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maybe we're better off without the moron doctors who cut their nose off to spite their face
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Jul 6, 2017 22:49
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LanceHunter posted:You're really just picking at anything possible to try and pretend that there wouldn't be a brain-drain issue. Some doctors near retirement shut down their practices rather than going through the process of digitalization required by Obamacare, even though ultimately that would have been a cost-saving measure. People can overweigh immediate costs when making decisions. I'm picking at unsubstantiated bullshit. If you want to argue the wage cut, then argue the wage cut, don't try to muddy the waters with random nonsense that is both disingenuous and not based in evidence.
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Jul 6, 2017 22:49
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A pay cut is a big deal If We aren't able to also do something about medical school debt. I'm sure there's a percentage cut that is acceptable just to never have to deal with inflated HMO pricing, it the loving retarded dance they do irt approving procedures and to realize that you now have a huge pool of new customers thanks to the expanded coverage.
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Jul 6, 2017 22:56
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You don't want to know how unhappy the doctors will be with their massive new patient load and fully paid procedures. You can't imagine how horrible having more customers is for business.
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Jul 6, 2017 22:56
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Don't doctors have to pay for their own medical care, a cost which will disappear with single payer?
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Jul 6, 2017 22:57
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LanceHunter posted:The continued shouts of "CALIFORNIA BUYING POWER" aren't going to cover up the hard realities that would accompany a switch to single-payer. There are certain drugs that aren't going to be covered. There are doctors who will choose not to practice in California. We shouldn't try to pretend that this isn't going to happen, but instead should decide if these are trade-offs that we're willing to make. The reality is likely somewhere in the middle, just like Medicare and large HMOs like Kaiser can negotiate low prices on some drugs but have to pay what's demanded for other drugs, and also buy generic when possible.
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Jul 6, 2017 23:08
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Cup Runneth Over posted:There is absolutely a logical reason to believe it will improve things. Your opposition is ostensibly based on a pearl-clutching "but what if the insurance companies say no?! California can't force them!" hypothetical. It's not that there's no reason to believe it would succeed, it's that there is a chance that it may fail. Maybe you'd be a better person if your dad made you try out for the softball team. Tell me, how exactly would you deal with this situation:  : "We have instituted single payer! Sick people will have their medications paid for by the state now, guaranteed! And we're going to get a big discount, because we are big and special."Sick People: "Hooray!" : "Big pharma, we want you to give us the drugs we promised at a big discount! Because we are big and special!" Pharma: "No. You are going to pay market rates with our small volume discount." : "No, we are only going to pay big discount rates. We said so." Sick people: "Where is the medicine you promised us we could have?" How will you deal with it if the Trump administration declines to sign the waivers to allow California to roll federal programs like Medicare and the VA into its state system? Maybe you would be a better person if your dad had spent more time teaching you logical thought instead of molesting you. Cup Runneth Over posted:Anti-single payer people are impossible to argue with. As perfectly epitomized by the way Dead Reckoning always posts in this thread, they have no solutions. They don't want to talk about it. They just say "no." There's no constructive dialogue on this topic, it's pure pathological aversion. Leverage is a problem? Well, what do you suggest we do about that? Nothing, don't even try. Meanwhile people continue to die, and they'd rather just sit on their thumbs than come up with numbers and solutions, despite the many examples of it working elsewhere, ostensibly because there's some places where it didn't work. (And there's nothing pearl-clutchy about that, any more than pointing out the AHCA will kill millions. It's a fact. People are dying.)  this is the dumbest poo poo ever, and yet unsurprisingly popular as a debate tactic: "You can't criticize my incredibly stupid idea until you come up for a way to get the result I want!"That's not how it works. I don't have any good solutions for implementing a state level single payer system because I don't think there are any good solutions and it's a bad idea. I think there are other, better ways to control medical costs. Sure, the status quo sucks, but I see no reason to blow billions of dollars on a quixotic project unlikely to meaningfully improve things so that you can feel like you did something, which is really what this is about. Duckbag posted:People in this thread don't dislike you two for disagreeing with us. We dislike you for having poo poo arguments. (USER WAS PUT ON PROBATION FOR THIS POST)
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Jul 6, 2017 23:32
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Family Values posted:The reality is likely somewhere in the middle, just like Medicare and large HMOs like Kaiser can negotiate low prices on some drugs but have to pay what's demanded for other drugs, and also buy generic when possible. And just like people already find that drugs they really want aren't covered by their plan, and either pay out of pocket or get supplemental insurance from another provider...or suffer without, I suppose. In other words, that whole class of objection is pointless: the claimed problem already exists and wouldn't be created or exacerbated by adopting single-payer.
