Request: A Generlal Explanation of the US Healthcare System

Username17 · Post by **Username17** » Sat May 02, 2009 1:32 pm

My understanding (from my dad who used to work at Dalhousie Medical School, though as an editor rather than a medical practitioner) is that the largest restriction of having more doctors is the medical associations who intentionally puts practices in place expressly designed to assure that only so many doctors will graduate during any given year so that they can maintain the asking price that doctors can ask for.

That's not really a very helpful way to think about it. The AMA lobbies against methods to increase the number of doctors, but they don't actually have the ability to keep people who graduated from medical school from having done so.

The big problem is that it takes a million dollars to train a doctor, and in a privatized world no one is going to spend that money. Oh sure, people will spend a million dollars to hire a doctor, but no one is going to spend a million dollars to train a doctor just to have them wander off. And that's the big problem. It takes a coordinated effort to train medical personnel, and it just doesn't exist in the United States.

The AMA periodically speaks against doing things about the problem (although they've been doing less of that lately as the power of the HMO has risen and the AMA finds itself wishing it had more people), but the real culprit is the knee-jerk anti-socialism of the US. Graduate medical schools should be getting a huge pile of money from the state to train a constant stream of new doctors. And they aren't.

In many areas of the country, they don't even exist.

-Username17

Meikle641 · Post by **Meikle641** » Sun May 03, 2009 1:15 am

In Canada (at least Ontario), we have a massive doctor shortage, since all the old docs are retiring. From what a friend has told me, our schools have insane standards for letting people in or something, which means we have lots of people who can't get in. And those who *do* get through usually go to the US for the money, compounding the issue.

Grah.

shau · Post by **shau** » Sun May 03, 2009 3:58 am

Of course, on the other hand you can do like law schools do and churn out lawyers like crazy. Then guys like me spend 100k in education and can't find a job.

Username17 · Post by **Username17** » Sun May 03, 2009 7:05 am

Meikle641 wrote:In Canada (at least Ontario), we have a massive doctor shortage, since all the old docs are retiring. From what a friend has told me, our schools have insane standards for letting people in or something, which means we have lots of people who can't get in. And those who *do* get through usually go to the US for the money, compounding the issue.

Grah.

Sort of. The standards are based on the number of slots they have, which is a number that isn't enough. It's really hard even in Canada to get the government to throw money at teaching doctors who won't be ready until next election cycle anyway.

The way it works is that there are minimum standards that are incredibly high. And then if you meet them you essentially get a random chance of getting a slot amongst all the other people who have the qualifications. So for example, I got into the 95% percentile that made me qualified, but I didn't get a space because I was low enough on the alternates list that I didn't get in. That's why I'm in Eastern Europe. Because out here it's just whoever gets the top score and then the next top score and so on until there are no spots left.

Actually, given the complete fucking lack of slots in the US and Canada, it's a good system (even though it fucked me). Because it ensures that no one can make a Japanese-style cram school geared directly to the test. Because if that happened, then the top scores would always be hogged by aristocrats and then we'd be in the situation of Imperial China where the technocracy was defacto hereditary.

But it all comes down to the fact that there are a hundred and twenty something medical schools in the US and Canada. For a combined population of 340 million people. And some of them are very small.

-Username17

Count Arioch the 28th · Tue May 05, 2009 1:50 am

Ooh, swine flu! Save me from the flu strain that has less severe symptoms and kills a lower percentage of people as regular flu!

Flu kills people, and is prone to mutation. That's what influenza does. The fact that Swine Flu does that isn't really relevant.

Crissa · Post by **Crissa** » Thu May 07, 2009 5:49 am

Excuse me?

Swine flu worldwide has killed 4% of those who have been diagnosed with it.

How exactly is that less than other flus?

Also: No vaccine.

-Crissa

Username17 · Post by **Username17** » Thu May 07, 2009 8:10 am

Swine Flu isn't more or less than normal Flu, because it is normal flu. The only thing interesting about it is that as the latest variant we don't have a vaccine for it yet.

-Username17

Fuchs · Post by **Fuchs** » Thu May 07, 2009 8:27 am

Why do we call it swine flu anyway? I heard that "Mexican Flu" was more correct, since the first swines to get it got it from a human farmer in Canada.

