Most US doctors now support a national health plan

[fourier jr]

No surprise to me, but in case there was still any doubt that the current for-profit situation in the US isn't working.....

Reflecting a shift in thinking over the past five years among U.S. physicians, a new study shows a solid majority of doctors — 59 percent — now supports national health insurance.

Such plans typically involve a single, federally administered social insurance fund that that guarantees health care coverage for everyone, much like Medicare currently does for seniors. The plans typically eliminate or substantially reduce the role of private insurance companies in the health care financing system, but still allow patients to go the doctors of their choice.

A study published in today’s Annals of Internal Medicine, a leading medical journal, reports that a survey conducted last year of 2,193 physicians across the United States showed 59 percent of them “support government legislation to establish national health insurance,” while 32 percent oppose it and 9 percent are neutral.

The findings reflect a leap of 10 percentage points in physician support for national health insurance (NHI) since 2002, when a similar survey was conducted. At that time, 49 percent of all physician respondents said they supported NHI and 40 percent opposed it.

*snip*

Support for NHI is particularly strong among psychiatrists (83 percent), pediatric sub-specialists (71 percent), emergency medicine physicians (69 percent), general pediatricians (65 percent), general internists (64 percent) and family physicians (60 percent). Fifty-five percent of general surgeons support NHI, roughly doubling their level of support since 2002.
http://www.pnhp.org/news/2008/march/most_doctors_support.php

[Poop-Loops]

I can imagine it must be tough to think "Great, we now know what's wrong with Mr. Smith. Just a matter of a relatively-safe operation... oh... no insurance... :frown:"

[Schrodinger's Dog]

Not a surprise, I've met American physicians on line who were deeply disillusioned with the current system. Which is why I don't spend a lot of time taking people who think it is a terrible idea seriously. Kind of heard all the arguments from the people in the know already. It makes more sense, private and nationalised health is better, it is both on paper and in the real world. Since the US is ranked 38th or if you want to manipulate the figures to favour your country then 17th, I'd say the 16 national/privatised systems above you say it all really.

It's really only a matter of convincing stubborn capitalists, that nationalised HS isn't really socialism honest. So that they'll swallow a medicine that is good for the system. :wink:

[turbo-1]

I managed the network of a very large (by Maine standards) ophthalmic practice, and I can attest to the strangle-hold that the insurance companies have on private medical practices. Each insurance company has its own fee schedules, and if a doctor wants to be able to accept patients covered by an insurance plan, they have to agree to accept whatever payment the insurance company allows for each procedure. In addition, each insurance company has their own coding requirements, and if the coding experts in the billing office don't adhere to those coding requirements exactly, the insurance company will either refuse to pay or will only pay a portion of the claim. Then the billing department has to figure out why the insurance company bounced the claim, re-code, and resubmit. The more claims the insurance companies can deny, reduce, or delay, the more money they have on hand to invest - and this comes at the expense of both doctors and patients.

A single-payer health care system would all but eliminate this friction by providing a single standard system for coding medical procedures. If the coding specialists in medical billing offices had only one set of standards to adhere to, their jobs would be greatly simplified, and doctors would be paid in a timely fashion instead of being stalled by the insurance companies.

One more advantage this would offer: Much of Maine borders Canada, and somehow Canadian lumber companies find it profitable to buy logs in Maine, truck them into Canada, saw them into lumber, and truck the lumber back to Maine for sale. One of the advantages that the Canadian companies have over our companies is that they don't have to pay for and administrate their own health-care plans for their employees. This is especially important for smaller companies that don't have a lot of clout in the insurance market.

[ShawnD]

One more advantage this would offer: Much of Maine borders Canada, and somehow Canadian lumber companies find it profitable to buy logs in Maine, truck them into Canada, saw them into lumber, and truck the lumber back to Maine for sale. One of the advantages that the Canadian companies have over our companies is that they don't have to pay for and administrate their own health-care plans for their employees. This is especially important for smaller companies that don't have a lot of clout in the insurance market.

Couldn't the US company just not pay health benefits? Since small companies don't have bargaining power with insurance, a lot of them don't offer insurance. I work for a small company in Canada and I don't get any benefits. A lot of Americans are in the same position as me, and they rely on insurance outside of their work.

[mgb_phys]

The problem in America is that insurance outside work is incredibly expensive - if small companies don't have much bargaining power, how much does an individual have. Especially since individuals with no insurance are bundled in with all the un-insurable. In Canda even without benefits you are basically just paying the extra bit of tax ( $50/month for me in BC) yourself instead of through the payroll.

It is interesting that British doctors were the main campaigners against the NHS in the 40s, then in Canda they went on strike in the 50s to prevent an NHS there - now it seems American doctors have learnt from history.

[lisab]

Couldn't the US company just not pay health benefits? Since small companies don't have bargaining power with insurance, a lot of them don't offer insurance. I work for a small company in Canada and I don't get any benefits. A lot of Americans are in the same position as me, and they rely on insurance outside of their work.

Not only is it expensive to buy individual insurance, but insurance companies can refuse to sell it to you if you have an "pre-existing condition." These are things like diabetes, heart disease, or a previous bout with cancer.

So, if you are trying to buy individual insurance and you're healthy, it'll simply cost you big bucks. But if you're already sick, good luck finding a company that will even sell it to you.

[ShawnD]

The problem in America is that insurance outside work is incredibly expensive - if small companies don't have much bargaining power, how much does an individual have. Especially since individuals with no insurance are bundled in with all the un-insurable. In Canda even without benefits you are basically just paying the extra bit of tax ( $50/month for me in BC) yourself instead of through the payroll.

But why does the logging company care about your health care? Other companies like McDonalds or Walmart give literally no benefits unless you're a supervisor, so why would the expectation be any different for the logging company? Methinks there's more to this than just health care, like a stronger union on the Maine side or maybe lower taxes in whichever province turbo is talking about.

[Poop-Loops]

But why does the logging company care about your health care? Other companies like McDonalds or Walmart give literally no benefits unless you're a supervisor, so why would the expectation be any different for the logging company?

Because a logging company needs people who know how to drive trucks, forklifts, etc., people who have an actual skill and are harder to find. They want to keep these people.

If an angry McDonald's employee wants insurance, he can just be ignored until he quits or does something stupid and gets fired, and lo a new person will come to fill his shoes, because that is so-called "unskilled labor".

[ShawnD]

Because a logging company needs people who know how to drive trucks, forklifts, etc., people who have an actual skill and are harder to find. They want to keep these people.

