Author Topic: What comes after the ACA?  (Read 746452 times)

pecunia

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Re: What comes after the ACA?
« Reply #4600 on: July 20, 2018, 08:04:25 AM »
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To fix that I propose that a system that is roughly 80% government, 20% private/individual will be best. I have no idea of details needed to implement that, but that's where I would like to go.

My gut feel is that this would be good.  If the system was all government, the spirit of medical innovation would be gone as the profit incentive would be gone.  If the system were all or mostly private, price gouging would occur.  (Doesn't this happen now?)  Service may be secondary to getting the bucks.  (Unless, we somehow develop competitive medicine.)

Jrr85

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Re: What comes after the ACA?
« Reply #4601 on: July 20, 2018, 08:18:59 AM »
4) NP and PAs have decent training but they are not physicians and need a physician to help out from time to time.  They are not a replacement for doctors but are very useful in making the doctors more efficient by helping in managing patient care. I love our NPs and PAs but don't fool yourself thinking they are equally qualified as a physician. A well oiled team can see more patients safely at a lower cost.

I don't think anybody beleives NPs are equally qualified as a physician.  They just recognize it doesn't take 4 years of medical school, and 3 years of residency for most primary care.  I've had NPs lance a staph infection, do minor stitches, sinus infections, etc.  Sure there is a chance they are giong to miss an underlying condition, but it's a pretty good tradeoff to not have to wait hours to see a doctor (assuming I can see them at all) and to not have to pay as much (although the discount isn't that big because they have to essentially pay the doctor to practice). 



swampwiz

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Re: What comes after the ACA?
« Reply #4602 on: July 20, 2018, 09:52:02 AM »
4) NP and PAs have decent training but they are not physicians and need a physician to help out from time to time.  They are not a replacement for doctors but are very useful in making the doctors more efficient by helping in managing patient care. I love our NPs and PAs but don't fool yourself thinking they are equally qualified as a physician. A well oiled team can see more patients safely at a lower cost.

I don't think anybody beleives NPs are equally qualified as a physician.  They just recognize it doesn't take 4 years of medical school, and 3 years of residency for most primary care.  I've had NPs lance a staph infection, do minor stitches, sinus infections, etc.  Sure there is a chance they are giong to miss an underlying condition, but it's a pretty good tradeoff to not have to wait hours to see a doctor (assuming I can see them at all) and to not have to pay as much (although the discount isn't that big because they have to essentially pay the doctor to practice).

I really don't see how the practice of medicine cannot be deduced to something like a "shop manual" for the human "platform".  Input the symptoms & tests into the file with the patient's history, and spit out the recommended treatment.  When you get down to it, a physician is merely a "human" mechanic.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4603 on: July 20, 2018, 11:36:46 AM »
4) NP and PAs have decent training but they are not physicians and need a physician to help out from time to time.  They are not a replacement for doctors but are very useful in making the doctors more efficient by helping in managing patient care. I love our NPs and PAs but don't fool yourself thinking they are equally qualified as a physician. A well oiled team can see more patients safely at a lower cost.

I don't think anybody beleives NPs are equally qualified as a physician.  They just recognize it doesn't take 4 years of medical school, and 3 years of residency for most primary care.  I've had NPs lance a staph infection, do minor stitches, sinus infections, etc.  Sure there is a chance they are giong to miss an underlying condition, but it's a pretty good tradeoff to not have to wait hours to see a doctor (assuming I can see them at all) and to not have to pay as much (although the discount isn't that big because they have to essentially pay the doctor to practice).

I really don't see how the practice of medicine cannot be deduced to something like a "shop manual" for the human "platform".  Input the symptoms & tests into the file with the patient's history, and spit out the recommended treatment.  When you get down to it, a physician is merely a "human" mechanic.

You are correct that much of medicine is very much protocol driven.  Person with symptoms X,Y,Z and a history of ABC will get certain tests and then a treatment is given based on those tests. I would bet a computer program can handle about 80-90% of medicine today.  It is that 10%-20% that require interpretation and a deeper understanding. It seams like almost every day I see something that doesn't follow the protocol 100% and needs adjustment.

But, I see no reason why we can't have a list of costs that are 100% transparent to the consumer so that they can make a better decision.  For example if a patient fell and hurt their ankle do you get an X-ray 100% of the time?  In todays medicine the answer is yes even if the likely hood of a fracture is low.  It would be much better if the physician had a conversation with the patient letting them know that an X-ray will cost $100 and that the doctor does not suspect a fracture.  We can get the x-ray now or we can see how the patient does in the next 5-7 days, and if the pain is still there we can x-ray it then. I think most people would prefer to save the $100 with that discussion. Especially if the final outcome is the same.

Today it is easier to just order the X-ray because the physician takes less liability and it is easier to order the X-ray as opposed to take time to educate the patient.  To keep up with all the paperwork a physician only has a few minutes with each patient and there is little time to educate everyone. Most physicians spend 3-4 times as much time on the computer as compared to talking to patients.

BTW, if the patient is paying $0 because taxes are covering their healthcare then the answer will always be "do all the tests now, and while your at it, check my cholesterol, see if I have an STD, and check if I am prone to some really rare bleeding disorder that I read on the internet last week."  In that event, the physician should have the ability to say no with absolutely no repercussion if they are wrong.

toganet

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Re: What comes after the ACA?
« Reply #4604 on: July 20, 2018, 01:26:05 PM »
4) NP and PAs have decent training but they are not physicians and need a physician to help out from time to time.  They are not a replacement for doctors but are very useful in making the doctors more efficient by helping in managing patient care. I love our NPs and PAs but don't fool yourself thinking they are equally qualified as a physician. A well oiled team can see more patients safely at a lower cost.

I don't think anybody beleives NPs are equally qualified as a physician.  They just recognize it doesn't take 4 years of medical school, and 3 years of residency for most primary care.  I've had NPs lance a staph infection, do minor stitches, sinus infections, etc.  Sure there is a chance they are giong to miss an underlying condition, but it's a pretty good tradeoff to not have to wait hours to see a doctor (assuming I can see them at all) and to not have to pay as much (although the discount isn't that big because they have to essentially pay the doctor to practice).

I really don't see how the practice of medicine cannot be deduced to something like a "shop manual" for the human "platform".  Input the symptoms & tests into the file with the patient's history, and spit out the recommended treatment.  When you get down to it, a physician is merely a "human" mechanic.

You are correct that much of medicine is very much protocol driven.  Person with symptoms X,Y,Z and a history of ABC will get certain tests and then a treatment is given based on those tests. I would bet a computer program can handle about 80-90% of medicine today.  It is that 10%-20% that require interpretation and a deeper understanding. It seams like almost every day I see something that doesn't follow the protocol 100% and needs adjustment.

But, I see no reason why we can't have a list of costs that are 100% transparent to the consumer so that they can make a better decision.  For example if a patient fell and hurt their ankle do you get an X-ray 100% of the time?  In todays medicine the answer is yes even if the likely hood of a fracture is low.  It would be much better if the physician had a conversation with the patient letting them know that an X-ray will cost $100 and that the doctor does not suspect a fracture.  We can get the x-ray now or we can see how the patient does in the next 5-7 days, and if the pain is still there we can x-ray it then. I think most people would prefer to save the $100 with that discussion. Especially if the final outcome is the same.