Username17 · Post by **Username17** » Thu May 07, 2009 4:27 pm

Fuchs wrote:Why do we call it swine flu anyway? I heard that "Mexican Flu" was more correct, since the first swines to get it got it from a human farmer in Canada.

The best discussion I've seen on that subject is actually on the Colbert Report. You can see it Here.

-Username17

shau · Post by **shau** » Thu May 07, 2009 5:36 pm

Fuchs wrote:Why do we call it swine flu anyway? I heard that "Mexican Flu" was more correct, since the first swines to get it got it from a human farmer in Canada.

I mentioned the fact that some people have been saying this to my Hispanic friend. She...let's say disagreed strongly with the idea of the new plague being named after her people.

In a conciliatory gesture, I suggested calling it the "Dirty Mexican Flu." That way not all Mexicans would be stigmatized, just the dirty ones. She was not mollified by this.

In other swine flu news, they have canceled shaking hands at my graduation. Apparently we just walk up to the dean and stare at each other awkwardly for a few seconds.

Fuchs · Post by **Fuchs** » Thu May 07, 2009 9:29 pm

The 1918 killer flu is called "Spanish Flu".

Username17 · Post by **Username17** » Fri May 08, 2009 12:48 am

We will take our checks from the government and spend them on beer. Mexican beer.

That is the cheapest kind of beer.

-Username17

Count Arioch the 28th · Mon May 11, 2009 11:02 pm

Not really. Mexican beer is expensive if you're not in Mexico.

Although I would hesitate to call cheap crap like Keystone or PBR beer.

Crissa · Post by **Crissa** » Tue May 12, 2009 2:41 am

Depends on how close to Mexico you live.

-Crissa

Count Arioch the 28th · Tue May 12, 2009 8:34 pm

Point taken. Where I live, it's expensive. Although I do enjoy a bottle of Dos Equis every so often.

CatharzGodfoot · Post by **CatharzGodfoot** » Tue May 12, 2009 9:23 pm

FrankTrollman wrote:We will take our checks from the government and spend them on beer. Mexican beer.

That is the cheapest kind of beer.

-Username17

Kind of ironic that people would drink Mexican beer in the Czech Republik.

ckafrica · Post by **ckafrica** » Wed May 13, 2009 3:59 am

We get bia hoi over here (which translates literally though not realistically) into fresh beer. It's about 10 cents a glass right now and is worth every penny.

MGuy · Post by **MGuy** » Mon Aug 17, 2009 8:56 pm

*Thread Necromancy* Its been coming up a lot in the news thread and now that I have been informed that this thread exist I'm raising it from the dead to ask how people feel about the Healthcare bill, what is known about it thus far, and if there are any legitimate concerns about it.

Crissa · Post by **Crissa** » Mon Aug 17, 2009 9:32 pm

Well, the various versions on the House floor vary in details not exactly known to the public. There's about a thousand pages so far written.

The basic plan is such:

Regulate Health Insurers:
Insurance firms will be banned from discriminating based on pre-existing conditions.
The firms will face yearly limits on the out-of-pocket expenses they can require.
They’ll have to pay for preventive care in full.
They’ll be barred from gender discrimination
They won’t be allowed to alter coverage if policyholders become very ill.
They won’t be able to put yearly or lifetime limits on coverage.
Kids will qualify for family plans until they’re 26.
If policyholders pay their full premiums, insurance companies will have to renew policies.

Control increases in Medical costs:
Create government panel to work specifically on how Medicare et al reimburse Medical providers (currently only congress can change how they pay)
Create a panel to pay for and use evidence based science to detail the effects and efficacy of medical products and procedures, so we know what works best and how much it costs.
Create a government mandated private insurer to provide a baseline coverage for private insurers to compete against.

Cover everyone for Health:
Require everyone to have coverage.
Subsidize basic coverage for those who don't have it.
Detail what coverage is considered 'basic' coverage.
Create a federally-watched market which ensures that plans have been compared against the base line, and are operating fairly.

I can source some of this so far... But alot of it is really in videos, I don't know what middle america has this fascination with video, but... Bleah.

-Crissa

Neeeek · Post by **Neeeek** » Tue Aug 18, 2009 1:10 am

MGuy wrote:*Thread Necromancy* Its been coming up a lot in the news thread and now that I have been informed that this thread exist I'm raising it from the dead to ask how people feel about the Healthcare bill, what is known about it thus far, and if there are any legitimate concerns about it.