True, but in turbo's previous posts he has stated that Maine has a pretty bad economy, and the median income was equivalent to something like 30k per year. When the economy is bad like that, people are willing to work for low wages and fewer benefits.

Of course that could be true on the other side of the border as well. Eastern Canada is sort of the welfare side of Canada, so they'll probably work for low wages as well.

[Poop-Loops]

True, but in turbo's previous posts he has stated that Maine has a pretty bad economy, and the median income was equivalent to something like 30k per year. When the economy is bad like that, people are willing to work for low wages and fewer benefits.

The economy isn't bad because people don't feel like working. It's bad because there is already a lack of good jobs. If you make pay-cuts, people won't buy as much crap any more. Meaning stores will lose money, meaning delivery (like trucking) and manufacturing will lose money since stores won't be able to afford it all, meaning there is now a lack of jobs.

Cutting health benefits means people are too afraid to do risky things with money, since if they get sick they NEED it for medicine or worse.

[turbo-1]

But why does the logging company care about your health care? Other companies like McDonalds or Walmart give literally no benefits unless you're a supervisor, so why would the expectation be any different for the logging company? Methinks there's more to this than just health care, like a stronger union on the Maine side or maybe lower taxes in whichever province turbo is talking about.Apart from teachers, law-enforcement and relatively few manufacturing jobs, there is very little unionization in Maine. Unemployment is high, wages are depressed, and the collapse of the housing market makes it difficult for people to sell out and move to another area (if they are lucky enough to find another job). Another problem is that real-estate prices have historically been depressed in more remote towns. That was OK when it allowed a fellow to take a low-paying job and still hope to make the mortgage on a modest house, but it makes moving quite problematic, because the equity (even if the mortgage is fully paid-off) in such a house wouldn't amount to much more than a down payment on a house within driving distance of Bath or Portland, where there may be some jobs at the shipyard, dry-dock, or other heavy manufacturing facilities. Affordable universal health care for all would at least provide a bit of a safety net for people facing our bleak economic prospects. I'm glad my wife and I aren't starting over again, and that she has an employer (New Balance Athletic Shoe Co.) that values their skilled employees and provides them with affordable health insurance and contributes to their 401K plans, etc. If I hadn't been covered by her health insurance, some of the medical problems I've had would have been a real drain on our savings. As it is, some treatments recommended by my primary care physician and specialist have been denied by the insurance company.

[mheslep]

Not a surprise, I've met American physicians on line who were deeply disillusioned with the current system. Which is why I don't spend a lot of time taking people who think it is a terrible idea seriously. Kind of heard all the arguments from the people in the know already. ...
Anecdotal evidence is meaningless (http://www.physicsforums.com/showpost.php?p=1660741&postcount=33)

[Schrodinger's Dog]

Anecdotal evidence is meaningless (http://www.physicsforums.com/showpost.php?p=1660741&postcount=33)

Er, considering the OP is far from being anecdotal evidence, I'm hardly resting my case on it, am I? If I was trying to say that its bad just because a few physicians said so you might have a point (it just backs up my anecdotal evidence and shows the concerns are more endemic). But since I've given a half a dozen other reason on as many threads, I don't feel the need to cite all the other stuff as well.

In that case Drankin (no one was prepared to debunk The Economist either) so i was trying to say because he made it to the top that was evidence that anyone can or that it was somehow related to social mobility statistics. In that case yes anecdotal evidence is meaningless. In my case I'm not working on anecdotal evidence alone, there are some pretty convincing statistics and well as I said the OP as well.

[mheslep]

...One more advantage this would offer: Much of Maine borders Canada, and somehow Canadian lumber companies find it profitable to buy logs in Maine, truck them into Canada, saw them into lumber, and truck the lumber back to Maine for sale. One of the advantages that the Canadian companies have over our companies is that they don't have to pay for and administrate their own health-care plans for their employees. This is especially important for smaller companies that don't have a lot of clout in the insurance market.The fix for that is to eliminate the employer based health deduction and thereby get employers out of the health care business.

[mheslep]

no one was prepared to debunk The Economist either
No one could read the subscription only link to read it.

[turbo-1]

My evidence may be dismissed as "anecdotal", too, but when you talk to doctors who are in private practice - especially specialists with convoluted coding requirements for procedures that are not commonly done, you'll find out what the biggest drag on their business is. Let's say a surgical laser craps out and it is a vital part of their business. They've got to go to the bank to get the big $$$$$ to get another one right away. They have their practice and their billed receivables as collateral, but they often have to demonstrate to the bank that their receivables are in good order. In other words, if the insurance companies are stalling, refusing payment, etc and billed receivables show ages of 60 and 90 days out, the bank will not consider them worthy of collateral. A practice that can keep its receivables aged primarily in the 30 days or less class stands a better chance of getting the loan at a reasonable interest rate. Insurance companies drive up the cost of health care for everybody and negatively effect the quality of care available.

Most doctors, especially those in small private practices would benefit from the establishment of a single-payer system. The drag and friction caused by the insurance companies makes it expensive for them to operate and requires them to over-staff to keep up with the work load.

[Schrodinger's Dog]

No one could read the subscription only link to read it.

That's not true actually, many people could, those that could just chose to dismiss it. I think you'll find one or two people can read subscription material in The Economist. And besides how is someone like me supposed to find an article that the proletariat can read? I tried, unfortunately most of the articles were by subscription only. Anyway someone kindly supported it with a source that was readable by all, my apologies for not having the sources at my finger tips, but that doesn't mean I was relying on anecdotal evidence alone. Any more than when someone here puts up a scientific paper only they and a few others can read are relying on anecdotal evidence alone. :smile:

Anyway the point still stands, and Turbo I don't think you have to support anecdotal evidence when the OP has 59% of Dr's agreeing with you it just adds. If it's on its own then it doesn't mean much on its own.

[mheslep]

The problem in America is that insurance outside work is incredibly expensive - if small companies don't have much bargaining power, how much does an individual have. Especially since individuals with no insurance are bundled in with all the un-insurable.
That depends. If you're chronically ill (diabetic) then yes and that needs to be fixed. Otherwise try an HSA. For example, quote from ehealthinsurance.com (https://www.ehealthinsurance.com) for 30 yr old male no family:
Humana, PPO, $5000 deductible, 0% coinsurance, $43/mo
Unicare, PPO, $2000 deductible, 30% coinsurance, $64/mo
Kaiser, HMO, $2500 deductible, 20% coinsurance, $110/mo

For comparison, avg cost of food, low cost plan, is $201/mo in the US, 2007 per USDA.