Today it is easier to just order the X-ray because the physician takes less liability and it is easier to order the X-ray as opposed to take time to educate the patient.  To keep up with all the paperwork a physician only has a few minutes with each patient and there is little time to educate everyone. Most physicians spend 3-4 times as much time on the computer as compared to talking to patients.

BTW, if the patient is paying $0 because taxes are covering their healthcare then the answer will always be "do all the tests now, and while your at it, check my cholesterol, see if I have an STD, and check if I am prone to some really rare bleeding disorder that I read on the internet last week."  In that event, the physician should have the ability to say no with absolutely no repercussion if they are wrong.

This is where robots & automation will likely change the nature of the problem we're talking about.  Diagnostic AI, automated surgeries, and home healthcare robots are not that far off.  Costs may be wildly different when your trip to the "doctor" involves only a few human beings, who rely heavily on the above systems, and who are attracted to the "interesting" cases vs. being incentivized by $$.

Another radical suggestion I've read is to allow patients to waive the right to sue for malpractice in exchange for reduced prices.  The idea being that costs could be kept in check, and many services are very safe and the downsides understood.

maizeman

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Re: What comes after the ACA?
« Reply #4605 on: July 20, 2018, 01:55:14 PM »
You are correct that much of medicine is very much protocol driven.  Person with symptoms X,Y,Z and a history of ABC will get certain tests and then a treatment is given based on those tests. I would bet a computer program can handle about 80-90% of medicine today.  It is that 10%-20% that require interpretation and a deeper understanding. It seams like almost every day I see something that doesn't follow the protocol 100% and needs adjustment.

So the question is, can a computer program reliably tell the difference between the 80-90% and the 10-20%? That seems to be the biggest hurdle that needs to be crossed in most fields where machine learning starts reducing the need for trained workers.

80% accuracy for medical treatment would suck.

99+% accuracy 80% of the time, and "I don't know, we're going to have to bring in a real human MD" 20% of the time would be game changing for both the quality and cost of healthcare.

Threshkin

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Re: What comes after the ACA?
« Reply #4606 on: July 20, 2018, 02:50:49 PM »
Are you opposed to government provided healthcare?

I am not opposed to government provided healthcare (e.g. Medicaid, Medicare, Tricare, etc).  I'm not opposed to expanding these programs, or adding new ones.  I'm also not opposed to government provided health insurance, the republican's proposed alternative, though as currently implemented I think it has some serious shortcomings.

Healthcare is never a free market.  Buyers can't comparison shop, prices are not transparent or consistent, competition is basically non-existent, and supply and demand are essentially uncoupled from the amount of care provided.  If there was ever an ironclad case for government intervention in an industry, I think this is it.  Every other western nation seems to agree.

Sol,  A lot of the issues you mention are a direct result of government intervention.  The lack of transparency and competition is because health care providers are not allowed to advertise prices.  Insurance companies can compete only in limited geographies.  Government regulations prohibit selling health care insurance plans across state lines.

In the US most products and services other than healthcare compete heavily on price.  Why not healthcare?  Government regulation......... 

fuzzy math

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Re: What comes after the ACA?
« Reply #4607 on: July 20, 2018, 09:30:10 PM »

This is such an easy fix, though!  Just allow doctors to immigrate!  There are tens of thousands of doctors and nurses in other countries who would kill for the chance to come to America and make half of what their US counterparts make.  Just let them.  Even if they have brown skin.

Wages would come down in the medical field.  I'm okay with that.  Every hospital around me is constantly under construction because they are such cash cows these days.


This is already happening / has happened. There are huge amounts of foreign nurses (Filipinos being the largest segment I can think of) who have immigrated here to care for us. Guess what there is still a shortage of nurses.
On the physician side its happening too. If you visit any academic medical center you will find that "white Muricans" make up a minority of graduating physicians. There is still a shortage. There is a huge shortage of older physicians to train these people because a lot of old timey Drs are sick of the shit that is going on in healthcare and leaving to another field of work or retiring early. Who is going to train all these physicians? In general the quality / experience level of a modern graduating physician is already much lower than a generation or two ago before residency hours were restricted. There are many specialty residency and fellowships going UNFILLED because there are not enough qualified applicants. Trust me when I say I've seen the effects of a bad physician treating a patient, its deadly. Now add in an individual language barrier, and multiple language barriers of many ESL residents of different backgrounds learning from each other and you've got a shit storm brewing.

Nurses are not overpaid, with most making under 6 figures. Most physicians are not over paid. A family practice doc will likely not earn much more than $200k. A specialist like cardiology will probably earn in the $600k range. Lets lower the salaries of these already scarce and fed up people, and then see what happens, all while not expecting other job fields (like govt science PhD ppl) to follow suit, keeping the economy exactly the same while expecting health care workers to adjust to lower standards of living, then acting surprised your local hospital is under staffed and you're complaining about the lack of care. It's not clinicians who are raking in the big bucks, its administrators, many of whom do not have clinical backgrounds.

If you're seeing a ton of hospitals remodeling and expanding, its likely that its because there are tons of baby boomers requiring care. It's not that health care workers are so overpaid and hospitals are making money hand over fist to the extent that they have nothing better to do that install gold toilets in each department's bathroom.
« Last Edit: July 21, 2018, 01:09:31 AM by fuzzy math »

maizeman

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Re: What comes after the ACA?
« Reply #4608 on: July 20, 2018, 09:54:27 PM »
Nurses are not overpaid, with most making under 6 figures. Most physicians are not over paid. A family practice doc will likely not earn much more than $200k. A specialist like cardiology will probably earn in the $600k range. Lets lower the salaries of these already scarce and fed up people, and then see what happens, all while not expecting other job fields (like govt science PhD ppl), keeping the economy exactly the same while expecting health care workers to adjust to lower standards of living, then act surprised your local hospital is under staffed and you're complaining about the lack of care. It's not clinicians who are raking in the big bucks, its administrators, many of whom do not have clinical backgrounds.

I have a PhD and I would support legislation to make it a lot easier for people with PhDs in the exact same field as me to immigrate to the USA. We used to be able to skim off the best and brightest from the whole world, now we're trying to actively discourage that same process. *shrug*

Also, I believe the suggestion was to increase the supply of trained nurses and MDs through immigration* which would naturally cause costs to come down by ameliorating shortages that currently require different hospitals to bid against each other just to fill their critical positions. It's hard to see how increasing the number of trained nurses and MDs available in the country would lead to a worse shortage of those positions.

