very resistant to the idea of education reform in general, very very resistant to student debt relief, and very very very resistant to student debt relief for "high earners" like doctors and lawyers, even when a huge chunk of that earn is going to debt service. But there is a shortage of doctors and we're doing everything in our power to make the path unattractive for new students. And this time the problem isn't even the AMA - the AMA agrees there is a problem and is onboard with expanding the pipeline... it's just not all that attractive a profession anymore when you can make equal/higher compensation (after considering the debt) in software or other fields.
doctors are still extremely well-paid professionals in other countries, but if we tackle the cost of education we can get our numbers down much closer to theirs. conversely if you push salaries too low then servicing $200-300k of student debt won't be realistic and the path becomes even less attractive.
medical care is probably the single most complex political problem in the US because it's basically at the nexus of every single social and political problem we have. doctors are too expensive... because they're trucking around a quarter million of student loan debt from our shitty education system. we spend way too much on end-of-life care and not enough on earlier care... because seniors vote. we have way too much overhead due to the multi-payer insurance system and the market-driven pricing system's overheads... and all those insurance companies are huge lobbyists too. Drug and device costs are out of control... because the US doesn't allow conditioning of regulatory approval on price negotiations, or reimportation from other countries, etc. It's just every single political problem in the US in a single field all at once and every hand is dipping into the till as much as they can get away with, and it's politically infeasible to slap the hands that are necessary to slap to actually get costs reduced.
A debt of 1 to 1.5 years salary does not go very far to explain why US doctors are paid double what they would be in other countries.
The US brought this problem upon itself by cutting medical school funding in the 1980s to reduce the number of doctors and keep salaries high. That situation remained until 2005. Now we have too few doctors, too few schools, and a generation that grabbed all the money for themselves and is now retiring.
My understanding is that the largest portion of the discrepancy with other nations is the price of facilities. And that those facilities cost much more at non-profit hospitals (which is most of them). The hypothesis is that administration compensation is proportional to procedures performed, but money taken in can't be kept, so it is pumped back into facilities perpetuating the cycle.
Probably because the people pushing for free college etc tend to be ones studying the humanities, which gives people a bad impression of the whole thing. People make fun of Fox News touting lesbian dance studies majors, but the reality is most people don't support funding your bullshit gender studies degree with their tax dollars.
> the AMA agrees there is a problem and is onboard with expanding the pipeline
Oh come on, they could start by accepting everyone with a 3.5+ and decent MCAT instead of requiring that you have a 3.95, volunteering experience, clinical experience, and near perfect MCATs. The path is unattractive because it's filled with bullshit requirements that don't matter.
On top of this most med schools discriminate against their largest pool of potential top students: Asians. It's well known if you're Asian you need much higher MCATs and GPA to get into med school. How many people have been pushed out of considering medicine because of this?
>>Oh come on, they could start by accepting everyone with a 3.5+ and decent MCAT instead of requiring that you have a 3.95, volunteering experience, clinical experience, and near perfect MCATs. The path is unattractive because it's filled with bullshit requirements that don't matter.
I for one am glad that it s hard for doctors to get into med school - allowing less qualified people to practice medicine sure doesn't sound like a recipe for good outcomes.
As far as the non-academic 'bullshit requirements' as you put it, they matter - last thing you want is someone going to med school because they were above average smart, and there parents told them to goto med school (it happens) - much better to have people that have been in the trenches dealing with medical issues at some level who know what they are getting into - i.e. people who perhaps were a nurse first, or EMT or paramedic, or even a non-skilled person who provided personal care to dementia patients in nursing home - just being smart isn't enough to be a good doctor - doctors deal with a lot of things that most of society would find distasteful - better to weed out those folks before they ever set foot on campus taking up the slot of someone else that is more well rounded and proven they are not choosing medicine just because it pays well and their parents pushed them to it.
I would take a smart doctor motivated by money over a dumber one motivated by caring for people.
The reality is all of the top surgeons, cardiologists, etc. didn't become those professions just because they were "well rounded", they were smart and they wanted prestige/money. It would be good for medicine to have more smart and ambitious people.
Well rounded is just a euphemism to discriminate against Asians through affirmative action.
>>I would take a smart doctor motivated by money over a dumber one motivated by caring for people.
Luckily we don't have to make that choice, we can have the best of the best - the smartest people who want to go into medicine for the right reason - thats why its hard to get into medical school, as it should be.
>>"The reality is all of the top surgeons, cardiologists, etc...."
I assume since you are making such a sweeping statement that presume to know what motivates 100% of MD's, that you have a link or reference to back up that unequivocal statement? I thought so.
>>Well rounded is just a euphemism to discriminate against Asians through affirmative action.
Are you one of those people that assumes if you simply mentioned race in your argument, you win by default? Pathetic.
