lol, of course chez and wellnamed are flocking to it like flies to a fresh pile of dogs****.

There's a big difference between the two imo.

Youre right, tuition costs for med school should be lowered significantly.

You make some good points Inso. Lower med school costs, and more people will become doctors, helping to fix the dema d problem.

Good to know that the abuses of the medical system are limited only by your imagination.

ITT Inso0 destroys his own argument about the "scattered" nature of the United States

https://www.irs.gov/pub/irs-drop/n-04-23.pdf

Some blood work is covered, other types aren't.

You make some good points Inso. Lower med school costs, and more people will become doctors, helping to fix the dema d problem.

Probably not, at least in the short term.

Paying for med school is essentially never a problem, if you don't mind getting out owing 250K or so - lenders are happy to front you the money, because they know they're going to get paid back. The default rate for docs on school loans is essentially zero.

Where our biggest problem lies is in the lack of enough residency programs pretty much across the board. Getting an MD doesn't allow you to do much on anything without completing a residency. (There are a couple of exceptions, but in the grand scheme of things they don't amount to much) For arcane reasons residency slots are paid for by Medicare and there's been essentially no increase in that funding for decades. Add in the huge cohort of docs (I'm one of them) hanging it up for various reasons in the next few years, and it's gonna get a LOT worse.

IMO, the best way out of this is to really expand the number of NP's and PA's - they can be churned out in a fraction of the time, for a fraction of the cost of an MD. A lot of stuff that I do could be done competently by either of those, as long as I'm around to help out if things get tricky. Otherwise, I should be taking care of really sick people.

MM MD

Scattered != sparse, which is what I think you believe I was saying.

However, if you further cut the financial resources for the overall healthcare system, that could certainly lead to already underfunded facilities cutting back on services or closing altogether, which would negatively affect access for the more rural areas of the country. What good is free healthcare if you have to make a day trip out of it every time you need to be seen for something beyond what a NP can handle?


Edit: hobbes is one example of countless doctors who may be willing to keep going if the price is right, but could tell us all to piss off if we just arbitrarily cut his pay by XX%. Which is not to say that we should be held hostage as a nation by people who are only in it for the money (not accusing him) but to pretend like slashing rates by fiat isn't going to have consequences is just ridiculous.

Inso0 should dial up AT&T and Time Warner to tell them their merger is really dumb, this country is just TOO BIG and TOO SCATTERED for one larger company to do things better than a bunch of smaller ones, as the American economy clearly shows us to be true

"Preventive care is not included. You get one "wellness" check a year and it doesn't include basic things like blood work. Ins0 is just straight lying about that. "

No he's not, or more properly, it depends on the plan. I have a 10k deductible, but I had a colonoscopy a couple of years ago and my bill was (I believe) 125.00, because I wanted to be put under for it. (Well worth the $$ IMHO). Diabetes screening is covered, as are some heart related things. They're not doing it out of the kindness of their hearts - my "free" colonoscopy is a LOT cheaper than having a polyp go malignant, and having to pay for 100K+ of oncology/surgical costs down the road.

MM MD

They have separate but equally stupid reasons for wanting to jump into the dog****.

If you save money in the overall system that opens up more space to give funding to rural hospitals. If that space is being taking up by insurance companies and billing departments you're giving money that could have gone to rural doctors to paper pushers and insurance salesmen.

The doctors of 2p2 can give you more insight on the types of completely unnecessary visits they get now. Multiply it by some unknown amount once you eliminate the cost barrier to entry.

This gets complicated, because how "unnecessary" a visit is greatly varies depending on who is looking at it.

I saw 19 patients in our fast track last night. A rough guess is that well over half could (or should) have been handled somewhere other than an ER. But there are all sorts of reasons that people show up that have little to do with the nature of their problem - they don't have (or increasingly can't find) a primary provider, they have one but couldn't get an appointment for three weeks, their pediatrician could have seen them in the office but they couldn't get off work, etc. etc. It's not as clear cut as it seems to the economist sitting behind his desk.

For the mods - maybe move all this stuff to the Obamacare thread and change its title, or something? Seems it would fit in better there.

MM MD

No, I'm saying if they want to work for a primary challenge in district A, then later work for an incumbent in district B, there's nothing wrong with that and if the incumbent in district B wants to hire them, he/she should be welcome to do that.

We're not talking about FUNDING these challenges, we're talking about NOT blacklisting people who work for the challengers.

It's not quite the same thing, but it's an important thing, especially given the way that the Overton window has been shifting over the last couple of decades (due to Fox News and gerrymandering).

The politicians can try to do that, but the party apparatus should not be used to help or hurt anyone in the party. The party's main job is to win GENERAL elections, the party is always going to win primary elections either way. The party boosts its chances of winning general elections when the best candidates are able to run... Protecting long-serving incumbents on the basis of their being incumbents is not conducive to making sure the best candidates are on the ballot in November.

I'm suggesting the party apparatus shouldn't be shilling for incumbents OR challengers. Maybe the DCCC shouldn't be run by sitting members of Congress, but rather someone elected in a separate election like the party chair is.

If you save money in the overall system that opens up more space to give funding to rural hospitals. If that space is being taking up by insurance companies and billing departments you're giving money that could have gone to rural doctors to paper pushers and insurance salesmen.