*Although to really do this effectively, this strategy would probably require allowing doctors from at least other first world countries to practice medicine without going through a whole second residency. This both is a big discouragement to immigration since you have to both lose social status and income for a number of years if you want to come to the USA and also means that bringing in more doctors from overseas really doesn't do anything to increase the supply, since the number of residency slots available each year is an even stronger bottleneck on the total number of new MDs produced each year than the number of medical school slots (both are capped and neither has kept up with population growth).

fuzzy math

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Re: What comes after the ACA?
« Reply #4609 on: July 21, 2018, 01:25:34 AM »

I have a PhD and I would support legislation to make it a lot easier for people with PhDs in the exact same field as me to immigrate to the USA. We used to be able to skim off the best and brightest from the whole world, now we're trying to actively discourage that same process. *shrug*

Also, I believe the suggestion was to increase the supply of trained nurses and MDs through immigration* which would naturally cause costs to come down by ameliorating shortages that currently require different hospitals to bid against each other just to fill their critical positions. It's hard to see how increasing the number of trained nurses and MDs available in the country would lead to a worse shortage of those positions.

*Although to really do this effectively, this strategy would probably require allowing doctors from at least other first world countries to practice medicine without going through a whole second residency. This both is a big discouragement to immigration since you have to both lose social status and income for a number of years if you want to come to the USA and also means that bringing in more doctors from overseas really doesn't do anything to increase the supply, since the number of residency slots available each year is an even stronger bottleneck on the total number of new MDs produced each year than the number of medical school slots (both are capped and neither has kept up with population growth).

I'm saying that immigration alone hasn't fixed the problem, and hoping to bring down wages by bringing in foreign labor (sol's statement) isn't going to do anything to address the labor shortage problem. The US still accepts foreign Dr's and RNs and we still have a major issue. Simply taking a person from another country (Many of whom have attended school for nearly free since other places value healthcare and education as a common good) does nothing but leave a shortage in that country.

States are slowly trying to deal with the residency issue, but I agree it's too little too late. I am just appalled that in the medical field people think a labor shortage should constitute lower instead of higher wages.


maizeman

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Re: What comes after the ACA?
« Reply #4610 on: July 21, 2018, 08:07:08 AM »
States are slowly trying to deal with the residency issue, but I agree it's too little too late. I am just appalled that in the medical field people think a labor shortage should constitute lower instead of higher wages.

Well it boils down to whether you think we have a labor shortage because wages aren't high enough to motivate people to go into the field, or we have a labor shortage because we've imposed caps that prevent us from having enough properly credentialed people to meet our own country's needs.

-If the problem is that going into medicine just isn't appealing to people given current earning potential, the solution is to raise pay.

-If the problem is that plenty of people would LIKE the jobs, they just cannot get the training and credentials that would allow them to accept them, the solution is to increase supply.

Since most med schools seem to have far more qualified applicants than they are able to accept each year, I'm inclined the think that, at least at the MD level, our problem is limited production of physicians (which could be addressed in the short term with immigration and the longer term by increasing domestic production of physicians) rather than the jobs being underpaid to the point not enough people want to do them.

When it comes to nurses, I don't know if there are similar constraints on annual production, so it may very well be that we're not paying nurses in certain positions enough money to make those jobs attractive to enough people.

Exflyboy

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Re: What comes after the ACA?
« Reply #4611 on: July 21, 2018, 08:41:18 AM »
Around here there are roughly twice as many qualified applicants for every nursing school place.

I know two very good applicants who didn't a place two years in a row.. They are now applying for the third time.

Brutally competitive!

DreamFIRE

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Re: What comes after the ACA?
« Reply #4612 on: July 21, 2018, 08:55:51 AM »

I've been hearing about nursing school graduates who can't even find jobs in nursing.  There was TV news story about it a year or so ago.  Here's some info I found online about the nursing shortage myth:

https://www.linkedin.com/pulse/myth-nursing-shortage-kathleen-maynard

https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/nursingprojections.pdf

https://nurse.org/articles/what-happened-to-the-nursing-shortage/

Classical_Liberal

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Re: What comes after the ACA?
« Reply #4613 on: July 21, 2018, 09:52:39 AM »

I've been hearing about nursing school graduates who can't even find jobs in nursing.  There was TV news story about it a year or so ago.  Here's some info I found online about the nursing shortage myth:

https://www.linkedin.com/pulse/myth-nursing-shortage-kathleen-maynard

https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/nursingprojections.pdf

https://nurse.org/articles/what-happened-to-the-nursing-shortage/

Nursing is very geographically dependent.  Higher paying union states can be tough for new grads.  New Grad nurses are not very well prepared for the "real world" of nursing.  Hence often require a year of on-the job-experience to be highly valued in the most competitive markets.  Also of note, though potentially irrelevant to your point, associate RN degrees are still available in most states.  In the competitive markets these new grad nurses are at a HUGE disadvantage to their B.S. counterparts.

In my neck of the wood in "fly-over" country, there are a metric s**t-ton of west coast new grad nurses who relocated.  They generally stay for 1-2 years experience before heading back home to higher wages and union/ state mandated patient ratios.

Around here there are roughly twice as many qualified applicants for every nursing school place.

I know two very good applicants who didn't a place two years in a row.. They are now applying for the third time.

Brutally competitive!

In addition, there is about a 40% attrition rate in first year acute care nurses.  The fast pace, stress level, crappy hours, etc of hospital nursing takes it's toll. Many remain nurses, but in LTC, clinic, or in some form of compliance or admin.  Good health care systems spend huge dollars training the new grads to try to avoid burnout.  The less good ones just deal with lots of turnover and tend to be heavily reliant on locum/travelers.
« Last Edit: July 21, 2018, 10:03:47 AM by Classical_Liberal »

pecunia

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Re: What comes after the ACA?
« Reply #4614 on: July 21, 2018, 12:54:27 PM »
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Most physicians are not over paid. A family practice doc will likely not earn much more than $200k. A specialist like cardiology will probably earn in the $600k range.

These guys are still human beings, right?  To me that is a LOT of money.  There are a lot of worthy human beings who can be trained and are not trained.  Is the difference between these highly paid people and many of the rest of us so great?  These posts talk of bringing in trained physicians from other countries.  Well - maybe if the system wasn't so artificially restricted, more of the great unwashed human beings of the 99 percent could also be given the opportunity to medically treat their fellow human beings.

Opinions, may, of course differ. 

former player

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Re: What comes after the ACA?
« Reply #4615 on: July 21, 2018, 01:16:33 PM »
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To fix that I propose that a system that is roughly 80% government, 20% private/individual will be best. I have no idea of details needed to implement that, but that's where I would like to go.

My gut feel is that this would be good.  If the system was all government, the spirit of medical innovation would be gone as the profit incentive would be gone. If the system were all or mostly private, price gouging would occur.  (Doesn't this happen now?)  Service may be secondary to getting the bucks.  (Unless, we somehow develop competitive medicine.)


Bolded not actually true, as the long history of medical innovations in the NHS demonstrates.  Clever and dedicated health professionals have motivations other than the profit motive: they work towards improving patient care.

pecunia

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Re: What comes after the ACA?
« Reply #4616 on: July 21, 2018, 01:55:26 PM »
former player:

Quote
Bolded not actually true, as the long history of medical innovations in the NHS demonstrates.

News to me and most likely true.  I did not bold it. 

I have heard that most of the medical innovations that occur in the US take place by government sponsored research at universities and not at the huge medical companies.  It has been an assumption of mine that the profit motive was the primary motivator for innovation.  However, I do understand that there are people who innovate for innovation's own sake and for altruism.  Does the profit motive produce most of the medical innovations or is it people motivated by other incentives?  If anyone has the answer, I am sure it will be interesting.

