Universal Health Care

[Vanquisher]

Re: Universal Health Care

I think there's been research suggesting that specialists' pay would decrease, but primary care compensation may actually increase. Again, something DH would support. And if you did a comprehensive reform of training costs as well, lower specialist pay might not even be so bad..

I am obviously NOT for this. Yes, I think primary care physicians should be paid more. Pediatricians? Holy crap! They get jipped! However, when you are talking about subspecialty surgery, you are talking about someone who had to go through a longer, more hellish residency. If you said to most gen. surg or ortho surg. or ENT or uro surg or neuro surg doctors, hey, how would you like to be paid the same as Dr. Family Medicine, I think you'd have a big problem. Instead of you get 100K and you get 300K, how about everyone gets 175? I don't think so. Yeah, surgeons do it for the love of their field, but asking them to do it for half as much money is not going to happen. You will see a huge decrease in the number of med students applying to subspecialty fields if they have to do twice the training (or more) and brutal residencies to boot. I just feel there should be a payoff for that.

Money really shouldn't be an issue, but it is. If we came out of medical school with no debt, I don't think dh would have chosen a different specialty, but it would have been easier for him to do so. As it is we have nearly 300K in student loan debt. Yeah, that's right. How could we pay that back on a pediatrician's salary. It wouldn't happen! If we came out of medical school with no debt and half the future expected income, there is no way we would have chosen this path. Well, maybe the idealism would have won out. First month of intern year? Screw this, buddy. No way, send me to the land of cushy schedules, no trauma call, and 3-year residencies. And fellowships? Forget it!

[SuzySunshine]

Re: Universal Health Care

I don't really have an opinion on the universal health care - I haven't done enough research to form an opinion.

But, I have to agree with Heidi on the specialty salary versus family/primary, etc. If DH was going to make 100K out of training he still would have chosen nsurg, BUT I agree that since he's doing 8 years of training versus a family/primary's 4 he should either get compensated better during those last four or something else has to also change.

Yes, some specialty salaries are high, but in my opinion they should be. Do you really want someone with less training opening your head or your heart or setting a bone that could affect how you walk for the rest of your life? There is a reason specialty training is longer and they should be compensated for it.

[PrincessFiona]

Re: Universal Health Care

We had a canadian member several years ago whose spouse is obviously a...canadian doc. At the time, DH and I had toyed with the idea of moving to Canada but we were concerned about salary. She sent me some job listings that made us really think. Beginning compensation for an ID doc was higher than many, many jobs here...ID docs in Canada (at last where she lives) are paid much better than the majority of US ID Docs.

Food for thought...

[Vanquisher]

Re: Universal Health Care

I have no idea on the validity of these numbers, but it's something to look at. Salary info for doctors can be so hard to find!

All numbers from http://www.payscale.com












I know the numbers for ortho are low. That's the only salary info I really know. Still, this is the same website, so that being said, with their numbers, ortho is still nearly 60% higher salary in the US than that of their Canadian counterparts. I know that the Candian dollar and US dollar aren't equal, but they are close.

[DrWahoo]

Re: Universal Health Care

Ahhhh, the joys of facts Very good find Pollyanna. Health care in America would also suffer under a universal program because there are simply not enough doctors or facilities now. In a rush to fulfill these needs more money would be needed to get them and quality would suffer as some colleges become doctor mills. I think the quality of health care would be like the quality of education in our country also. Richer areas would have better docs, poorer areas would have under qualified doctors. If universal health care looks anything like military medicine, I think we should all be very afraid. Finally, where would all the people who work for insurance companies work ?

[SuzySunshine]

Re: Universal Health Care

DH had two friends in medical school that were canadian. One is doing residency in TX (derm) and the other returned to Canada for residency, I beleive he's going into cardiology. The one who is in derm always commented that she better get a good residency b/c she put herself in more debt by coming to the US for school so it better pay off with a better job afterwards. She won't go back to Canada, her husband is American and they plan to stay in Texas I beleive.

Re: Universal Health Care

Oh, and I've said this here before, but I hate the argument that the government is simply incapable of running anything. Because I work for the government, and I work with some of the smartest people I've ever met. Period. Sure there are tons of incompetent people in the government, but there are tons of incompetent people in the private sector, too. Customer service help-line, anyone?

