On top of the concerns previously mentioned regarding people in our age group, preexisting conditions and early retirement, I have 2 thoughts:
How many people past the age of 50 have preexisting conditions? If you include things like high blood pressure and/or cholesterol and other health factors that arise past a certain age, my guess is a lot of us fall into this camp.
How many of us may unwillingly fall into the early retiree camp? It’s not uncommon to be laid off in your 50s/60s and it becomes harder to replace a job and income at that age. I know quite a few people who have had this happen.
Not with US levels of medical school student loan debt. However, the cost of medical school in France is much lower, and students can go to medical school directly from high school there (no bachelor’s degree and associated cost of such).
Older doctors would retire early.
The best and brightest would reconsider whether going to medical school is a sound investment of time and money
The quality of the applicants to medical school would go down (this is already happening in law schools as the jobs dried up).
One interesting situation is the cost-sharing reimbursements. The US government is currently involved in a lawsuit about cost-sharing reimbursements, the extra supports for people who enroll in Obamacare policies and who have incomes less than 250% of the federal poverty level. If they enroll in a Silver policy, they get decreases in their co-pays and coinsurance, and they also get a lower deductible. The insurer is responsible for these cost-lowering features, and the federal government then reimburses the insurers.
In House v. Burwell, the House of Representatives sued the federal government, saying that the law requiring the feds to pay back the insurers was illegal. The government lost, but they’re appealing. The new President could drop the appeal. That would mean that the feds wouldn’t have to pay back insurers, but the insurers would still be required to give the cost sharing to the people with incomes under 250% of poverty. I guess it would be a way to shift those costs from taxpayers in general to the other subscribers of these insurance plans, raising the costs for all the other subscribers. Or possibly it would just drive all insurers out of the market.
@TatinG if anticipated compensation for doctor services was reduced slightly (and let me highlight slightly), but administrative costs and liability insurance also declined, how would that impact the field?
It would let doctors serve patients and net a good income for doing so. Those with a passion to help people would choose the field, and those only chasing a payday would find a more lucrative alternative.
I know a lot of doctors hate the administrative costs, the paperwork and also hate the high medical malpractice insurance rates they have to pay. But doctors, like most business people, do not want to be salaried government employees, which is what would happen on single payer.
Some of the happiest doctors I know are in the military. Pay is decent, lots of travel and interesting medical work. They get to practice medicine without any of the administrative paperwork.
To keep things in perspective, that’s still more than 4 times the median salary for the times.
Right now, the median salary is 20K and doctors still make 4 times what a regular college graduate makes.
Medical school is entirely tuition-free; they have a system put in place in the 70s called “numerus clausus”,
which keeps the number of students moving from Level 1 (PACES) to Level 2 (Medical Doctor) to low levels and it’s become a problem for the past 5 years or so because the medical board won’t change he numerus clausus or hardly, even if the country’s running out of doctors. Another issue is the selection process (standardized tests including questions on footnote 3 p.214 rather than on the key elements), content of studies, a hazing process whereby second-year students competing with first-year students fighting to move to Level 2 effectively keep them from being able to learn - last year, as a “fun welcome”, the Second year students in Bordeau dropped buzzing beetles on the 1st years, etc-. Also, you can’t combine research with clinical work and there’s no undergraduate research or MD/PHD. So medical studies have a lot of issues.
But if you’re willing to study for 12 hours a day for one or two years, are great at memorozing hundreds of pages, and are fluent in French, you’re welcome to try. 15% move to Level 2 and start right away with a hospital internship. Once you’re a doctor, if you’re willing to work in a small town, you’ll have an office in a health “house” that the townhall pays for you (you pay rent or may have rent paid for you for a year), can see patients as you wish, each pays 23 euros, your insurance costs are low. No debt. The lack of doctors (not from dearth of young people wishing to join the medical profession) is the biggest problem. Rural health care is another issue.