The biggest legitimate concern about the health care bill is that Congress will water it down too much to appease a bunch of obnoxious idiots who clearly don't have a fucking clue what they are talking about.

See, the primary objections that have been made about the bill are based entirely on lies. There really isn't anything there that is remotely like the "death panels" people have been screaming about. Nothing even remotely like it, and the funny thing is, there should be and private insurance companies have them now. What they are claiming to be against is literally the status quo that the bill is trying to fix.

Lago PARANOIA · Post by **Lago PARANOIA** » Tue Aug 18, 2009 1:20 am

Public option ain't happening.

Obama really fucked up by leaving the details to Congress. That's assuming that he wanted one in the first place. But anyway, there are a lot of pissed-off progressives who feel that the Senate caved in too much to Blue Dogs and Republicans. This is really going to bite the Blue Dog caucus in the ass and by extension the Democratic party.

MGuy · Post by **MGuy** » Tue Aug 18, 2009 3:18 am

Just as planned. I mean really I'd expect no less from the republicans. Just because they aren't the majority doesn't mean they handed congress over to anybody. As long as people remain too stupid to know a good thing when it shows up this is the kind of shit we get stuck with. It just shows the American people only get what they deserve.

Ganbare Gincun · Post by **Ganbare Gincun** » Tue Aug 18, 2009 4:52 am

Lago PARANOIA wrote:Public option ain't happening.

I wouldn't be so sure. There's several bills floating around Congress right now that probably won't be formally presented until November. And word on the street is that all but one of them have a public option, and the one that doesn't have one right now could very well have a public option incorporated into it in conference committee. By the time this rolls around, we'll all have grown weary of the screaming TBWs and their antics and the Dems will be able to launch an effective, timely P.R. counterattack against their critics.

Let me put it to you this way: I recently spent some time with some VERY conservative friends of mine, and all of them indicated that they were 100% behind the most extreme health care reform possible. That's right: the very same people that spent all of their time talking shit about Obama when he was elected are eagerly waiting for his administration to provide relief from our barbaric health care system. And that holds true for most of the conservatives that I know (aside from the TBWs, the racists, and the ones that have oil wells).

So yeah. I think that meaningful health care reform is possible. But it's going to be a long fight against formidable opposition, and we pretty much have to come to terms with that fact. In the meantime, I'd urge you and all of your friends to write your federal representatives and let them know how important this issue is to you. The fact of the matter is that Washington is still very "old media" and that an actual physical letter is going to have much more impact then if you just shoot them an E-Mail.

Crissa · Post by **Crissa** » Tue Aug 18, 2009 5:27 am

Obama really fucked up by leaving it to Congress.
Clinton really fucked up by leaving it to his Administration.
Ford really fucked up by leaving it to the Courts.
Bush II really fucked up by leaving it to Big Pharma.

What a specious argument.

Now, that Congress and the President are considering removing sections of the proposed bill to placate people complaining about things that aren't in the bill at all? Stupid.

-Crissa

Lago PARANOIA · Post by **Lago PARANOIA** » Tue Aug 18, 2009 5:52 am

No, really, the President is really fucking it up leaving it to Congress.

The Democratic House and Senate have completely different priorities and choking points. They have the progressive wing saying flat-out that they will vote against a bill that does not have a public option and they also have 3 to 5 Senators who have it in their best interests not to pass any kind of meaningful reform.

If Obama did want it he should've twisted arms before Big Pharma stuck their claws into the Blue Dogs and should also stop his staff from sending mixed messages. If he didn't want a public option then he should've let the progressive wing down ahead of time.

By not taking control of the debate Obama has let Pelosi and the Senate Blue Dogs engage in brinksmanship that will only lead anywhere good if there is actually a public option. Which I still don't think is going to happen. But if they don't actually get it then either:

A) This means that the progressive wing backed down, which will piss off the Democratic base immensely for said wing backing down on a promise.

or

B) The progressive wing stuck to their word and ended up voting against the bill. Massive political failure for Obama.

This is definitely a case of a multi-millionaire not writing down a will for his greedy children; when the fighting clears there won't be much of the pie left.