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Re: What comes after the ACA?
« Reply #4617 on: July 21, 2018, 03:04:06 PM »
Does the profit motive produce most of the medical innovations or is it people motivated by other incentives?
The answer is probably unknowable, but it is reasonable to assume at least some very bright people with a choice of careers are influenced by a profit motive.  Thus the less opportunity in a given field for profit, the fewer very bright people that field will attract.

sol

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Re: What comes after the ACA?
« Reply #4618 on: July 21, 2018, 07:39:53 PM »
Sol,  A lot of the issues you mention are a direct result of government intervention.  The lack of transparency and competition is because health care providers are not allowed to advertise prices.  Insurance companies can compete only in limited geographies.  Government regulations prohibit selling health care insurance plans across state lines.

In the US most products and services other than healthcare compete heavily on price.  Why not healthcare?  Government regulation.........

Sorry, but I strongly disagree in this case.  Government intervention is NOT the problem with healthcare.

Where did the government say that hospitals can't advertise prices?  They choose not to advertise because they don't want competition, they want max reimbursement from insurance companies.

Insurance companies can compete in any state they want to, if they follow that state's insurance regulations.  Insurance companies are self-limiting when it comes to expansion.  The good ones expand.  The cheap ones have decided it's more profitable to only play in the most gougiest of markets.

And as for selling insurance across state lines, which has been a staple soundbyte of the GOP repeal and replace effort, Obamacare already made that explicitly legal!  That's right, section 1333 of the ACA was written for the express purpose of encouraging insurance companies to sell across state lines, and five states have already taken advantage.  Why not more than five?  Because Republicans in Congress defunded section 1333 in order to prevent insurance companies from selling across state lines  The hypocrisy here is truly astounding.

So don't come to me and claim the federalis are the problem here.  Healthcare isn't competitive because a man who's having a stroke can't ask for quotes before he gets treated, because he's definitionally unfit to make those decisions at the moment when the decision needs to get made.  Not because the government dictates which hospital is going to treat him or what care he's going to get, but because he's a totally captive consumer.  Prices aren't transparent because hospitals deliberately obfuscate them with a chargemaster that they have lobbied Congress to keep private, and then they deviate from the chargemaster for each insurer, as part of their basic business model.  Care is uncoupled from supply and demand because facilities get to charge guaranteed rates by the procedure, rather than by the outcome, so of course it's more profitable to do every test every time (and because doctors are afraid of getting sued).

The UK health system has it's problems, but one of it's great breakthroughs was paying doctors for outcomes.  They get government bonuses for things like convincing people to stop smoking, or successfully treating injuries with the minimum number of diagnostics.  They've figured out how to align the doctor's financial incentives with the patient's welfare, and overall costs plummeted as patient outcome improved.  That solution pretty much requires a single payer system, though, in order to have every doc eligible for the same incentives.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4619 on: July 21, 2018, 08:49:49 PM »
Healthcare isn't competitive because a man who's having a stroke can't ask for quotes before he gets treated, because he's definitionally unfit to make those decisions at the moment when the decision needs to get made.

It's a shame, too.  If he was up for making the choice along with some cost transparency, he might be able to save his insurance company $50 by being taken to a more distant hospital.  I'm sure that's what he would want.

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Re: What comes after the ACA?
« Reply #4620 on: July 22, 2018, 03:49:27 AM »
There is a small hospital in my town that is affiliated with a bigger hospital about 20 miles away. Almost anytime there is an accident in my town, big or small, they haul the people to the hospital 20 miles away. Even when the accident is only a mile from the hospital! I have read in the newspaper sometimes after the person was examined at the bigger hospital they were released right away. We have a brand new emergency room, they do chemo and radiation at this small hospital and have the ability to admit patients if they need to stay. So why on earth do they ship these people 20 miles away when they aren't even severely injured? I could understand it if the injuries were life and death.

pecunia

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Re: What comes after the ACA?
« Reply #4621 on: July 22, 2018, 05:52:25 AM »
Quote
So why on earth do they ship these people 20 miles away when they aren't even severely injured? I could understand it if the injuries were life and death.

Do you think, maybe, it could have something to do with making some additional revenue with the added miles?

maizeman

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Re: What comes after the ACA?
« Reply #4622 on: July 22, 2018, 07:43:53 AM »
If your local hospital has a small emergency room/limited staff maybe they are intentionally sending the people with less life threatening injuries to the bigger farther away hospital (the kind of injuries where sometimes they examine you and then send you home) with lots of spare capacity so that the smaller hospital is still available in case there are people with injuries who won't survive a 20 minute drive?

Or maybe your local hospital has a bed reputation (I lived for a while in a town where the local hospital had a terrible cath lab, and usually ambulances would try to take people having heart attacks to a more distant hospital in the next city over).

Or maybe it is insurance payment shenanigans like you suggest. *shrug*

coppertop

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Re: What comes after the ACA?
« Reply #4623 on: July 22, 2018, 08:32:59 AM »
My friend is an LPN who worked at the same hospital for more than 35 years.  They cut her loose, together with the other four remaining LPN's at the hospital, stating they only want RN's to work there now.  She has told me that the young, new RN hirees would turn to her for guidance and training, so it's not that she was incompetent or undertrained for her job.  It was a huge blow for her, because she loves patient care.  She now works at a nursing home, but is not very happy with the job, because it is much different from the hospital patient care at which she excelled.  I have had occasion to see her in action with patients, and she is a fabulous nurse.  But no RN or bachelor's degree, so she is toast in the eyes of hospital administration.  If there is a shortage of nurses, wouldn't you think they would want to keep these highly experienced LPN's in their employ? 

Roadrunner53

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Re: What comes after the ACA?
« Reply #4624 on: July 22, 2018, 08:36:41 AM »
The two hospitals are 'partners' along with some other local hospitals. The big hospital is the kingpin so maybe they need to show that they are treating X amount of patients. Most likely it is something to do with money and not the patients need to go there.

maizeman

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Re: What comes after the ACA?
« Reply #4625 on: July 22, 2018, 08:45:04 AM »
My friend is an LPN who worked at the same hospital for more than 35 years.  They cut her loose, together with the other four remaining LPN's at the hospital, stating they only want RN's to work there now.  She has told me that the young, new RN hirees would turn to her for guidance and training, so it's not that she was incompetent or undertrained for her job.  It was a huge blow for her, because she loves patient care.  She now works at a nursing home, but is not very happy with the job, because it is much different from the hospital patient care at which she excelled.  I have had occasion to see her in action with patients, and she is a fabulous nurse.  But no RN or bachelor's degree, so she is toast in the eyes of hospital administration.  If there is a shortage of nurses, wouldn't you think they would want to keep these highly experienced LPN's in their employ?

This is a big problem in medicine and I don't really understand why it is happening. Basically at every level there is a move towards requiring credentials that take more and more years to learn, without (as far as I know) any strong evidence that this increases quality of patient care or improves outcomes.

