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<p>Isn’t it the way it is currently done by insurance companies? People with practically no knowledge of medicine make decisions as to which procedures will be allowed and reimbursed? People who may have a degree in accounting or some other major but never even took a biology class?</p>
<p>“They specifically recommend “Free, universal health care for all residents, for life” which is different than giving a hungry kid breakfast. It also means giving the Trump’s, Kennedy’s, Bush’s and Gates’s free breakfasts (i.e., health care), for life. But, yet, we don’t give even give them free water.”</p>
<p>Right. (And free water makes sense to me.) The reason it should be “free” (i.e., not a matter of individual payment) is it then means everyone has a skin in the game. You don’t end up with Trump deciding - based on his profit considerations - what I get in health care. </p>
<p>Don’t take the first of the three sentences out of context. “Free, universal health care” makes no sense if there are still private health insurance companies engineering their profits off of it. </p>
<p>“I think also that what this will lead to is even more promising doctors being scared away from medicine, and from primary care if the government ties their reimbursements to procedures instead of diagnosis, as is the case now.”</p>
<p>In what other country has this happened? (If it scares away doctors who are in the game to feather their own nests, I’m all for it.)</p>
<p>The main problem with the U.S. health care system is not that the uninsured don’t get care. That’s a symptom, not the disease. The disease is that the quest for profit has bent the system - for everyone - so far out of shape that it is rather a game of Russian Roulette as to whether anyone, insured or not, gets appropriate, timely access to health care supported by the best available evidence (as opposed to the largest amount of profit.) The uninsured don’t get care because “there’s no money in it”; “real” wait times in the U.S. may be longer than in Canada (and certainly longer than virtually everywhere else with universal coverage) because of incentives to keep folks away from care; individuals use the emergency room for primary care because there’s not enough money in being a primary care doc; drug companies work on “new” versions of old drugs because there is no money for them in generics; etc., etc.</p>
<p>The problem is NOT the number of uninsured. The problem is that the health care system is broken.</p>
<p>(If it scares away doctors who are in the game to feather their own nests, I’m all for it.)</p>
<p>Many medical students graduate with $250,000 in debt and have given up many years of their lives for mediciane. They need to be able to earn an income to support themselves comfortably and pay off loans. Hard to do now in primary care.</p>
<p>^^ But one cost-cutting measure by insurance companies is restricting access to specialists.</p>
<p>“Many medical students graduate with $250,000 in debt and have given up many years of their lives for mediciane. They need to be able to earn an income to support themselves comfortably and pay off loans. Hard to do now in primary care.”</p>
<p>Absolutely true. And that’s absurd. A single-payer system should much more heavily subsidize the education of health care providers (as they are in several dozen other countries), and if there are shortages in certain areas, a system of incentives can overcome them. This has NOT turned out to be a problem elsewhere, only within our broken system. This just isn’t an insurmountable problem - and in many countries with universal access, isn’t a problem at all.</p>
<p>And what possible incentive could a health insurance company have today to pay primary care docs more other than in using them to keep patients away from the care they actually need?</p>
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<p>Seriously? Moore is a multi-millionaire. The cost of health care is the least of his worries.</p>
<p>Do you expect a McDonald’s worker with four kids, one of whom is sick but is denied coverage, to research, produce, and distribute a documentary on the relative merits of international health care systems?</p>
<p>Maybe he could do so while waiting in line for the referral which has already been denied him by his primary care doc, who pocketed the bonus for the denial.</p>
<p>Doctors, loans, and high costs:</p>
<p>My H graduated 20 years ago with six figure loans. Working in a comparatively “low paying” area (pediatrician for low income patients), he was able to pay the loans off. We didn’t live the socalled “doctor” lifestyle, and that was fine with us. Any doctor can make enough to pay the loans off; the income levels only are a problem if you think you deserve a certain high level lifestyle.</p>
<p>Secondly, he left medicine precisely because the system is broken, as Mini says. The stresses of watching kids die who were denied care, or, more often, watching families ruined by the uncovered price of the care, along with dealing with (fighting with) insurance companies with dozens of different regulations, each making decisions based, ultimately on profit, not health, collectively drove him out of medicine, despite a stellar record and a pile of awards attesting to it.</p>
<p>He’s now in a comparatively low paying, “socialized” field–education–and loving it.</p>
<p>The system that we have now drives out many of the best, most altruistic doctors. I agree with Mini–it is broken.</p>
<p>“My H graduated 20 years ago with six figure loans. Working in a comparatively “low paying” area (pediatrician for low income patients), he was able to pay the loans off. We didn’t live the socalled “doctor” lifestyle, and that was fine with us. Any doctor can make enough to pay the loans off; the income levels only are a problem if you think you deserve a certain high level lifestyle.”</p>
<p>Did he have $250,000 in loans, and was there a second income to help cover expenses? (Especailly if he is married to another doctor.) Do you live in an area where the cost of living is relatively high or low? Not all doctors have spouses who work. With the type of busy lifestyle, many want to have a spouse that stays home and raises the children. There should be this option.</p>
<p>That kind of loan payment is a problem for many students. Some medical students, esp from poor or immigrant backgrounds, have extended families to care for, and, in addition, their own families to raise without a second income.</p>
<p>The loan burden is very real, and a deterrent from entering the field.</p>
<p>The government will never subsidize medical education, there is a feeling that “doctors are rich” and can pay back $250,000 easily. This just isn’t true now, with the high costs of housing, etc.</p>
<p>It is a deterrent and I know lots of young people who would never go into medicine because of the finances. Actually, nursing is a better deal now.</p>
<p>Answers–100K loans (20 years ago) are probably close to equivalent of 250K now.</p>
<p>Second income was very part time adjuncting, piecemeal, low pay. (Mostly, with his hours, I was that spouse you spoke of who stayed home and raised the kids.)</p>
<p>We live in North Jersey, one of the highest expense areas in the country.</p>
<p>Additionally, we had two kids by the time he graduated med school, and while he was in residency, thus four people were living on that income while loans were repaid.</p>
<p>did I miss any questions? :)</p>
<p>To the question, why not tax supported food and water for all? Why healthcare? First, food and water are not things out of reach of most people. Even rent isn’t out of reach for most. We do have homeless people, and I think we should do more than we currently do for them, but fortunately, most working families can afford rent somewhere.