It is interesting that British doctors were the main campaigners against the NHS in the 40s, then in Canda they went on strike in the 50s to prevent an NHS there - now it seems American doctors have learnt from history.
Private clinics have been opening in Canada at the rate of about one per week since the Montreal Supreme Court decision that stopped the govt. from blocking private care.
http://www.apatheticvoter.com/Newsletter_Articles/CanadianHealthcareSystem.htm
http://opinionjournal.com/editorial/feature.html?id=110010266

[mheslep]

Apart from teachers, law-enforcement and relatively few manufacturing jobs, there is very little unionization in Maine. Unemployment is high, wages are depressed, and the collapse of the housing market makes it difficult for people to sell out and move to another area (if they are lucky enough to find another job). Another problem is that real-estate prices have historically been depressed in more remote towns. That was OK when it allowed a fellow to take a low-paying job and still hope to make the mortgage on a modest house, but it makes moving quite problematic, because the equity (even if the mortgage is fully paid-off) in such a house wouldn't amount to much more than a down payment on a house within driving distance of Bath or Portland, where there may be some jobs at the shipyard, dry-dock, or other heavy manufacturing facilities. Affordable universal health care for all would at least provide a bit of a safety net for people facing our bleak economic prospects. I'm glad my wife and I aren't starting over again, and that she has an employer (New Balance Athletic Shoe Co.) that values their skilled employees and provides them with affordable health insurance and contributes to their 401K plans, etc. If I hadn't been covered by her health insurance, some of the medical problems I've had would have been a real drain on our savings. As it is, some treatments recommended by my primary care physician and specialist have been denied by the insurance company.The overhead due to the insurers you have described hear and elsewhere sounds bad. The question is how did it get that way.
Given Maine's history of the government trying to run the health system, I would think you'd be more cautious about having .gov run the entire thing. In '93 the Maine legislature got in the insurance business w/ its 'community rating' plan and went about telling the insurers what and how to do.

Health Care News,2004
http://www.heartland.org/Article.cfm?artId=15674
“Just over 10 years ago,” he said, “we had well over 90,000 Maine consumers in the individual market. Today there are fewer than 30,000. From a competitive market with more than 10 carriers, we now have a monopolistic market with only one, Anthem, writing new individual policies.”

“We know that Maine has the highest tax burden of all 50 states,” wrote State Senators Paul Davis (R-Sangerville) ..... “But do you also know that Maine has some of the highest health insurance [premium] rates?

[ShawnD]

Private clinics have been opening in Canada at the rate of about one per week since the Montreal Supreme Court decision that stopped the govt. from blocking private care.
http://www.apatheticvoter.com/Newsletter_Articles/CanadianHealthcareSystem.htm
http://opinionjournal.com/editorial/feature.html?id=110010266

Private clinics are covered by UHC.

[Economist]

No surprise to me, but in case there was still any doubt that the current for-profit situation in the US isn't working.....

Full scale doctor support is in no way proof that it's a good idea. In fact, I'm somewhat suspicious of what they say (no matter which side they're on in this debate) given the fact that they're so financially/professionally involved. To give a counter example, most economists think we already have to much government intervention and third party payments (read not enough profit and consumer payments). However, I don't think anyone should find that convincing just because 1 group of individuals within a discipline have a similar view.

[turbo-1]

Full scale doctor support is in no way proof that it's a good idea. In fact, I'm somewhat suspicious of what they say (no matter which side they're on in this debate) given the fact that they're so financially/professionally involved. To give a counter example, most economists think we already have to much government intervention and third party payments (read not enough profit and consumer payments). However, I don't think anyone should find that convincing just because 1 group of individuals within a discipline have a similar view.It's a business decision that an economist should be able to appreciate. When you (as a private-practice physician) have to over-staff your medical practice to keep up with all the tricks and traps used by the medical insurance companies, and you have to pay more to borrow money from the bank because the insurance companies drive up the age of your receivables with their denials and delays, you've got trouble. Insurance companies drive up the cost of medical care and reduce the quality of medical care. Nobody knows this better than doctors and their staff. Despite the natural resistance to making such a sweeping change, doctors know that the financial performance of their practices will improve if a single-payer system is put in place.

[mheslep]

Private clinics are covered by UHC.There's no blanket 'are covered' by the UHC. They can be, if your Ca. Medicare people send you to one.

[Moonbear]

In talking with physicians about this story, it seems it's not really as clear-cut as the survey and headlines would like people to think. It's not about simply having a national health care plan, but the form it takes and who is running it. A patient with an insurance plan that refuses to pay for care the doctor deems necessary or that gives the patient no choice to change doctors if they are uncomfortable with their current provider is no better off than one with no insurance at all.

[Schrodinger's Dog]

In talking with physicians about this story, it seems it's not really as clear-cut as the survey and headlines would like people to think. It's not about simply having a national health care plan, but the form it takes and who is running it. A patient with an insurance plan that refuses to pay for care the doctor deems necessary or that gives the patient no choice to change doctors if they are uncomfortable with their current provider is no better off than one with no insurance at all.

Well that's a bad system, in most countries you have the right to change doctors, for whatever reason you see fit, even practices, if you're not happy with a Dr then you can just go somewhere else. Problem solved, health insurance or not, you can go private, you can go to another HS provider.

[Moonbear]

Well that's a bad system, in most countries you have the right to change doctors, for whatever reason you see fit, even practices, if you're not happy with a Dr then you can just go somewhere else. Problem solved, health insurance or not, you can go private, you can go to another HS provider.

In the US, you can run the gamut from excellent health insurance with low co-pays (or no co-pays for preventative care) and the flexibility to go to any provider you like, to HMOs where you're locked into a provider network and can have long waits to see providers and might have costly co-pays, to medicare where you're stuck with whatever one physician is willing to take you on a plan that seems to go out of it's way to deny claims based on incomprehensible coding systems that turns into more charity on the part of the physician than an actual healthcare plan. Of those, medicare is the one that's currently government run, so not a lot of people with decent health insurance think switching to something like medicare is a good plan, including the physicians.

Basically, until someone proposing national health care spells out some details of how it will function, it's really hard to know whether it's going to be on the good end of the spectrum where patients will get the care they need and doctors will get paid for providing that care with minimal hassle, or if it'll be on the bad end of the spectrum where patients will get stuck with physicians they don't like or won't get the care they need while physicians fill out mounds of government paperwork just to be told the claims are denied because they forgot to check box 26b-a-2 on page 37 of the form.