Nurse practitioners are seeing the same thing: right now you can be one with an bachelors + a masters degree in nursing (call it 6 total years of education) but they are trying to change it to require an bachelors + a doctoral degree in nursing (call it at least 8 total years of education).

I'm sorry for your friend, she sounds like exactly the sort of person I'd hope to run into if I'm ever admitted to a hospital.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4626 on: July 22, 2018, 08:59:18 AM »
There is a small hospital in my town that is affiliated with a bigger hospital about 20 miles away. Almost anytime there is an accident in my town, big or small, they haul the people to the hospital 20 miles away. Even when the accident is only a mile from the hospital! I have read in the newspaper sometimes after the person was examined at the bigger hospital they were released right away. We have a brand new emergency room, they do chemo and radiation at this small hospital and have the ability to admit patients if they need to stay. So why on earth do they ship these people 20 miles away when they aren't even severely injured? I could understand it if the injuries were life and death.

Trauma Center level perhaps?  Playing it safe in case injuries are more serious than may at first appear.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4627 on: July 22, 2018, 10:07:28 AM »

The UK health system has it's problems, but one of it's great breakthroughs was paying doctors for outcomes.  They get government bonuses for things like convincing people to stop smoking, or successfully treating injuries with the minimum number of diagnostics.  They've figured out how to align the doctor's financial incentives with the patient's welfare, and overall costs plummeted as patient outcome improved.  That solution pretty much requires a single payer system, though, in order to have every doc eligible for the same incentives.

Just an FYI Sol,
With the implementation for MACRA which is the new reimbursement plan for CMS physicians and hospitals are paid for outcomes. 

EnjoyIt

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Re: What comes after the ACA?
« Reply #4628 on: July 22, 2018, 10:11:39 AM »
My friend is an LPN who worked at the same hospital for more than 35 years.  They cut her loose, together with the other four remaining LPN's at the hospital, stating they only want RN's to work there now.  She has told me that the young, new RN hirees would turn to her for guidance and training, so it's not that she was incompetent or undertrained for her job.  It was a huge blow for her, because she loves patient care.  She now works at a nursing home, but is not very happy with the job, because it is much different from the hospital patient care at which she excelled.  I have had occasion to see her in action with patients, and she is a fabulous nurse.  But no RN or bachelor's degree, so she is toast in the eyes of hospital administration.  If there is a shortage of nurses, wouldn't you think they would want to keep these highly experienced LPN's in their employ?

It is crazy, but every industry is demanding higher and higher certification.  LVN/LPN have a role to play but hospitals are not hiring them anymore just because they have a 2 year degree.  Not to mention RNs demand a higher wage as compared to LVNs but the hospital boards think that LVNs are inferior and don't want to hire them because of the degree.

BTW, if your friends wanted to he/she can get their education online and get their RN.  Your friend will be back where they were before and get paid more in the process.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4629 on: July 22, 2018, 10:13:04 AM »
There is a small hospital in my town that is affiliated with a bigger hospital about 20 miles away. Almost anytime there is an accident in my town, big or small, they haul the people to the hospital 20 miles away. Even when the accident is only a mile from the hospital! I have read in the newspaper sometimes after the person was examined at the bigger hospital they were released right away. We have a brand new emergency room, they do chemo and radiation at this small hospital and have the ability to admit patients if they need to stay. So why on earth do they ship these people 20 miles away when they aren't even severely injured? I could understand it if the injuries were life and death.

Trauma Center level perhaps?  Playing it safe in case injuries are more serious than may at first appear.

Bingo.  it has to do with trauma designation and the capabilities of the two hospitals.  Believe me, you are far better off going to a designated trauma center if there are any potential injuries.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4630 on: July 22, 2018, 10:37:45 AM »
Maybe that is it.

seattlecyclone

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Re: What comes after the ACA?
« Reply #4631 on: July 22, 2018, 10:48:53 AM »
Healthcare isn't competitive because a man who's having a stroke can't ask for quotes before he gets treated, because he's definitionally unfit to make those decisions at the moment when the decision needs to get made.

You're right that people seeking emergency care don't have the chance to shop around, but I can't agree that this is the main reason price competition isn't really a thing in the US health care market. The vast majority of interactions between patients and caregivers aren't an emergency; shopping around certainly could happen if prices were transparent and patients had some incentive to care about the cost.

For example, I'm looking back at my son's history right now. He had a well-child visit with a couple of vaccinations earlier this year. We were at the clinic for about half an hour. We were with the nurse for a few minutes for some measurements, waited a few minutes, talked with the doctor for a few minutes, and then the nurse came back for a minute to do the vaccines. The insurance company paid $238. Seems like a lot to me!

I had no idea what it would cost in advance, nor did I have any reason to care because it was a preventive service and therefore fully paid by the insurance company. I chose the provider based on convenience to my house and good reviews. If prices were transparent and I was on the hook for even a fraction of the costs, I would gladly spend a few minutes looking around at different providers to see if any would offer substantial cost savings. However the whole system is set up to discourage this. Costs are largely paid by an intermediary, and prices are a mystery until after the fact.

If we want to have free-market health care, we need to have transparent prices and we also need to have patients paying a portion of the cost so that they have a reason to care what the cost is. Without those things, the market is broken. No competition can occur in these conditions.

I'd be happy enough to switch to a system where reasonable prices are dictated from above, like other countries have. But if we want to stick with this notion of a free market, we need to actually implement one.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4632 on: July 22, 2018, 10:59:42 AM »
My dog recently had surgery. It was a BIG, EXPENSIVE procedure. However, the surgeon gave us an estimate of costs. She gave us a high estimate and a low estimate. The day of surgery we had to pay 1/2 of the high estimate and when we picked the dog up the next day, we had to pay the balance. The balance ended up being lower than the low estimate. I thought it was really professional and there were no hidden costs. Of coarse, if something went dreadfully wrong I am sure the cost would have gone up. They had everything listed and the cost of each item. They even sent the dog home with 3 prescriptions that were included in the cost. The follow up visit two weeks later was included too.

So why is human medicine so secretive?

LAGuy

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Re: What comes after the ACA?
« Reply #4633 on: July 22, 2018, 11:05:02 AM »
My friend is an LPN who worked at the same hospital for more than 35 years.  They cut her loose, together with the other four remaining LPN's at the hospital, stating they only want RN's to work there now.  She has told me that the young, new RN hirees would turn to her for guidance and training, so it's not that she was incompetent or undertrained for her job.  It was a huge blow for her, because she loves patient care.  She now works at a nursing home, but is not very happy with the job, because it is much different from the hospital patient care at which she excelled.  I have had occasion to see her in action with patients, and she is a fabulous nurse.  But no RN or bachelor's degree, so she is toast in the eyes of hospital administration.  If there is a shortage of nurses, wouldn't you think they would want to keep these highly experienced LPN's in their employ?

This is a big problem in medicine and I don't really understand why it is happening. Basically at every level there is a move towards requiring credentials that take more and more years to learn, without (as far as I know) any strong evidence that this increases quality of patient care or improves outcomes.

Nurse practitioners are seeing the same thing: right now you can be one with an bachelors + a masters degree in nursing (call it 6 total years of education) but they are trying to change it to require an bachelors + a doctoral degree in nursing (call it at least 8 total years of education).