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Jul 6, 2017 23:34
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Boot and Rally posted:What is the difference between mandating a lower price and saying how much you're willing to pay? How is Canada forcing the sale? Presumably this means that if drug companies want to sell, they must sell at a certain price, not that they HAVE to sell. In both Canada and California the drug companies can walk away. Jo posted:Are there any federal laws preventing Cal-Single-Payer from requiring a California ID or license? (Similarly, does Canada require citizenship for medical benefits?) CPColin posted:The bill itself extends eligibility to "every resident" of California, though it does not define how one is considered a "resident." I'm guessing that determination is codified elsewhere. CPColin posted:Maybe doctors (and their staff) can make up that pay cut by not wasting so much time dealing with the loving insurance companies.
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Jul 6, 2017 23:39
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Raskolnikov38 posted:maybe we're better off without the moron doctors who cut their nose off to spite their face Remember Obama's "if you like your plan, you can keep your plan" quote? The thought behind that was "okay, the ACA may cause some insurance plans to be stopped, but those plans were dog-poo poo. Any plan that's actually good will still be there." Then a lot of those dog-poo poo plans got cancelled and that quote came back to haunt him. I mean, yea, gently caress moron doctors. The problem is, people tend to really trust their moron doctors. When their moron doctors start saying that they are packing up and moving away, there is going to be some political fallout. When you have a political strategy of "gently caress the idiots, this is what's best", you end up with the kind of backlash that gets Trump elected. Family Values posted:The reality is likely somewhere in the middle, just like Medicare and large HMOs like Kaiser can negotiate low prices on some drugs but have to pay what's demanded for other drugs, and also buy generic when possible. This is true, the vast majority of procedures and drugs will almost certainly be covered. Every one that isn't, though, is gonna be a giant scare piece about how "California's socialized medicine means this child can't get his cancer treatment! <dun dun dun>"
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Jul 6, 2017 23:40
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LanceHunter posted:Remember Obama's "if you like your plan, you can keep your plan" quote? The thought behind that was "okay, the ACA may cause some insurance plans to be stopped, but those plans were dog-poo poo. Any plan that's actually good will still be there." Then a lot of those dog-poo poo plans got cancelled and that quote came back to haunt him. LanceHunter posted:This is true, the vast majority of procedures and drugs will almost certainly be covered. Every one that isn't, though, is gonna be a giant scare piece about how "California's socialized medicine means this child can't get his cancer treatment! <dun dun dun>"
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Jul 7, 2017 00:05
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Dead Reckoning posted:Which, again, I am personally fine with, but we have to own "we are going to let some people, who have people that love them, die sooner because we have decided that it isn't worth the cost to keep treating them. (Yay Quality Adjusted Life Year metrics!)"
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Jul 7, 2017 00:14
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Dead Reckoning posted:Which, again, I am personally fine with, but we have to own "we are going to let some people, who have people that love them, die sooner because we have decided that it isn't worth the cost to keep treating them. (Yay Quality Adjusted Life Year metrics!)" Of course, the current healthcare system does this constantly. We just currently blame the families when we do it.
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Jul 7, 2017 00:44
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Dead Reckoning posted:Which, again, I am personally fine with, but we have to own "we are going to let some people, who have people that love them, die sooner because we have decided that it isn't worth the cost to keep treating them. (Yay Quality Adjusted Life Year metrics!)" "Which will be much less people than now but I felt compelled to bring this up for some reason"
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Jul 7, 2017 00:49
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LanceHunter posted:Sometimes neither party will blink and it just means that certain drugs aren't provided to people on the single-payer plan. As I mentioned previously, this is fairly common, and it's something that is part of having a single payer plan. How is this different from what happens now, where private insurance companies refuse to cover expensive drugs all the time.
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Jul 7, 2017 00:55
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VitalSigns posted:How is this different from what happens now, where private insurance companies refuse to cover expensive drugs all the time.