You have to keep in mind that we're a nation of people who don't trust government, somewhat by design, so while there are good models of nationalized healthcare in the world, we tend not to trust our politicians very much to choose one of those or implement it correctly, especially when they have probably never experienced the hassles of bad insurance plans or not having the money to pay for something out of pocket if they wanted/needed it.

[Schrodinger's Dog]

Indeed I'm looking at it from the perspective of a NHS looking back. And of course the US is different. But I think on a state by state basis, ie try it out see if it works given each individual states needs, it might work? Slowly and progressively to see what works and what doesn't. Obviously centralised by the government is not going to work. I don't think anyone is going to trust that, your country is too large to have one single system work.

That said your system seems very confusing. If it was centralised on a state by state basis, I guess the only people who lose out are those companies that aren't nationalised, but of course no one is talking about making the system solely nationalised, that is not what works in practice. Combination of both, seems to be better than one or the other. Those who want to pay above and beyond get above and beyond, those who can't or wont pay are covered by taxes. Now that sounds horrible, but when you're paying twice what any other country in the world is by GDP or close to, you're already paying more in taxes than the cost of a private healthcare plan. You just don't feel it because it comes out of your stealth taxes.

[Moonbear]

Indeed I'm looking at it from the perspective of a NHS looking back. And of course the US is different. But I think on a state by state basis, ie try it out see if it works given each individual states needs, it might work? Slowly and progressively to see what works and what doesn't. Obviously centralised by the government is not going to work. I don't think anyone is going to trust that, your country is too large to have one single system work.

Yes, it might have more of a chance at a state level than a national level to begin implementation. Thinking about that, predominantly rural states would probably be good starting points. Afterall, you can't really make the choice of providers any worse than what's already offered (not that providers are necessarily bad, but that they are few and far between, so people don't have much choice regardless), the populations are poorer so can't really afford out-of-pocket expenses if they don't have insurance, etc. It would probably not take so well starting out in states with large urban populations...while the urban poor would benefit, the suburban rich would fight it tooth and nail.

[ShawnD]

There's no blanket 'are covered' by the UHC. They can be, if your Ca. Medicare people send you to one.

There isn't 1 clinic in my entire country that is unwilling to accept payment from UHC, because they would go out of business immediately. If one clinic asks for your health card and charges you nothing, and the one next door only accepts cash/credit and charges $130 per visit (that's what visiting Americans are charged), guess which one goes out of business the fastest. Non-UHC clinics in Canada are comparable to finding a Walmart that will only accept cash; no credit or debit. They simply do not exist.

Yes, it might have more of a chance at a state level than a national level to begin implementation.
Not only that, but having it vary from state to state allows people to vote for the system they want. 50 states with 50 different systems, at least somebody will be happy somewhere. 1 country with only 1 system is just asking for trouble.

[mgb_phys]

That does pose the problem of 'health tourism' unless you are going to insist on a minimum residency requirement in each state before you get benefits (which Canada does).

[mheslep]

That does pose the problem of 'health tourism' unless you are going to insist on a minimum residency requirement in each state before you get benefits (which Canada does).That right there would prevent insurance reaching several million of the of the US 46million uninsured figure that is so often quoted. A large portion of that figure are illegal aliens and hence would not be covered under Canadian rules.

[mheslep]

so while there are good models of nationalized healthcare in the world, Where do you have in mind?

[mheslep]

There isn't 1 clinic in my entire country that is unwilling to accept payment from UHC, because they would go out of business immediately. If one clinic asks for your health card and charges you nothing, and the one next door only accepts cash/credit and charges $130 per visit (that's what visiting Americans are charged), guess which one goes out of business the fastest. Non-UHC clinics in Canada are comparable to finding a Walmart that will only accept cash; no credit or debit. They simply do not exist.Thats not the issue. Of course private clinics will take payment from anyone or any source. The issue is whether or not CHC agrees to pay the clinic for you, or not.

[devil-fire]

Frontline just did a show on the health care systems in other countries, http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Americans generally pay too much for too little of something many other countries consider to be a basic human right.

[ShawnD]

That right there would prevent insurance reaching several million of the of the US 46million uninsured figure that is so often quoted. A large portion of that figure are illegal aliens and hence would not be covered under Canadian rules.
Good. Illegals don't have a SS (US) or SIN (Canada), which means they don't pay taxes. If you're not paying taxes, you should not receive tax-funded benefits. It seems like a very simple concept.


Thanks for the Frontline link.

[drankin]

The problem in America is that insurance outside work is incredibly expensive - if small companies don't have much bargaining power, how much does an individual have. Especially since individuals with no insurance are bundled in with all the un-insurable. In Canda even without benefits you are basically just paying the extra bit of tax ( $50/month for me in BC) yourself instead of through the payroll.

It is interesting that British doctors were the main campaigners against the NHS in the 40s, then in Canda they went on strike in the 50s to prevent an NHS there - now it seems American doctors have learnt from history.

What do you call expensive? I insure my whole family outside of my work offered insurance for $250/mo. It's part of the new HSA system we have in the US. The reason it is low is because my deductible is high. Since it is high I can put my pretaxed income into a HSA savings account with my bank where it can collect tax free interest. I can use that money towards any health needs when I have them, including dental and vision. If I have a medical emergency I pay the first $5000 (using my savings) my insurance pays the rest up to 1 million dollars (or maybe it's 2). I love the program because I no longer pay a high premium for insurance I never use but if I have a major emergency I'm only out a few grand that I have in my tax shelter. It's new, simple, and I have control of where I want to spend my money on medical needs. I'm not restricted by my insurance as to where I get my health care and I'm insured for the kind of care needed that can be financially devestating. I can build my savings as quickly or slowly as I want and it isn't taxable. It depends on how much of a medical needs consumer you are but if you are like most families, you don't use as much as you would typically pay in premiums.

[quadraphonics]

Good. Illegals don't have a SS (US) or SIN (Canada), which means they don't pay taxes.

Not true. In order to work, you have to supply a Social Security number, which is then used to withhold taxes from your paycheck. Illegal immigrants simply supply a false Social Security number, and so pay the same taxes as everyone else (actually, they tend to pay even more, as they are typically too afraid of being found out to file for refunds). Also, illegal immigrants tend to consume much less public services than citizens/legal immigrants with the same income (again, fear of being caught and deported but also because they can't ever collect Social Security). All of which adds up to them being a much lower burden on tax-funded services than comparable legal workers.