I know there were a couple of comments about government running healthcare. I'm not sure if mine about Medicare are included in the above.

I too have worked for the government (state and state universities) and I worked with some great people. And great includes intelligent as part of that. I worked primarily with health programs and, IMO, the programs that involved private insurers like Medicaid managed care and the SCHIP program worked better than the state run and managed programs.

I have spent hours upon f'ing hours dealing with Medicare. It is not the fault of the usually-trying-to-be-helpful customer service people that it has been such a ginormous PITA. It is the rules and policies and procedures that they have been handed. My experience trying to settle claims with them has been maddening and far worse than anything I have experienced via a private insurer. I could not stand behind any sort of "government-run" healthcare if it looked like Medicare.

Some day when I have more spare time, I will volunteer with a senior center to help people with their Medicare claims. I don't know how someone like, say, my slightly demented 90 year old grandmother is supposed to deal with the bs phone system they have. To be fair, when a claim works, it is a piece of cake and hasn't been a problem for us but when there is a glitch -- charge up the phone battery and get ready to set aside an entire morning. At least.

[Flynn]

Re: Universal Health Care

I think part of this conversation should focus on hospitals making money. That's their goal right?

Some docs make more money for the hospitals than others....that doesn't mean there should ONLY be specialists -- far from it but you get my point.

DH gets paid well for his services -- BUT the hospital makes money HAND OVER FIST for all his procedures. Ortho, Neuro, and CT surgery make hospitals TONS of money. The docs should get a piece of that pie (so they can pay back their HIGH LOANS) in my opinion.

CT surgery compensation will drop 12% next year.
The system now SUCKS and makes no sense.

[PrincessFiona]

Re: Universal Health Care

CT surgery compensation will drop 12% next year.
The system now SUCKS and makes no sense.

It's crazy, isn't it? I think one of the problem we have here in the US is that we expect everything to be done for every patient regardless....We blow more medicare dollars in the last 6 weeks of someone's life than in the entire time that they get it on things like ICU care for someone dying of endstage cancer who clearly needs palliative care but whose relatives want every last heroic measure done. People have come to expect....demand....mri's for every ache and pain and physicians order a lot of CYA tests to make sure that they aren't sued if the do happen to miss the rare zebra.

Health care executive compensation continues to rise. While Physician compensation falls in some areas, executives are continuing to take home near million dollar salaries plus bonuses....

Unfortunately, many people in the US aren't as lucky as we are in terms of the quality of their health care. As the spouses of physicians, we are blessed with quick, efficient, quality care....in the real world though, people wait on waiting lists here in the US, are denied care because of their insurance denying it and not having the tens (and sometimes hundreds) of thousands to pay for things. If you are the normal working man in the US, you would be better off living in Canada, or the UK despite the pitfalls of thsoe systems simply because you would have access to lifesaving healthcare without it bankrupting you.

Our health system only protects the wealthy and those who are fortunate enough to have top quality health insurance.

Kris
kris

[Flynn]

Re: Universal Health Care

DH's hospital has a PA job listing right now.

Granted smaller places have to pay more to get "good" people.
With that being said the starting salary for a PA here is $134,000 .

Um....yeah.
I had NO IDEA.

[JaneDoe]

Re: Universal Health Care

Unfortunately, many people in the US aren't as lucky as we are in terms of the quality of their health care. As the spouses of physicians, we are blessed with quick, efficient, quality care....in the real world though, people wait on waiting lists here in the US, are denied care because of their insurance denying it and not having the tens (and sometimes hundreds) of thousands to pay for things. If you are the normal working man in the US, you would be better off living in Canada, or the UK despite the pitfalls of thsoe systems simply because you would have access to lifesaving healthcare without it bankrupting you.


kris

This is true and the government doesn't even run the healthcare system. That's what I don't understand. Much of the healthcare in the U.S. is funded by private insurance and it still sucks! It's often inefficient and some may even argue that the quality of care has gone down with the rise of HMOs. Perhaps the US government shouldn't entirely run the healthcare system, I don't know. But, as it stands, private insurance isn't doing much better than medicare/medicaid.