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Jul 7, 2017 00:59
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Dead Reckoning posted:Which, again, I am personally fine with, but we have to own "we are going to let some people, who have people that love them, die sooner because we have decided that it isn't worth the cost to keep treating them. (Yay Quality Adjusted Life Year metrics!)" This happens more now, we just tell ourselves the people it happens to deserve it for being poor, and the universe will never let this happen to you and me because our personal virtue will protect us from cancer. The ultra-rich will still be able to pay for whatever they want don't worry, and you and I aren't going to be dropping $100 million on treatment that insurance companies won't pay for anyway. E: This argument has a very interesting structure. You admit that arguments against single-payer are bad, but then say "well what if other people agree with wrong arguments, what then?" I'm not sure how to refute that, I guess we make the same case that convinced you they were wrong arguments in the first place? Or I guess we never do anything because theoretically someone could always disagree for insane reasons? VitalSigns fucked around with this message at 01:45 on Jul 7, 2017 |
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Jul 7, 2017 01:04
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Dead Reckoning posted:Again, you'd need to ask someone more familiar with the intricacies of the Canadian system, but my guess would be that, in exchange for the government enforcing their patents and copyrights, manufacturers agree to be bound by the Canadian regulatory system and pricing model. Even then, there are likely drugs that the Canadian NHS simply does not provide. California doesn't run the patent office, so it can't offer that carrot/stick. California could establish a formulary and try to play manufacturers against each other, but that means that some higher priced drugs will no longer be offered in CA unless the patient pays out of pocket. That in turn means that patients who currently have health insurance in CA will be getting a lower level of care than they currently enjoy, and proponents of Single Payer need to be up front about that. Since you're claiming the difference between California and nations, I am asking you. Don't get too caught up in Canada in specific. Patents and copyrights are enforced by international treaties not on a company by company basis. Companies can decide not to sell because Canada mandates prices they don't like and still have their patents enforced. The only option in that case is for Canada to abrogate former treaties and begin producing their own drugs (at non-zero implementation time) and then sit down with the US government (or whoever) to hash out new trade agreements that allow Canada to produce any drug they want or need. Or they can suffer a trade war or the economic difficulties I actually just read a really great illustration of how this happens: Dead Reckoning posted:
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Jul 7, 2017 01:37
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: "We have instituted single payer! Sick people will have their medications paid for by the state now, guaranteed! And we're going to get a big discount, because we are big and special."
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LanceHunter posted:In the 2040 dramedy remake of Fresh Prince of Bel-Air, Will has to leave Philadelphia because he has leukemia and stay with Uncle Phil and Aunt Viv to get CA residency and get treatment. People say this about Canada all the time and yet their healthcare system doesn't seem to be crippled by it. If doctors leave California in droves, their markets will shrink drastically. They'll have to compete against the doctors in those other states, who have their monopoly down pat, and against each other. It's not that simple for them. The people in those other states aren't hurting for doctors so much as affordable medical care, so how are they going to make more money moving there to a niche that's already filled than they would just staying in Cali?
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Jul 7, 2017 01:47
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Cup Runneth Over posted:People say this about Canada all the time and yet their healthcare system doesn't seem to be crippled by it. Many cities with growing populations are constantly in need of doctors. Here in Austin it took me a while to find a GP that was accepting new patients. Many practices are at capacity, even with our terrible uninsured rates. As long as the doctors aren't moving to Rustbelt McGhosttown, it's unlikely they'll be hurting for business.
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Jul 7, 2017 02:06
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LanceHunter posted:Many cities with growing populations are constantly in need of doctors. Here in Austin it took me a while to find a GP that was accepting new patients. Many practices are at capacity, even with our terrible uninsured rates. As long as the doctors aren't moving to Rustbelt McGhosttown, it's unlikely they'll be hurting for business. Fair enough. And what about the millions of new Californians who will need doctors? The old ones may be accustomed to a wealthier lifestyle, but you think that no one will want to fill that gap? Plus, they could have moved to Austin at any time. It's unlikely it was just the money that kept them in California.