I'm sorry for your friend, she sounds like exactly the sort of person I'd hope to run into if I'm ever admitted to a hospital.

I work in the hospital laboratory. I have to call all over the hospital to inform nurses of various issues regarding their patients lab results, specimen quality, etc. By and large, the people I deal with are competent. However, when I do get an idiot, invariably that idiot is an LVN. Even when they're not idiots, if I have a complicated issue to discuss with them, I have to basically explain it to an LVN like I'm explaining it to a child. They just do not understand the science behind what they do, and no amount of experience can fix that. An RN, however has a complete grasp of the science behind medicine and are head and shoulders better than an LVN when dealing with complicated issues. And today, medicine in a hospital setting is a very complicated industry. Only the sickest are hospitalized and only for the minimum amount of time that it takes to stabilize them and move them to hospice care or discharge them. Trust me, if you're hospitalized, you do not want an LVN doing anything more than wiping your ass.

But don't take my word for it. Look at your own industries and you tell me that there's no difference in education and comprehension of complicated technical issues when comparing somebody with a 2 year vocational degree from the local junior college vs a full 4 year bachelor of science degree with their required industry certifications.

EnjoyIt

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Re: What comes after the ACA?
« Reply #4634 on: July 22, 2018, 11:08:48 AM »
Healthcare isn't competitive because a man who's having a stroke can't ask for quotes before he gets treated, because he's definitionally unfit to make those decisions at the moment when the decision needs to get made.

You're right that people seeking emergency care don't have the chance to shop around, but I can't agree that this is the main reason price competition isn't really a thing in the US health care market. The vast majority of interactions between patients and caregivers aren't an emergency; shopping around certainly could happen if prices were transparent and patients had some incentive to care about the cost.

For example, I'm looking back at my son's history right now. He had a well-child visit with a couple of vaccinations earlier this year. We were at the clinic for about half an hour. We were with the nurse for a few minutes for some measurements, waited a few minutes, talked with the doctor for a few minutes, and then the nurse came back for a minute to do the vaccines. The insurance company paid $238. Seems like a lot to me!

I had no idea what it would cost in advance, nor did I have any reason to care because it was a preventive service and therefore fully paid by the insurance company. I chose the provider based on convenience to my house and good reviews. If prices were transparent and I was on the hook for even a fraction of the costs, I would gladly spend a few minutes looking around at different providers to see if any would offer substantial cost savings. However the whole system is set up to discourage this. Costs are largely paid by an intermediary, and prices are a mystery until after the fact.

If we want to have free-market health care, we need to have transparent prices and we also need to have patients paying a portion of the cost so that they have a reason to care what the cost is. Without those things, the market is broken. No competition can occur in these conditions.

I'd be happy enough to switch to a system where reasonable prices are dictated from above, like other countries have. But if we want to stick with this notion of a free market, we need to actually implement one.

Depending on the study you look at 2%-10% of healthcare is done on an Emergency basis.  Personally I think it is closer to 2% because the study that quote 10% include emergency care that should have been performed at a physicians office and not the ER.  Either way, the vast majority of health care are not emergencies and a person can take 1 hour of their time to price shop if there was transparency.

I think that needs to be the number one item to help curb the cost of healthcare.  100% transparency on everything.  It should be law and a good step in decreasing cost. 

pecunia

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Re: What comes after the ACA?
« Reply #4635 on: July 22, 2018, 11:30:13 AM »
Roadrunner53:
Quote
My dog recently had surgery. It was a BIG, EXPENSIVE procedure. However, the surgeon gave us an estimate of costs.

Next time I ask for a price at a medical establishment, I can honestly say, "You wouldn't treat a dog like that."

DreamFIRE

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Re: What comes after the ACA?
« Reply #4636 on: July 22, 2018, 12:25:14 PM »
But don't take my word for it. Look at your own industries and you tell me that there's no difference in education and comprehension of complicated technical issues when comparing somebody with a 2 year vocational degree from the local junior college vs a full 4 year bachelor of science degree with their required industry certifications.

I've worked in the IT field and have worked with many others in the field and am also involved in the interviewing and hiring selection process of IT co-workers.  What I've found is that experience outweighs education fairly quickly.  My past and present co-workers with 4 year degrees don't understand or perform their technical duties any better than those with no degree (some have had college classes and/or technical school training and certifications but no 4 year degree).  We actually had two IT workers without degrees take classes to earn their bachelors (one of them even continued to earn a masters), but this changed nothing.  One of them was a poor worker and continued to be after getting his bachelors.  The other employee was decent, and continued to be with his masters.  I put a much higher premium on experience than formal education, but education is certainly better than nothing if you can't find anyone with applicable experience.  I realize this would be different in some other fields of work.
« Last Edit: July 22, 2018, 12:26:58 PM by DreamFIRE »

maizeman

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Re: What comes after the ACA?
« Reply #4637 on: July 22, 2018, 02:20:55 PM »
But don't take my word for it. Look at your own industries and you tell me that there's no difference in education and comprehension of complicated technical issues when comparing somebody with a 2 year vocational degree from the local junior college vs a full 4 year bachelor of science degree with their required industry certifications.

I don't disagree that you learn and understand more with more education. My point above is that we currently have people with X amount of education, and they are able to do their jobs. I'm not convinced that adding more years necessarily means they'll be able to do the same jobs better (even if it means they are now qualified for more technical positions in addition to their current positions).

In my group we have people with everything from one year of college on up through PhDs working on different tasks and projects. There are jobs I wouldn't give to a technician because they wouldn't have the training or skillset to do a good job (or even to know where to start).

But at the same time, for jobs that a technician CAN do, I don't think that they generally do those jobs any worse or more slowly than if I ask someone with a PhD to do the same work. If I fired all of my undergrads, grad students, and techs and replaced them all with postdocs, I'd be spending a lot more on payroll each month, but I don't think our total productivity or the quality of our work would go up much at all, and it might well go down.

Classical_Liberal

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Re: What comes after the ACA?
« Reply #4638 on: July 22, 2018, 04:09:13 PM »
But don't take my word for it. Look at your own industries and you tell me that there's no difference in education and comprehension of complicated technical issues when comparing somebody with a 2 year vocational degree from the local junior college vs a full 4 year bachelor of science degree with their required industry certifications.

I don't disagree that you learn and understand more with more education. My point above is that we currently have people with X amount of education, and they are able to do their jobs. I'm not convinced that adding more years necessarily means they'll be able to do the same jobs better (even if it means they are now qualified for more technical positions in addition to their current positions).

In my group we have people with everything from one year of college on up through PhDs working on different tasks and projects. There are jobs I wouldn't give to a technician because they wouldn't have the training or skillset to do a good job (or even to know where to start).

But at the same time, for jobs that a technician CAN do, I don't think that they generally do those jobs any worse or more slowly than if I ask someone with a PhD to do the same work. If I fired all of my undergrads, grad students, and techs and replaced them all with postdocs, I'd be spending a lot more on payroll each month, but I don't think our total productivity or the quality of our work would go up much at all, and it might well go down.