> thats why its hard to get into medical school, as it should be
We literally have a shortage of doctors and this is your attitude? Someone who wants to make money is an equally good or better doctor than the person who wants to help people. Medicine is scientific: you either do the operation successfully or you don't. You diagnose the patient successfully or you don't. A person's motivations for becoming a doctor doesn't play a factor in their skill.
We don't ask McDonald's workers why they want to work at McDonald's, why do we need to do it for doctors?
> Are you one of those people that assumes if you simply mentioned race in your argument, you win by default? Pathetic.
Do you deny that terms like "well rounded" and "holistic" are used to discriminate against Asians? Or should I point you to SFFA vs. Harvard, which showed that your coveted "well-rounded" personality traits can be and are used as tools of discrimination? I'll remind you that Harvard intentionally reduced the personality scores of Asians to make them seem less "well-rounded".
Med school admissions would be fairer without requiring such things as "well rounded" candidates. Personality scores are subjective and subject to bias and foul play, MCAT scores are not.
>the US is very resistant to the idea of education reform in general,
I suspect almost all Americans are interested in education reform, but are split between two opposing directions: getting rid of nondischargeable, subsidized federal loans; or making the whole thing run on federal money.
That price pays for the parking deck, security, janitors, nurses to administer the bag, needle disposal, IT, admin salaries, the hospital building itself, etc etc.
An urgent care can probably administer an IV. If that’s all you need, go there. They are far cheaper and not as lavish (or equipped) as hospitals.
The US has a mortality rate due to preventable causes comparable to Poland/Slovakia despite having nearly a 4x higher GDP per capita. Even poorer countries with better systems do far better w.r.t preventable mortality. This amounts to an extra 100,000 deaths per year approx vs countries like Italy, Germany, Switzerland, Sweden, etc.
There are lot of people who don't go to a doctor when they should. Even taking an ambulance after an accident is a gamble a lot of people can't afford.
>>There are lot of people who don't go to a doctor when they should.
and there are an awful lot of people, even if it is free or paid for by a great health insurance plan that ALSO don't go to the doctor when they should - thats just human nature
and on the other hand, lots of people running up ten's of thousands of dollars in unnecessary tests because they are hypochondriacs and run to the doctor every time they have a sniffle and demand every treatment and test under the sun.
It's pretty bad probably. It's basically a system that is incentivizing companies to make lots of money where a lot of the checks and balances are misaligned (in some cases intentionally so) which further enables this. So, you have pharmaceutical companies charging extortion rates for products that they sell for next to nothing elsewhere. Insurers that squeeze their patients hard. And hospitals that blindly prescribe medication because the patient demands it because they pay so much money for their insurance. Hospitals don't care because it's not their money and they get to bill the insurer for all sorts of bullshit. Insurers simply raise the prices for their customers. And they can actually cut loose patients over all sorts of technicalities so patients don't complain about this.
Aligning the incentives is pretty hard but not impossible. The Dutch system was facing rising cost a few decades ago. It was split in a private insurance and public insurance system. Privately insured people enjoyed all sorts of perks (like private hospital rooms, less waiting time, etc.). The same system still exists in Germany (I live there currently).
To improve financial efficiency the Dutch government decided to get rid of public insurance and empower people to switch insurance. Everybody has to have insurance, all the insurers are private, and they have to compete to keep people as they can choose to jump to another insurer and they don't get to reject people. They all have to offer the same base package of care to everyone but can choose to diversify on top of that. This results in people shopping around and being treated like customers by insurers.
The second thing they then did was empower insurance companies to make deals with care providers. After all, they are paying the bills and if some hospital is being inefficient, they have to pay for it. They can't reject patients. But they can make deals with certain care providers or refuse to do business with others. This incentives care providers to align with insurers.
Likewise, pharmacies that supply medication are incentivized to look for cheaper alternatives. So, pharmaceuticals end up competing with each other for some things and pharmacies will pick what's cost effective rather than what doctors prescribe (in case of compatible alternatives).
It's not a perfect system but it has resulted in hospitals and insurers improving their game and getting rid of inefficiencies or bad service. Bad insurers lose their customers, inefficient hospitals result in insurers taking their business elsewhere and they suffer financially. Smart hospitals and insurers align what they are doing and avoid needless treatment. Patients and employers shop around for the best insurers based on the needs and means and to get the best rate and care or access to their preferred care providers.
I actually live in Germany which has a system that resembles what things used to look like in the Netherlands. It's a bloated, inefficient system. There's stupid bureaucracy left right and center, endless referrals and waiting lists, and you are treated like cattle. I have private insurance so I get to jump the queue but I also get to deal with doctors that are a bit too trigger happy with treatments and needless appointments that they can squeeze the insurer for. The insurance is super expensive for me. And I can't easily switch insurer so they can squeeze me hard and up their rates. The hospitals are pretty bad and miserable compared to Dutch hospitals.