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Jul 7, 2017 04:16
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Cup Runneth Over posted:Fair enough. And what about the millions of new Californians who will need doctors? The old ones may be accustomed to a wealthier lifestyle, but you think that no one will want to fill that gap? Unless California is going to spend some of that tax money building a lot more med schools (and also offering some very generous scholarships to help more people pay for med school), then the number of doctors isn't going to change that much. Increasing the supply of doctors would definitely help blunt the flight effect caused by single payer lowering wages, as it could lower prices overall. But becoming a doctor takes years of graduate-level study. It isn't just something you can jump into because the job market is hot. (In fact, an increased demand for doctors in California wouldn't necessarily lead to anyone jumping into the profession to "fill the gap", because the mechanism that generally gets people to change careers to fields where there is high demand is the increased pay caused by that demand, and California's single-payer system will be lowering doctors' pay.) I don't know any doctors that are hurting for patients right now. Telling them "hey, you're gonna make around 30% less per patient, but you can have so many more patients!" sounds like a pretty raw deal (and frankly, if their plate is already full, it wouldn't be ethical for them to take on more patients than they could reasonably care for). A good single-payer bill is going to need to include a lot of extra funding for med schools, teaching hospitals, and probably scholarships, too. I don't see this in the current CA plan, which is why the whole thing needs serious overhaul.
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Jul 7, 2017 05:48
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LanceHunter posted:then the number of doctors isn't going to change that much Isn't that the opposite of what you were arguing before? Is it not going to change, or is it going to decrease as doctors flee the state to get their six figure salaries where they can still overcharge people? Or maybe doctors get into medicine to help people, and not milk them dry? At least some of them, right? Should we just ignore the medical professional unions in favor of single-payer? Cup Runneth Over fucked around with this message at 05:59 on Jul 7, 2017 |
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Jul 7, 2017 05:57
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Cup Runneth Over posted:Isn't that the opposite of what you were arguing before? Is it not going to change, or is it going to decrease as doctors flee the state to get their six figure salaries where they can still overcharge people? Are you being willfully dense? The number of doctors in the US won't change much. We'll have around the same number of doctors graduating from US med schools if this plan passes as we would if it didn't. It's the number of doctors continuing to practice in California that will decrease. (A problem you get when you have only a single state going single-payer. As I mentioned previously, there's a much lower barrier to leaving to practice in another state than there is immigrating to another country.) And yea, most doctors get into medicine to help people, but you still see a lot of positions in the VA that are unfilled because doctors choose to take higher-paying options of civilian hospitals and/or private practice.
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Jul 7, 2017 06:10
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I'll say it again: Should we just ignore the medical professional unions in favor of single-payer? The California Nurses' Association is one of the largest driving forces behind the bill. The listed supporting orgs also include the California Physicians Alliance, the California Health Professionals Student Alliance, Decus Biomedical, etc. Opposing it are...quote:America’s Health Insurance Plans Not a single doctors' alliance. Almost entirely health insurance companies and chambers of commerce. This doesn't lend credence to the idea that California's doctors hate the bill and will leave.
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Jul 7, 2017 06:22
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It's also seems pretty out of touch with the bigger picture to think that the high cost of medical services is somehow directly tied to doctor's wages and not a totally unchecked system of unquantified costs for services.
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Jul 7, 2017 07:30
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Also the artifical scarcity of doctors due to limiting immigration of the medical profession. Clearly those medical unions have a good reason right? Since Canada and the rest of the free world have a system similar or better than single player, does that mean all their doctors are leaving to our awesome system?
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Jul 7, 2017 09:29
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Dead Reckoning posted:Tell me, how exactly would you deal with this situation: I like how you are arguing the state of california in this
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Jul 7, 2017 10:39
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One of the largest economies in the world and arguably culturally the most relavent. I'd be embarrassed making an argument stating that CA couldn't negotiate with medical companies but some are attempting to.
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Jul 7, 2017 17:19
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I'm sure the medical companies haven't been promoting that argument at all.
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Jul 7, 2017 18:32
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Buckwheat Sings posted:One of the largest economies in the world and arguably culturally the most relavent. In a vacuum, I'm sure CA could negotiate quite sufficiently. Where I think it'll break down is that we have a national government who will gladly ignore every concept of state rights the moment it gets in the way of something they're paid enough to care about. I would gladly push through a single-payer system at state level but expect that, if California did it, it'd run into every possible hurdle and eventually get blocked at federal level. (I'm not saying the state shouldn't still try; I'm just opining my expected outcome.)
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Jul 7, 2017 18:49
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Buckwheat Sings posted:One of the largest economies in the world and arguably culturally the most relavent. CA can negotiate with PhARMA if CA wants to setup a medication wholesaler and distribution system. This is not what is being proposed by proponats of medication price controls. The major issue with the proposed price control system is that while CA can control prices sold at CA pharmacies they can not control how much the pharmacies pay from a wholesaler in another state.