There are certainly anecdotes.  Some LPN/LVN are a fantastic nurses and some RN's are less than stellar.  However, there has been research regarding outcomes, particularly in the acute care setting. More RN's= better outcomes period.  I can link more studies if anyone is interested, but they may have paywalls.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444311/

Gin1984

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Re: What comes after the ACA?
« Reply #4639 on: July 22, 2018, 04:16:49 PM »
But don't take my word for it. Look at your own industries and you tell me that there's no difference in education and comprehension of complicated technical issues when comparing somebody with a 2 year vocational degree from the local junior college vs a full 4 year bachelor of science degree with their required industry certifications.

I don't disagree that you learn and understand more with more education. My point above is that we currently have people with X amount of education, and they are able to do their jobs. I'm not convinced that adding more years necessarily means they'll be able to do the same jobs better (even if it means they are now qualified for more technical positions in addition to their current positions).

In my group we have people with everything from one year of college on up through PhDs working on different tasks and projects. There are jobs I wouldn't give to a technician because they wouldn't have the training or skillset to do a good job (or even to know where to start).

But at the same time, for jobs that a technician CAN do, I don't think that they generally do those jobs any worse or more slowly than if I ask someone with a PhD to do the same work. If I fired all of my undergrads, grad students, and techs and replaced them all with postdocs, I'd be spending a lot more on payroll each month, but I don't think our total productivity or the quality of our work would go up much at all, and it might well go down.

There are certainly anecdotes.  Some LPN/LVN are a fantastic nurses and some RN's are less than stellar.  However, there has been research regarding outcomes, particularly in the acute care setting. More RN's= better outcomes period.  I can link more studies if anyone is interested, but they may have paywalls.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444311/
That was a disturbing article.

maizeman

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Re: What comes after the ACA?
« Reply #4640 on: July 22, 2018, 05:07:15 PM »
I stand corrected, I guess there is evidence of better patient outcomes. Thanks @Classical_Liberal

Gin1984

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Re: What comes after the ACA?
« Reply #4641 on: July 22, 2018, 07:01:10 PM »
I stand corrected, I guess there is evidence of better patient outcomes. Thanks @Classical_Liberal
And this is what brings me back to this site, over and over.  We take new information and learn from it, instead of getting mad and hunkering down.

Jrr85

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Re: What comes after the ACA?
« Reply #4642 on: July 23, 2018, 08:21:46 AM »

I have a PhD and I would support legislation to make it a lot easier for people with PhDs in the exact same field as me to immigrate to the USA. We used to be able to skim off the best and brightest from the whole world, now we're trying to actively discourage that same process. *shrug*

Also, I believe the suggestion was to increase the supply of trained nurses and MDs through immigration* which would naturally cause costs to come down by ameliorating shortages that currently require different hospitals to bid against each other just to fill their critical positions. It's hard to see how increasing the number of trained nurses and MDs available in the country would lead to a worse shortage of those positions.

*Although to really do this effectively, this strategy would probably require allowing doctors from at least other first world countries to practice medicine without going through a whole second residency. This both is a big discouragement to immigration since you have to both lose social status and income for a number of years if you want to come to the USA and also means that bringing in more doctors from overseas really doesn't do anything to increase the supply, since the number of residency slots available each year is an even stronger bottleneck on the total number of new MDs produced each year than the number of medical school slots (both are capped and neither has kept up with population growth).

I'm saying that immigration alone hasn't fixed the problem, and hoping to bring down wages by bringing in foreign labor (sol's statement) isn't going to do anything to address the labor shortage problem. The US still accepts foreign Dr's and RNs and we still have a major issue. Simply taking a person from another country (Many of whom have attended school for nearly free since other places value healthcare and education as a common good) does nothing but leave a shortage in that country.

States are slowly trying to deal with the residency issue, but I agree it's too little too late. I am just appalled that in the medical field people think a labor shortage should constitute lower instead of higher wages.

Pretty sure this is wrong, unless by "accept" you mean we allow them to come here and take the USMLE, then go through residency, and then take the last phase of the USMLE. 

swampwiz

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Re: What comes after the ACA?
« Reply #4643 on: July 23, 2018, 08:47:00 AM »

This is such an easy fix, though!  Just allow doctors to immigrate!  There are tens of thousands of doctors and nurses in other countries who would kill for the chance to come to America and make half of what their US counterparts make.  Just let them.  Even if they have brown skin.

Wages would come down in the medical field.  I'm okay with that.  Every hospital around me is constantly under construction because they are such cash cows these days.


This is already happening / has happened. There are huge amounts of foreign nurses (Filipinos being the largest segment I can think of) who have immigrated here to care for us. Guess what there is still a shortage of nurses.
On the physician side its happening too. If you visit any academic medical center you will find that "white Muricans" make up a minority of graduating physicians. There is still a shortage. There is a huge shortage of older physicians to train these people because a lot of old timey Drs are sick of the shit that is going on in healthcare and leaving to another field of work or retiring early. Who is going to train all these physicians? In general the quality / experience level of a modern graduating physician is already much lower than a generation or two ago before residency hours were restricted. There are many specialty residency and fellowships going UNFILLED because there are not enough qualified applicants. Trust me when I say I've seen the effects of a bad physician treating a patient, its deadly. Now add in an individual language barrier, and multiple language barriers of many ESL residents of different backgrounds learning from each other and you've got a shit storm brewing.

Nurses are not overpaid, with most making under 6 figures. Most physicians are not over paid. A family practice doc will likely not earn much more than $200k. A specialist like cardiology will probably earn in the $600k range. Lets lower the salaries of these already scarce and fed up people, and then see what happens, all while not expecting other job fields (like govt science PhD ppl) to follow suit, keeping the economy exactly the same while expecting health care workers to adjust to lower standards of living, then acting surprised your local hospital is under staffed and you're complaining about the lack of care. It's not clinicians who are raking in the big bucks, its administrators, many of whom do not have clinical backgrounds.

If you're seeing a ton of hospitals remodeling and expanding, its likely that its because there are tons of baby boomers requiring care. It's not that health care workers are so overpaid and hospitals are making money hand over fist to the extent that they have nothing better to do that install gold toilets in each department's bathroom.

There certainly is more than enough interest from qualified folks wanting to go to medical school, so it would seem that the solution is to expand medical school places.  Oh, but the AMA would not like that, which explains why there is cartel pricing.

swampwiz

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Re: What comes after the ACA?
« Reply #4644 on: July 23, 2018, 08:54:57 AM »
My dog recently had surgery. It was a BIG, EXPENSIVE procedure. However, the surgeon gave us an estimate of costs. She gave us a high estimate and a low estimate. The day of surgery we had to pay 1/2 of the high estimate and when we picked the dog up the next day, we had to pay the balance. The balance ended up being lower than the low estimate. I thought it was really professional and there were no hidden costs. Of coarse, if something went dreadfully wrong I am sure the cost would have gone up. They had everything listed and the cost of each item. They even sent the dog home with 3 prescriptions that were included in the cost. The follow up visit two weeks later was included too.

So why is human medicine so secretive?