Note that I say "comparable legal workers," as it is the case that pretty much everyone in the bottom income brackets consumes more in government services than they pay in taxes. In all cases, it's people in higher tax brackets who are ultimately paying for most of the services that everyone uses, and illegal workers are actually less of a burden than legal workers with comparable incomes.

[edward]

What do you call expensive? I insure my whole family outside of my work offered insurance for $250/mo. It's part of the new HSA system we have in the US. The reason it is low is because my deductible is high. Since it is high I can put my pretaxed income into a HSA savings account with my bank where it can collect tax free interest. I can use that money towards any health needs when I have them, including dental and vision. If I have a medical emergency I pay the first $5000 (using my savings) my insurance pays the rest up to 1 million dollars (or maybe it's 2). I love the program because I no longer pay a high premium for insurance I never use but if I have a major emergency I'm only out a few grand that I have in my tax shelter. It's new, simple, and I have control of where I want to spend my money on medical needs. I'm not restricted by my insurance as to where I get my health care and I'm insured for the kind of care needed that can be financially devestating. I can build my savings as quickly or slowly as I want and it isn't taxable. It depends on how much of a medical needs consumer you are but if you are like most families, you don't use as much as you would typically pay in premiums.

Your plan looks good because you haven't used it yet. You don't get much medical care for $5,000 these days. The 5g's wouldn't even pay for an outpatient appendectomy. Then you would have to start worrying that another illness or injury may strike the family before the $5000 is replaced.

Testing labs and imaging centers expect the co-pays up front. All of them accept credit cards and a lot of people are having to use them.

That is exactly the point where your plan won't look so good anymore.

[edward]

Note that I say "comparable legal workers," as it is the case that pretty much everyone in the bottom income brackets consumes more in government services than they pay in taxes. In all cases, it's people in higher tax brackets who are ultimately paying for most of the services that everyone uses, and illegal workers are actually less of a burden than legal workers with comparable incomes.

True to some extent, but when it comes to medical care they are sucking the life out of Arizona's medical system. The money they pay into the federal government never makes it back to the individual states.

[drankin]

Your plan looks good because you haven't used it yet. You don't get much medical care for $5,000 these days. The 5g's wouldn't even pay for an outpatient appendectomy. Then you would have to start worrying that another illness or injury may strike the family before the $5000 is replaced.

Testing labs and imaging centers expect the co-pays up front. All of them accept credit cards and a lot of people are having to use them.

That is exactly the point where your plan won't look so good anymore.

That $5000 is good for an entire year and then they reset your deductible. I can save up as much as I want in my HSA and the beats traditional insurance. My money stays mine, not to an insurance company. If I'd had started this 20 years ago it would still be there collecting interest because I haven't had any medical emergencies for that long. To think of all that money I was throwing at insurance companies in the past.

If I had a bunch of emergencies and didn't have to pay for it because of socialized health care, then my fellow tax payers would have to pick up the tab. Someone has to pay for it, I think it's only right that I pay my way and determine where I get my medical care.

[devil-fire]

That $5000 is good for an entire year and then they reset your deductible. I can save up as much as I want in my HSA and the beats traditional insurance. My money stays mine, not to an insurance company. If I'd had started this 20 years ago it would still be there collecting interest because I haven't had any medical emergencies for that long. To think of all that money I was throwing at insurance companies in the past.

If I had a bunch of emergencies and didn't have to pay for it because of socialized health care, then my fellow tax payers would have to pick up the tab. Someone has to pay for it, I think it's only right that I pay my way and determine where I get my medical care.

in socialized health care systems the cost of care is always cheaper then in the USA due in part because the system isn't trying to suck a profit out of sick people and the administrative costs are much lower. the current American health care system is inefficient at providing care for the unhealthy.

a quote from the frontline report- "...but heres the thing. these capitalist countries don't trust health care entirely to the free market. they all impose limits. There are three big ones. First, insurance companies must accept everyone and can't make a profit on basic care. Second everyone is mandated to buy insurance and the government pays the premium for the poor. Third, doctors and hospitals have to accept one standard set of fixed prices. Can Americans accept ideas like that? Well the fact is that these foreign health care ideas arn't really so foreign to us. For American veterans we're just like Britain's NHS, for seniors on Medicare we're like Taiwan, for working Americans with insurance we're Germany and for the tens of millions without health insurance we're just another poor country"

[quadraphonics]

True to some extent, but when it comes to medical care they are sucking the life out of Arizona's medical system. The money they pay into the federal government never makes it back to the individual states.

Well, they pay state taxes as well, both in paycheck withholdings, sales taxes, property taxes and so on. But it does bear mentioning that the issue is concentrated in certain states, those on the border obviously being the most impacted. And the federal government should probably compensate border states for this in some way. My point was simply that the tax burden of wealthy Arizonans would be even *worse* if they had a similar population of legal workers. No matter which way you slice it, a bottom-heavy workforce is a drain on government benefits, which in turn have to be funded by wealthier workers. The strains are a product of the demographics of the state, not the illegal status of whatever segment of the workforce (again, that they're illegal means they're *less* of a burden than a comparable legal worker).

[mheslep]

Your plan looks good because you haven't used it yet. You don't get much medical care for $5,000 these days. The 5g's wouldn't even pay for an outpatient appendectomy. Then you would have to start worrying that another illness or injury may strike the family before the $5000 is replaced.

Testing labs and imaging centers expect the co-pays up front. All of them accept credit cards and a lot of people are having to use them.

That is exactly the point where your plan won't look so good anymore.These HSA plans can be just as good or bad as you want them to be. That is, given a first class cover-everything PPO Blue Cross Blue Shield plan, one can get the exact same HSA plan from BCBS except you pay the high deductible.

And BTW, $5000 will get you a great deal of medical care if you tell the provider that you are paying out of pocket and you care what they charge you. If you just hand them an insurance card then, yes, it gets you very little and thats no surprise.

[mheslep]

Not true. In order to work, you have to supply a Social Security number, which is then used to withhold taxes from your paycheck. Illegal immigrants simply supply a false Social Security number, True, for the legit jobs & employers that do withholding.

and so pay the same taxes as everyone else (actually, they tend to pay even more, as they are typically too afraid of being found out to file for refunds).False, as a great deal of illegal alien income is off the books.
Also, illegal immigrants tend to consume much less public services than citizens/legal immigrants with the same income (again, fear of being caught and deported but also because they can't ever collect Social Security). All of which adds up to them being a much lower burden on tax-funded services than comparable legal workers.