Yeah, the fabled rural doctor. Like Bigfoot, a lot of people believe in him, but photos are blurry and they only show up in foggy weather.

Pretty much NO ONE wants to practice in Assknuckle South Dakota. All sorts of strategies have been tried - the stated reason for the existence of the Nevada school of medicine was to train rural docs, and I can count on my fingers with some left over their success rate. It ain't ever going to happen, for reasons that should be obvious. Those spots get taken by FMG's who agree to work their for a few years to get their entry ticket to the US. Or they get staffed by NP's/PA's and they send anything remotely sick to us.

Note that I'm talking about rural rural here - Elko has decent coverage - they have a population of 20k or so. Much smaller than that, and having a doc is gonna be tough. I was born in a small town in Wisconsin - they had a town doc back then. Now they share one with four or five similar small towns - he rotates his office days thru the week. Seems to work out OK. But if you need a surgeon/orthopod/ENT/etc. you're driving to Madison or Dubuque.

MM MD

Yeah same strategy used here in Canada but if you had to choose between Donald Trump USA and Canada ???

Yeah same strategy used here in Canada but if you had to choose between Donald Trump USA and Canada ???

Well, docs make a bit more in the US, if they stay here - and AFAIK the vast majority of them move to an urban area the day they're able to. But I'd guess it would play into their career choices.

MM MD

Yes, I wasn't being clear, I mean they are trying to deny resources to potential primary opponents. Again, I don't think there is anything wrong with a firm doing what you describe, I'm just saying that incumbents trying to prevent this is just normal politics - sitting politicians will take revenge against firms, donors, clubs, activists, anyone who they think are supporting an opponent. This is just an example of a more organized way of doing this.

The DCCC isn't the "party apparatus" in some generic sense. It is the "official campaign arm of the Democrats in the House of Representatives." If you want to complain about the DNC not being neutral in primaries, fine, go ahead. If you want there to be a different organization that funds congressional races that is directly tied into a party organization rather than the representatives in Congress, fine, I favor that as well. But it seems weird to complain about a fundraising group that is run by and whose money is raised by incumbents for favoring incumbents.

Except that studies show it WOULD be cheaper. Also, as others have already ripped your more populous and more scattered arguments to shreds, with a little help from you dunking on yourself over how far some Canadians live from hospitals, I won't go too far on that... Suffice it to say a larger population HELPS with single payer, and we are less scattered than a bunch of countries that have done it successfully.

Ah, yes, believing the actual studies instead of listening to whatever Sean Hannity says about it is idiocy now. Good stuff Inso0.

Norway is a little bigger than New England + New York. So is your argument that the USA could do regional single payer, but NOT national single payer? Like we could have a Northeast pool, a Southeast pool, a Midwest pool, etc. Pray tell why this could work but a national version could not, oh wise one.

Canada is actually a larger country by area than the United States. At this point I'm not sure what you're even arguing. You've said we can't do it because we have too many people, but also that we have too few people in certain geographic areas. You've said we can't do it because our country is too big, but also that bigger countries can do it. You've said our population isn't dense enough, but also we know that less densely populated countries have succeeded.

Seems an awful lot like you're just throwing **** at the wall trying to get something to stick.

As others have pointed out, increasing usage can decrease cost because preventative care saves money.

This is effectively false: https://www.latimes.com/business/laz...nap-story.html.

I think most people probably expect to pay either about a 20% co-pay or a $20-$50 copay for an office visit, and even if you go in for a "free" annual physical, if you mention anything that's been ailing you in any way, congrats, you're no longer on a free annual physical. They can now bill it as a sick visit.

And what good is an annual physical if you aren't allowed to discuss anything that's been bothering you in any way?

Yes, which I view as a problem. Like, if Crowley defeated AOC and then didn't want to hire anyone that worked for her, I'd have no problem with that. I mean, it would seem kind of silly for them to apply for him in the first place and could even be a political liability for him in the future.

But if Ted Lieu wants to hire someone who worked on her campaign, but can't for fear of retribution from the DCCC, that's a big ****ing problem in my opinion.

Yeah, I mean I'm not saying they should have to give 10% of their money to primary challengers, or that they shouldn't be able to give money to incumbents to use against primary challengers. I'm saying that blacklisting people based on ever working for any primary challenger is absurd.

Like if I go work for someone who primaries a Democrat next year, the DCCC thinks I should never be able to be hired by any Democratic incumbent ever. You're telling me that's reasonable? C'mon...

Edit: never mind, this is going to create 50 more derail opportunities.

They also have more wealth than the bottom 90% combined.

I didn't say it had to be funded by local taxes, and it's not really a system I'd support. I was just trying to prove (successfully I might add), that not only was your "We're too big and scattered," argument wrong, it was also typical Inso0 Disingenuous Bull****.

Because what it's really about... What it's always about with people like you and awval...

Is that the poor people don't deserve healthcare enough for the rich people to have to pay for it, so **** the poor.

Once we cut through all your bull**** and disingenuous nonsense, it always comes back to the same thing...

Nice try. You've gotta be faster than that at deleting your horrible posts that make it obvious what it's really all about for you.

The top 1% owns more than the bottom 90% combined.