Because a dog can die; a human can't (i.e., EMTALA law).

pecunia

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Re: What comes after the ACA?
« Reply #4645 on: July 23, 2018, 09:44:06 AM »
swampwiz:

EMTALA?

[urlhttp://newsroom.acep.org/2009-01-04-emtala-fact-sheet[/url]

EMTALA is a federal law that requires hospital emergency departments to medically screen every patient who seeks emergency care and to stabilize or transfer those with medical emergencies, regardless of health insurance status or ability to pay this law has been an unfunded mandate since it was enacted in 1986.

It is not apparent why this law would preclude giving a patient (customer) the price of a basic blood test.  I realize they can test for many things, but these things with their associated prices could be listed.

I have another idea why they don't list the prices.  They don't have to.


Jrr85

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Re: What comes after the ACA?
« Reply #4646 on: July 23, 2018, 04:34:50 PM »

This is such an easy fix, though!  Just allow doctors to immigrate!  There are tens of thousands of doctors and nurses in other countries who would kill for the chance to come to America and make half of what their US counterparts make.  Just let them.  Even if they have brown skin.

Wages would come down in the medical field.  I'm okay with that.  Every hospital around me is constantly under construction because they are such cash cows these days.


This is already happening / has happened. There are huge amounts of foreign nurses (Filipinos being the largest segment I can think of) who have immigrated here to care for us. Guess what there is still a shortage of nurses.
On the physician side its happening too. If you visit any academic medical center you will find that "white Muricans" make up a minority of graduating physicians. There is still a shortage. There is a huge shortage of older physicians to train these people because a lot of old timey Drs are sick of the shit that is going on in healthcare and leaving to another field of work or retiring early. Who is going to train all these physicians? In general the quality / experience level of a modern graduating physician is already much lower than a generation or two ago before residency hours were restricted. There are many specialty residency and fellowships going UNFILLED because there are not enough qualified applicants. Trust me when I say I've seen the effects of a bad physician treating a patient, its deadly. Now add in an individual language barrier, and multiple language barriers of many ESL residents of different backgrounds learning from each other and you've got a shit storm brewing.

Nurses are not overpaid, with most making under 6 figures. Most physicians are not over paid. A family practice doc will likely not earn much more than $200k. A specialist like cardiology will probably earn in the $600k range. Lets lower the salaries of these already scarce and fed up people, and then see what happens, all while not expecting other job fields (like govt science PhD ppl) to follow suit, keeping the economy exactly the same while expecting health care workers to adjust to lower standards of living, then acting surprised your local hospital is under staffed and you're complaining about the lack of care. It's not clinicians who are raking in the big bucks, its administrators, many of whom do not have clinical backgrounds.

If you're seeing a ton of hospitals remodeling and expanding, its likely that its because there are tons of baby boomers requiring care. It's not that health care workers are so overpaid and hospitals are making money hand over fist to the extent that they have nothing better to do that install gold toilets in each department's bathroom.

There certainly is more than enough interest from qualified folks wanting to go to medical school, so it would seem that the solution is to expand medical school places.  Oh, but the AMA would not like that, which explains why there is cartel pricing.

There is no reason to expand medical schools as long as residencies aren't expanded. 

EnjoyIt

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Re: What comes after the ACA?
« Reply #4647 on: July 23, 2018, 05:41:52 PM »

This is such an easy fix, though!  Just allow doctors to immigrate!  There are tens of thousands of doctors and nurses in other countries who would kill for the chance to come to America and make half of what their US counterparts make.  Just let them.  Even if they have brown skin.

Wages would come down in the medical field.  I'm okay with that.  Every hospital around me is constantly under construction because they are such cash cows these days.


This is already happening / has happened. There are huge amounts of foreign nurses (Filipinos being the largest segment I can think of) who have immigrated here to care for us. Guess what there is still a shortage of nurses.
On the physician side its happening too. If you visit any academic medical center you will find that "white Muricans" make up a minority of graduating physicians. There is still a shortage. There is a huge shortage of older physicians to train these people because a lot of old timey Drs are sick of the shit that is going on in healthcare and leaving to another field of work or retiring early. Who is going to train all these physicians? In general the quality / experience level of a modern graduating physician is already much lower than a generation or two ago before residency hours were restricted. There are many specialty residency and fellowships going UNFILLED because there are not enough qualified applicants. Trust me when I say I've seen the effects of a bad physician treating a patient, its deadly. Now add in an individual language barrier, and multiple language barriers of many ESL residents of different backgrounds learning from each other and you've got a shit storm brewing.

Nurses are not overpaid, with most making under 6 figures. Most physicians are not over paid. A family practice doc will likely not earn much more than $200k. A specialist like cardiology will probably earn in the $600k range. Lets lower the salaries of these already scarce and fed up people, and then see what happens, all while not expecting other job fields (like govt science PhD ppl) to follow suit, keeping the economy exactly the same while expecting health care workers to adjust to lower standards of living, then acting surprised your local hospital is under staffed and you're complaining about the lack of care. It's not clinicians who are raking in the big bucks, its administrators, many of whom do not have clinical backgrounds.

If you're seeing a ton of hospitals remodeling and expanding, its likely that its because there are tons of baby boomers requiring care. It's not that health care workers are so overpaid and hospitals are making money hand over fist to the extent that they have nothing better to do that install gold toilets in each department's bathroom.

There certainly is more than enough interest from qualified folks wanting to go to medical school, so it would seem that the solution is to expand medical school places.  Oh, but the AMA would not like that, which explains why there is cartel pricing.

There is no reason to expand medical schools as long as residencies aren't expanded.

And, residencies are funded by CMS which dictates how many spots are available.  You need to be approved/funded for more spots.
Here is a CNN article that discusses it in more detail.
https://www.cnn.com/2017/03/13/health/train-more-doctors-residency/index.html

I am not a big fan of the AMA but they have little to do with this. Actually most physicians state we need more doctors and that there just isn't enough physicians in a communities to keep up with the patient demands.  Physicians are feeling overworked and welcome more help if it becomes available.  Add in all the extra documentation and red tape that is now required to administer healthcare these days and the docs are seeing less patients per hour which increases demand even more. 
« Last Edit: July 23, 2018, 05:45:58 PM by EnjoyIt »

EnjoyIt

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Re: What comes after the ACA?
« Reply #4648 on: July 23, 2018, 05:49:29 PM »
swampwiz:

EMTALA?

[urlhttp://newsroom.acep.org/2009-01-04-emtala-fact-sheet[/url]

EMTALA is a federal law that requires hospital emergency departments to medically screen every patient who seeks emergency care and to stabilize or transfer those with medical emergencies, regardless of health insurance status or ability to pay this law has been an unfunded mandate since it was enacted in 1986.

It is not apparent why this law would preclude giving a patient (customer) the price of a basic blood test.  I realize they can test for many things, but these things with their associated prices could be listed.

I have another idea why they don't list the prices. They don't have to.

And by being secretive they are able to make more money.  It is complete rubbish if you ask me.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4649 on: July 23, 2018, 06:15:20 PM »
And, residencies are funded by CMS which dictates how many spots are available.  You need to be approved/funded for more spots.

So, it costs money.  Now, we've gone full circle.