Note that I say "comparable legal workers," as it is the case that pretty much everyone in the bottom income brackets consumes more in government services than they pay in taxes. In all cases, it's people in higher tax brackets who are ultimately paying for most of the services that everyone uses, and illegal workers are actually less of a burden than legal workers with comparable incomes.This is highly debatable as the evidence is hard to collect. Illegals send children to public schools, use emergency rooms for medical care under the EMTALA law, criminal aliens make up a large share of the prison population, and so on.

[mheslep]

in socialized health care systems the cost of care is always cheaper then in the USA due in part because the system isn't trying to suck a profit out of sick people and the administrative costs are much lower.Note that most all of the former socialist health care countries are rapidly increasing the use of private/market based medical care - Canada, France, Netherlands, etc.
the current American health care system is inefficient at providing care for the unhealthy.Yes, exactly right. Doesn't make economic sense to use 'insurance' to cover the chronically ill, as is.

[edward]

And BTW, $5000 will get you a great deal of medical care if you tell the provider that you are paying out of pocket and you care what they charge you. If you just hand them an insurance card then, yes, it gets you very little and thats no surprise.

Actually the insurance companies as well as Medicare have a set amount that they will pay for any given treatment or procedure. As far as I know individuals don't have the option to bargain for a lower price at for profit medical facilities.

I had a Kidney CAT scan last week and I saw a woman with no insurance trying to bargain for a lower price. The office manager could only suggest that the woman use her credit card.

[quadraphonics]

True, for the legit jobs & employers that do withholding.

False, as a great deal of illegal alien income is off the books.

Only a small percentage is off the books (and mostly consists of people hiring day-labor to clean their houses or help with yardwork). Meanwhile, every restaurant, hotel and farm in the United States is withholding taxes from the paychecks of illegal aliens. And there's no way for them to avoid sales and property taxes (you know, the ones that actually pay for those schools and roads?), regardless of where their income comes from.


Illegals send children to public schools, use emergency rooms for medical care under the EMTALA law, criminal aliens make up a large share of the prison population, and so on.

All those statements are equally true of American high-school drop-outs. Like I said, "comparable American workers."

[drankin]

Actually the insurance companies as well as Medicare have a set amount that they will pay for any given treatment or procedure. As far as I know individuals don't have the option to bargain for a lower price at for profit medical facilities.

I had a Kidney CAT scan last week and I saw a woman with no insurance trying to bargain for a lower price. The office manager could only suggest that the woman use her credit card.

Usually there is more than one hospital to chose from. But, if you are already in one then you are pretty much stuck with that unless you want to manage a transfer to another. Not something you are in the position to do in an emergency. We definately need some changes to where everyone can be insured, kind of like everyone needs car insurance. Someone told me Ron Paul had a well thought up plan something like this.

[mheslep]

Frontline just did a show on the health care systems in other countries, http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
Don't waste your time on the folksy T.R. Reid video. Read the interviews by the experts.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/
A for instance, not found in the video:
Reinhardt: Well, if I were to do a balance sheet of the system, the good things are that we[the US] have an extremely well-trained labor force, particularly physicians; I don't think any nation trains doctors better. We have the latest technology, simply because we throw so much money [at it]. ... We are really technology-hungry in this country. That's a good thing.

More and more, our system treats patients like customers, which is actually a good thing; that it's very, in general, customer-friendly -- not always, particularly if you're poor, which is a different story, but that is, by and large, a good thing.
And it's very innovative, both in the products we use, in the techniques we use and the organizational structures we use. Those are all very good things, highly competitive.

Better yet see M. Tanner's
The Grass Is Not Always Greener
A Look at National Health Care Systems Around the World
http://www.cato.org/pub_display.php?pub_id=9272

I believe you'll find in general that a) if you get sick and have access the US is the best bet in the world, b)the US system is too expensive and drops many through the cracks.

Americans generally pay too much for too little of something many other countries consider to be a basic human right.Not long ago urban governments around the world considered housing 'a right' and used rent controls to provide it creating a housing disaster. Now thats all gone.

[mheslep]

Only a small percentage is off the books (and mostly consists of people hiring day-labor to clean their houses or help with yardwork). Meanwhile, every restaurant, hotel and farm in the United States is withholding taxes from the paychecks of illegal aliens. I'm skeptical of how 'small' the income tax evasion is. The statistics are hard to get, but we know at least that the IRS estimates tax evasion done by everybody in the US is 14% / $345B (http://www.npr.org/templates/story/story.php?storyId=15111003). Then, another IRS report says 47% (www.mises.org/etexts/underground.pdf) of 'independent contractors' report no income. Thats a lot of guys standing on the corner working for cash.

Back to health care ...

[mheslep]

Actually the insurance companies as well as Medicare have a set amount that they will pay for any given treatment or procedure. As far as I know individuals don't have the option to bargain for a lower price at for profit medical facilities.

I had a Kidney CAT scan last week and I saw a woman with no insurance trying to bargain for a lower price. The office manager could only suggest that the woman use her credit card.

The Health Insurance Mafia (http://online.wsj.com/article/SB120813453964211685.html)
Dr Jonathan Kellerman, clinical professor of pediatrics and psychology at USC's Keck School of Medicine
...Several years ago, I suffered a sports injury that necessitated an MRI. The "fee" for a 20-minute procedure was over $3,000. My insurance company refused to pay, so I informed the radiologist that I'd be footing the bill myself. Immediately, the "fee" was cut by two thirds. And the doctor was tickled to get it....


Kellerman's article is the best yet that Ive seen in sizing up the current economic model for US health - Tony Soprano Care:
...The health insurance model is closest to the parasitic relationship imposed by the Mafia and the like. Insurance companies provide nothing other than an ambiguous, shifty notion of "protection." But even the Mafia doesn't stick its nose into the process; once the monthly skim is set, Don Whoever stays out of the picture, but for occasional "cost of doing business" increases. When insurance companies insinuate themselves into the system, their first step is figuring out how to increase the skim by harming the people they are allegedly protecting through reduced service....
So hopefully soon the US can break free of big Tony's 'protection' racket. And BTW, this is not a reason for a federal takeover, any more than ridding the garbage business of organized crime was a reason the nationalized garbage service.