All people, when they’re born, are given a social security number and at some age (I don’t know if it’s 18 or earlier) receive a green card with a chip called “carte vitale” which you enter to pay for the doctor and the drugs you are prescribed. You can’t go to a specialist without a general practitioner’s referral, you have to pay etra for non-generic/brand-name drugs, better facilities at the hospital (private room, TV…) and to get a faster appointment for non urgent care (like for acne), but you see the doctor you want. Very low income people don’t pay anything. Lower income people are supposed to contribute a few euros (lik 1 or 2). Health care is seen as a right. Everybody pays directly from their monhly paycheck, a small percentage of income.
To @NoVADad99’s example of military doctors, another example is how many doctors have chosen to become hospitalists because of the hours and lack of administrative burden.
Also, many physicians have moved into large multispecialty practices, where the administrative overhead (dealing with insurance, etc.) is its own piece of the practice shared by the physicians instead of something that each physician has the manage and staff on his/her own.
The military doctors also do not have the medical school tuition debt because that is paid for by the military. But to impose a single payer system with significantly reduced pay on people who have 200 and 300k in debt with 6 - 8% interest would result in a medical meltdown.
I think the graduating medical student in my own family would be happy to exchange a more moderate salary for the debt she is carrying after med school. It certainly would be less stressful over time. I’d note that her salary for her residency is just about the same as what is quoted as average in France – only she has her med school debt on top of it. So that’s 4 years of paying down US-doctor debt while earning a mid $50K range salary … and limited flexibility in the future given the ever-present debt. Others who aspire to some of the higher paying specialties may feel differently – but for many doctors there isn’t all that much left over under the present system, even if on paper they are earning mid 6 figures.
The burden of medical school debt may be why there is a relative shortage of primary care physicians, and the apparent higher likelihood of primary care physicians being immigrants who did their medical school in places where it is much less expensive.
This “best and brightest” argument doesn’t hold much water with me.
I went to a highly-regarded college, and on average, the premeds were typically not as talented as those who went to other kinds of graduate school. Some of them just truly wanted to help people. Some wanted lots of money for fancy specialties. Some were biding their time because of not being sure what to do (analogous to what I understand prelaw can be at liberal arts schools). Sure, they were smart enough and a few were probably even “best and brightest”.
Being a doctor does not actually require one to be the absolute smartest person possible. It requires intelligence, empathy, humility, creativity…like many jobs.
But mostly, the “best and brightest” argument is incredibly insulting to people like me, i.e. teachers. I am a high school teacher, and I graduated first in my STEM major. I love my work, and yes I’m happy with my job, even if others would denigrate it as “working as a government employee” or however it was phrased. The salary is certainly lower than I could (or did) earn in industry. But in my district, it is a middle-class income and sufficient for my needs.
So although I wish teachers were paid/valued more, we still do get “best and brightest” types much of the time, and people who truly want to teach children, nearly all of the time.
Yes, we’d have to do something about the cost of medical school, but I don’t see that as a deal-breaker since it has been solved in other countries.
It was just an expression, no offense intended to anyone. My mother was a high school teacher and graduated summa cum laude from her university also.
As it is now, only 35% (approx) of those who apply, get into medical school. And then it is 4 years of very hard work, no summer break, followed by three or four or five or six (depending on the field) of residency. It is one of the longest slogs of any profession.
Well, I certainly hope that many of the “best and brightest” do go into medical care. That doesn’t preclude others in that category from becoming teachers
I think the point is that the “best and brightest” have many options. They can become doctors, or teachers, or professors, or business people, etc. The last thing you want to do is make medicine unattractive for them.
BB, those types of stories are going around fast and furious through my maternal & child health listservs. My friends who work in women’s health clinics have said that there have been an enormous surge of women calling in and asking for IUDs. As someone who is a huge advocate of LARC methods, I am happy that women are obtaining IUDs. I despise the reason they are doing it though.
Various disability and chronic illness networks that I’m linked into are highly encouraging people to get any tests and procedures done ASAP.