But most working families cannot afford healthcare without insurance, and those that have insurance are spending a great deal for it and often still not getting what they need. And heaven forbid, you lose your job.</p>
<p>Our family of four, with the contribution from H’s company, and our own contribution, give the insurance companies about 12,000 a year. Since we’re pretty healthy, we use only a fraction of that in actual medical claims each year, yet we can still be turned away (as in the case of my daugter’s broken leg) when care should be given.</p>
<p>I would be happy to pay the 12,000 through taxes into a universal plan where I could walk into an emergency room with my child and know that they won’t send me home without providing the necessary care- necessary by a doctor’s opinion, not the opinion of the insurer who will lose money if they approve the care we need. Believe it or not, other countries do have such a system. And they do it for less money because they have eliminated the middle-man, the insurance companies and their multi-billion dollar profits.</p>
<p>And doctors in those countries still do very well. They are not all fleeing their own countries to work here. </p>
<p>People really need to see this movie. Moore did a pretty good job covering some of the obvious and not unreasonable objections of critics.
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<p>We would gladly do this too.</p>
<p>“Answers–100K loans (20 years ago) are probably close to equivalent of 250K now.”</p>
<p>So you think then that the loan burdens now are easily assumed and paid off, for a primary care doctor such as the pediatrician that your husband was at that time? </p>
<p>If a pediatrician makes 90,000 a year to start, with taxes taken out (25%) and paying $2000 a month back in loans, that leaves approximately 3625/month for housing, food, transportation, clothing, utilities, and then there is baby. I assume that diapers are bought, and of course no babysitters or anything extra, breast feed for 2 years to avoid formula and then to cut down on buying milk. I think that New York or Northern NJ would certainly be easy to live in. Are we talking 800 sq foot studio apartment in Manhattan for $3000? Or way out in the burbs? Maybe a sl larger condo for about the same price? So all of the rest of living expenses for $625 a month? Really, I don’t think it’s very possible. How about becoming a surgeon instead?</p>
<p>“And doctors in those countries still do very well. They are not all fleeing their own countries to work here.”</p>
<p>I live not far from the Canadian border, in a town with extremely high quality of living, great schools, higher education, beautiful environment, good climate, relatively low-cost housing, no state income taxes, and a massive shortage of primary care docs. I used to work for the state board of health, and my wife is a nurse. We have yet to meet a single Canadian doc who has moved here to practice. </p>
<p>In fact, in some outlying areas, I know of two PAs from Afghanistan (medical training in Pakistan.)</p>
<p>“I would be happy to pay the 12,000 through taxes into a universal plan where I could walk into an emergency room with my child and know that they won’t send me home without providing the necessary care- necessary by a doctor’s opinion, not the opinion of the insurer who will lose money if they approve the care we need.”</p>
<p>Emergency rooms are required to provide care to all comers, see ERISA.</p>
<p>“I live not far from the Canadian border, in a town with extremely high quality of living, great schools, higher education, beautiful environment, good climate, relatively low-cost housing, no state income taxes, and a massive shortage of primary care docs. I used to work for the state board of health, and my wife is a nurse. We have yet to meet a single Canadian doc who has moved here to practice.”</p>
<p>I know several of them, also living near Canada. And health care providers who live in Canada and commute to the US to practice.</p>
<p>“Emergency rooms are required to provide care to all comers, see ERISA.”</p>
<p>Not true. They are required to triage and to diagnose, NOT to provide care (and they often don’t). (Twenty years ago they were required to treat, under Hill-Burton; no longer. This was part of the “Reagan Revolution”.)</p>
<p>“I know several of them, also living near Canada. And health care providers who live in Canada and commute to the US to practice.”</p>
<p>I actually do know some “snow-bird” docs who come down from Winnipeg to North Dakota for the winter. But I’ve yet to meet a commuting Canadian DOC in Washington State (I’m sure there is one somewhere; if you pay enough, they’ll come. Not in primary care, though. Surgeons, etc.)</p>
<p>^ Or turned away from necessary care in general. BTW, I know of a situation where a patient was transported to an ER of a teaching hospital near my home. The physicians did not feel that they could adequately treat his condition and sent him to another hospital. Do you know that they recommended flying him and the insurance company refused to pay (I was told that the cost was 10k). They would only pay for a regular ambulance. The family did have the patient flown, and had to pay the 10k out of their pocket.</p>
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They’re not required to treat but to medically stabilize an ER patient before transfer. That was frequently an issue in the town where I used to live. Three hospitals, two of them religious-affiliated and non-for-profit, the third for-profit. All level 2 trauma centers. The for-profit was notorious for dumping uninsured ER patients. Their definition of stable was notably more fluid than the other two hospitals’.</p>