[adrenaline]

I've never understood why America's outstanding talents in so many other market forces is so dismally incapable of fixing our medical system as it exists now.


I believe it comes down to our expectation. For the last 30 years, health-care costs have been rising 6 percent to 8 percent a year—more than double the inflation rate in the rest of the economy—because demand keeps outstripping supply.

As people's real income rises, they expect more medical care; our society is aging, so people need more care; and with new technologies treating formerly intractable conditions, people want more care.

In practice, almost everyone, insured or not, has access to health care, especially in emergencies. (By law, an ER in the US cannot turn away a sick patient.) Insurance affects how much people actually use health services:

The access of the uninsured involves inconveniences and costs that encourage them to underconsume medical services, sometimes with grim results.

By contrast, some people with insurance often have such broad access that many overconsume those services. People are running to the doc after two days of dealing with a viral upper respiratory infection. (I see this a lot) . Or they want a 1000 dollar MRI for a sprained achilles tendon or rotator cuff. These consumption patterns drive the price increases that ultimately shrink insurance coverage.


As a society we determine how much health care we want . Unfortunately, our desires have no relation to what we would spend. This is what makes us different from socialized medicine. The current system has no balances.


Our health care insurance system is broken and other countries do get more bang for their buck when it comes to medicine . The first step is to admit our health care system is in shambles and needs fixing, but some people still have their heads stuck in the sand!


Like most of the doctors in that survey I favor a national health insurance (Heck we already have it for the elderly and the poor in the form of Medicaid and Medicare) and tort reform so physicians can go back to practicing medicine, not legal medicine (ie: overordering tests to cover your A$$) in addition, any real medicine reform ( wether it is national health insurance or otherwise) we also need to be talking about making medical education cheaper, (so doctors aren't saddled with huge debts), tort reform so doctors don't have to garner a certain wage just to pay malpractice premiums etc.

Turbo-1 hit the nail on the head. Our 4 physician practice has an army of 32 , most of whom are not medical employees, who have to deal with the morass of insurances and and their different rules,full time coders, full time medicare insurance billers, full time medicaid billers, full time collections filers, 6 check in / check out people who have to figure out if we can run their blood work in house, or send to quest labs or can we do a treadmill test in house or do we send to the hospital, can i do a skin biopsey or do i have to send to derm etc. etc. One national insurance would save me the expense of hiring so many personell who need health insurance, dental, retirement planning, workman;s comp, disability, unemployment tax etc.


Besides, there is truly no such thing as Universal Health care system that does not involve a healthy private paying sector where if you have the money , you can purchase the type of health care you want. In Britain, there is a healthy private sector that employs almost half of the health care workers.http://www.medrants.com/index.php?s=...&submit=Search under British NHS. In Canada, you just drive over to America!

[mheslep]

I believe there is little or no market system in play due the government's intervention in the system via the employer based health care tax exemption, and regulations that restrict nationwide portable insurance.

After reading Adrenaline's post and the physicians study I believe that what physicians really want is all of the billers, coders, filers and other expensive time wasters time to go away; its ancillary that many believe Universal Care is the way to make this happen.

adrenaline: Do you have an opinion on the proposed application of anti trust law to hospitals and doctors? By this I mean anti trust remedies to these current practices:
- Mergers among hospitals that lead to very high concentrations of market power
-The practice of doctors and hospitals colluding to boycott patients and their health plans to obtain anticompetitive concessions .
-The barrier to entry of new physicians by the Accreditation Council for Graduate Medical Education (ACGME). ACGME enjoys complete control over the number of residency programs and residents.
-The barrier to new medical schools created by the AAMC. As Adrenaline mentioned med. school costs Im particularly interested in opinions here.

[mgb_phys]

We are really technology-hungry in this country. That's a good thing.
I would be interested in knowing how many lives MRI has saved?
As far as I can see the possible scenarios are:
1, We thought it was a minor injury and the MRI confirmed = no save
2, We thought it was serious and we are treating it = no save
3, We thought it was minor but it's really serious AND we can treat it = save
It would seem that the last one is not a majority of cases!

Meanwhile (in the UK at least) hospital infections kill twice as many peoples as road accidents - it would seem a good idea to use all the money put into airbags, drink driving and speed cameras to persuade doctors to was their hands!

[mheslep]

I would be interested in knowing how many lives MRI has saved?
As far as I can see the possible scenarios are:
1, We thought it was a minor injury and the MRI confirmed = no save
2, We thought it was serious and we are treating it = no save
3, We thought it was minor but it's really serious AND we can treat it = save

I expect the wins are
4. We know it is serious from the obvious problems but it is perhaps due to one of 3-4 things, we determine which one w/ the MRI - win
5. We know it is serious and we know the type of problem (like a tumor) but we need to know where it is; the MRI tells us - win.
6. We know it is serious, we have been treating you but now we need precision feedback on the on the results of the treatment in order to more narrowly tailor future treatments - win.

[adrenaline]

I believe there is little or no market system in play due the government's intervention in the system via the employer based health care tax exemption, and regulations that restrict nationwide portable insurance.

Agree completely


After reading Adrenaline's post and the physicians study I believe that what physicians really want is all of the billers, coders, filers and other expensive time wasters time to go away; its ancillary that many believe Universal Care is the way to make this happen.

No. Just showing the waste of the private insurance sector that goes to paperwork and non medical related personnell. I volunteer at a free medical clinic and hospitalize and treat "gratis" very ill uninsured patients who now must face bankruptcy and future strings of failed safety nets for their health. Many doctors like myself on the front lines see the ethical travesty and the social and economic consequences of leaving a good portion of our society uninsured.


Do you have an opinion on the proposed application of anti trust law to hospitals and doctors? By this I mean anti trust remedies to these current practicees. -mergers among hospitals that lead to very high concentrations of market power.

I agree, studies show mergers do not save money. I also, along that lines propose better regional planning to reduce duplicated services such as every hospital in the area having the same expensive new scanner or open heart surgery program. This will produce seperate interdependant hosptials that share the costs and burdens of the newer technologies. A monopoly system would not allow that.



-The practice of doctors and hospitals colluding to boycott patients and their health plans to obtain anticompetitive concessions .