I think most people agree that something has got to change with regard to healthcare in the US. I wish there was an easy fix, but I do think it's going take government involvement to some degree to fix the problems. As a spouse of a doctor who's income would be affected, it makes me very nervous what changes, if any, are in store. But, as consumer of healthcare it's plain as day that the sytem is broken. Dealing with private insurance is PITA.

[SuzySunshine]

Re: Universal Health Care

Mayo nsurg has a hard time keeping PA's because they can get a lot more money in private practice. A very good PA left here about a year ago and is making close to $150K in a private practice in CO.

[MrsC]

Re: Universal Health Care

FWIW, my personal opinion is that people should have to pay something, but on the scale of what we pay now as welfare contribution, not crazy insurance premiums. In Canada there is such a system and it depends on your income. And, most of Canada would want to shoot me, but I also think there is nothing wrong with having a private system as well, so if you can afford it, you can have a better hospital room or can choose your own specialist (Ireland and the UK have a 2 tiered system).
Oh, and there is no perfect system!

I agree with Bugs on this one. A social healthcare system would certainly be better than the current one. Having grown up in Ireland, which has social healthcare (and the system there is NOT perfect), it is definately better. There are so many issues, however with establishing a system like this in the U.S, it would call for some drastic changes.

I'm going to use the Irish system as a comparison since that's what I've experienced.

Costs - In my opinion, no human being should be in the position where they cannot afford to go to the doctor, or fill a prescription. We should NOT have to rely on an insurance company in order to receive healthcare. The income limit for pre-natal care and delivery (I take this example because I worked with a non-profit who dealt with this issue) for Medicare is $18,000 in some states. This means that if you earn more than $18,000, you have to pay out of pocket. If you earn $35,000 a year and are without healthcare benefits, or have benifits that don't cover maternity, you can expect to pay $5k to $10k out of pocket just to have your baby. Medical costs are tha #1 reason for bankruptcy. A visit to a family doctor should cost $45, not $145 for an uninsured person. If I'm between jobs and between benefits, I shouldn't have to pray that I don't get sick.

Physician salaries - A social healthcare system no doubt will reduce physician salaries. The Irish government has just increased salaries for consultants (attendings) in public hospitals to 215,000 euro, that's $315,000. Keep in mind that medical school in Ireland is free for high school graduates (you do not need an undergraduate degree to get into medical school). After graduating medical school in Irl, interns get paid double what they do in the U.S but it can take up to ten years to reach attending status. The system is graduated, with doctors earning a higher position every couple of years (nothing like residency). The problem with applying this to the U.S is a) huge amounts of educational debt, b)doctors are older graduationg from med school and want to earn big money fast, c) the number of med school and residency spots is being kept down to keep attending salaries up.

I think these are the main points involved and like I said, the Irish system is far from perfect, there is a severe shortage of physicians there. To explain more about the system, doctors are paid a salary by the government for working in public hospitals. In addition, they can have a clinic in a private hospital and get paid per procedure. I go to a family doctor and pay 45 euro for the visit, then maybe 20 euro for a prescription. I can go to a public hospital or use my health insurance and go to a private hospital.

Honestly, I think it is doable in the U.S but it will take a LONG time and require a LOT of change. God knows, something has got to change.

- Something I forgot to add. The use of auxillary staff here is so costly, I'm talking CRNA's, techs. They're necessary because of the lack of physicians, which means if there were more residents, less auxillary staff, higher salaries for physicians. Of course this poses a problem if doctors won't perform certain duties, DH is always complaining about the amount of physicians who refuse to draw blood etc.

[GrayMatterWife]

Re: Universal Health Care

How's this for selfish and greedy?

I think healthcare should be a universal right. However, I am unwilling to sacrifice dh's bottom line. Screw that.

It's easy to be a liberal with other people's money.

How's this for confession of the self-contradictory: I am against the government running health care unless they are fund big grants so that my husband can live comfortably doing neurosurgical research. Then, hey, yeah...bring it on.

[Rapunzel]

Re: Universal Health Care

Yeah, the military has a socialized medical system. And, pardon my French, but it sucks. Big time.

Why would we expect a government that brings us FEMA to be able to adequately run a healthcare system? Can we think of ANY government program that operates better than its private counterpart(s)?