I boycotted a private insurance that did not pay me a dime for providing 500 of their members with medical care for three years.That is not collusion. I still have to pay my nurses a salary and pay my $250,000 dollar rent etc. . My hospital stopped taking aetna after 99% of their claims remained unpaid after 9 years. By default , I had to stop accepting Aetna since I could no longer take care of my patients in the hospital or order any ancillary service testing without sending them across town. I tried in the beginning, but begging other hospitals to admit my patients for me when they became sick became a liability when many of them refused. I still take medicaid even though it is a losing profit game because these folks don't have the ability to purchase their insurance by encouraging their company to look for other insurance alternatives. ( 450 of these patients remained after they convinced their company to purchase humana instead.)


-The barrier to entry of new physicians by the Accreditation Council for Graduate Medical Education (ACGME). ACGME enjoys complete control over the number of residency programs and residents

This is mute. Due to the following....so many residency slots no longer get filled, Internal medicine residencies, general surgery and other surgical specialites are almost 50% unfilled. Only select high competative slots like dermatolgy aand radiology ( which there is no shortage of doctors for these fields ) have filled their slots.

http://www.insurancenewsnet.com/article.asp?n=1&innID=398236378

Also, almost all the residency training slots are funded by medicare, and medicare has not expanded it's budget for this . Without the funding, new residency positions cannot be created, ( unless you want private pharmaceuticals/biotech companies to sponser them which brings up some ethical dilemmas).

http://www.slate.com/id/2121755/

Because the total number of residents funded by Medicare has been fixed by the Balanced Budget Act since 1997, a particular hospital or specialty that wants more residents of a given sort must either pilfer some of the slots of another specialty—a difficult trick—or find outside funding for them


-The barrier to new medical schools created by the AAMC. As Adrenaline mentioned med. school costs Im particularly interested in opinions


Did not know there was a barrier when their official goal is to create positions by expanding existing class sizes and creating new medical schools.

https://www.amsa.org/news/release2.cfx?id=271

AMSA agrees that the proposed AAMC strategy of expanding the physician workforce through both the expansion of existing schools and the creation of new allopathic medical schoolsis the most effective way to quickly and economically address the significant shortage of physicians expected early in this century.


I come from a poor family. If had had my first choice ( georgetown university) i would have owed half a million dollars in student loans with interest over the course of the loan payback. I was lucky enough that one of the ivey leauges gave me a $ 80,000 dollar grant. I still had to borrow but it was less than it could have been ( I still lived on $7,000 a year as a student in 1990s which was just astounding ...I learned to bike 15-20 miles quickly since i did not have a car )

[mheslep]

Thanks for your thoughtful response
I boycotted a private insurance that did not pay me a dime for providing 500 of their members with medical care for three years.That is not collusion. Quite right. I'm talking about agreement among competitors/peers to set prices and ... well, collude.

This is mute. Due to the following....so many residency slots no longer get filled, Internal medicine residencies, general surgery and other surgical specialites are almost 50% unfilled. Only select high competative slots like dermatolgy aand radiology ( which there is no shortage of doctors for these fields ) have filled their slots.

http://www.insurancenewsnet.com/article.asp?n=1&innID=398236378

Also, almost all the residency training slots are funded by medicare, and medicare has not expanded it's budget for this . Without the funding, new residency positions cannot be created, ( unless you want private pharmaceuticals/biotech companies to sponsor them which brings up some ethical dilemmas).I didn't know Medicare was responsible for all US residency positions. How was that done before Medicare?
Anyway, here's the basis for my question:
Barriers to Entering Medical Specialties, Sean Nicholson, 2004
Abstract
Non-primary care physicians earn considerably more than primary care physicians in the United States. I examine a number of explanations for the persistent high rates of return to medical specialization and conclude that barriers to entry may be creating a shortage of non-primary care physicians. Entry barriers exist due to cartel behavior by residency review committees, regulation that until recently required residents in all specialties to receive the same wage, and/or scarcity of teaching material. I estimate that medical students would be willing to pay teaching hospitals to obtain residency positions in dermatology, general surgery, orthopedic surgery, and radiology rather than receiving the mean residents’ salary of $34,000. In the simulation, the quantity of residents in these four specialties would increase by an estimated six to 30 percent, rates of return would fall substantially, and teaching hospitals would save an estimated $0.6 to $1.0 billion per year in labor costs.

www.ftc.gov/be/workshops/healthcare/nicholsonpaper.pdf

Got to go now, more later ...

[adrenaline]

Thanks for your thoughtful response
Quite right. I'm talking about agreement among competitors/peers to set prices and ... well, collude.

With that strict definition I agree on ethical principles that it should not be allowed. However, since this country allows the medical industry ( rightfully or wrongly) to operate under free market principles, I think this is a natural consequence of such economic freedom.



I didn't know Medicare was responsible for all US residency positions. How was that done before Medicare?

Honestly, don't know how it was done before medicare. Remember, back in the "old days" any doctor could set up shop after medical school ( without undergoing the rigors of residency) as a general practioner. And since many general practioners did the work of the many specialists, ( delivered babies, take out appendix , even administered anesthesia etc.) there may not have been a huge need for residency positions in these other sub specialties.


First of all, I agree with limiting residencies for non -primary care specialties where there is an over supply of these overpaid specialties. ( Our country has more dermatologists, ent practioners, plastic surgeons and radiologists than it needs). Non primary care specialties that have shortages are geriatricians, rheumatologists, oncologists, thoracic and general surgeons who cannnot even begin to fill their slots.
The non primary care sspecialties that are well reimbursed are much more highly paid primary care docs because the current system rewards procedures and not thinking and time. ( not because residency slots are limited.) Medicare pays me more for doing a skin biopsey or take out a hang nail over spending one and a half hours addressing complicated medical problems and diagnosing someone with gluten enteropathy and early supranuclear palsey. Medicare pays a radiologist more for reading an abdominal cat scan and pelvic cat scan than a general surgeron who spends four hours doing a difficult bowel obstruction surgery and then has to follow that person in the ICU for weeks on end. I believe this country needs to limit the residency slots for such non primary care specialties. My friend is one of 500 applying for one of two opthalmology residency slots here and the internal medicine residency program of 90 has only 100 applying. We don't need 500 opthalmolgists who get paid 5 times the salary of a internist who works more hours and puts in more time and thinking.

Thus, if you were a valedictorian of a medical school that could make $350,000 dollars doing cosmetic dermatology or radiology working five days a week vs. $120,000 dollars a year for an academic thoracic surgeron working 90-100 hours a week, which would residency position do you think most of these valedictorians go into? ( I'm sorry but the generation X values quality of life above a lot of things ( not that it is wrong). I'm damn glad we only have 5 dermatology positions here. Who needs that many dermatologists?