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Jul 7, 2017 18:51
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FilthyImp posted:A pay cut is a big deal If We aren't able to also do something about medical school debt. Interesting idea: I have an ex in social services who has her student debit wiped after ten years of service in the public sector. With public healthcare, that could conceivably also include medical school.
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Jul 7, 2017 21:03
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CopperHound posted:This discussion reminds me of the Glorious Sunset scheme from Freakanomics. It is both so beautiful and evil that it can never happen. Old people can already sell out their retirement and/or life insurance early, so But it's not like we'll become logan's run, even countries with NHS (england, etc) have pretty similar life expectancy
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Jul 7, 2017 21:10
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Jo posted:Interesting idea: I have an ex in social services who has her student debit wiped after ten years of service in the public sector. With public healthcare, that could conceivably also include medical school. I just thought this morning that the "Pay Cut" night also be worth it of they could stop the retarded 36 hour rotations that leave physicians and residents burned out ambulatory husks. What worker protections?
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Jul 7, 2017 21:14
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FilthyImp posted:I just thought this morning that the "Pay Cut" night also be worth it of they could stop the retarded 36 hour rotations that leave physicians and residents burned out ambulatory husks. What worker protections?
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Jul 7, 2017 21:28
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CopperHound posted:I don't understand why this is so accepted... It is surreal being the partner of someone who is going the residency when I won't work 15 minutes over 40 hours a week without overtime compensation. Ironically, I think that part of that is how competitive the medical field is. You are unemployable if you won't work those hours. If we shed some doctors to other states, hospitals might be willing to employ them at normal hours.
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Jul 8, 2017 02:19
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another part is that a lot of older doctors who are in a position to change the culture have rationalized it as being character building or necessary education, or else they did all that suffering when they were younger for no reason.
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Jul 8, 2017 02:27
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https://www.theatlantic.com/business/archive/2017/02/doctors-long-hours-schedules/516639/quote:Residents in America are expected to spend up to 80 hours a week in the hospital and endure single shifts that routinely last up to 28 hours—with such workdays required about four times a month, on average. (Some licensed physicians continue to work similar schedules even after residency but, importantly, only because they choose to do so. The vast majority of doctors work fewer than 60 hours a week after they complete their training.) So we're not really talking about "doctors" so much as "residents." quote:Part of the reason medical training is so demanding in the United States is that hospitals control the labor market for residents by assigning spots based on a centralized matching system rather than an ordinary, competitive market. So residents in the US face grueling hours and a lack of negotiating power that leads to them mostly because hospitals are acting as a collusive monopoly and the government does fuckall about it. In fact, quote:“The match was created in 1952 to eliminate the pressure that was being placed on medical students to accept offers earlier and earlier during medical school, and typically before the students knew what other offers might be available,” explains Mona Signer, the president and CEO of the National Resident Matching Program (NRMP), which administers the match. Signer therefore dismisses the notion that the match harms residents. Instead, she says, it “creates order out of chaos,” to the benefit of both institutions and the residents they employ. (She further notes that the NRMP itself “does not take any position on the salaries and benefits received by residents in training.”) Congress decided the benefits of kowtowing to the various hospitals and medical associations and etc. (e.g., donations, lobbyists) was more important than either antitrust laws, or the safety and welfare of residents and their patients. quote:residents are also a cheap source of skilled labor that can fill gaps in coverage. They are paid a fixed, modest salary that, on an hourly basis, is on par with that paid to hospital cleaning staff—and even, on an absolute basis, about half of what nurse practitioners typically earn, while working more than twice as many hours.* After adjusting for inflation, residents’ salaries have remained essentially unchanged for the last 40 years. So residents massively reduce the total cost to a hospital for not just their doctors but even their nursing staff. The article goes on to mention, fairly, that residents mostly pick their options based on quality of education and not pay. But, quote:Working conditions, though, are another matter. Residents work exceptionally long hours and are subject to unrivaled physical and psychological demands. And it used to be worse. In 2003, the Accreditation Council for Graduate Medical Education (ACGME), the governing body for medical-training programs, introduced “duty hour” restrictions that, among other things, capped the average number of hospital hours per week at 80 (meaning one week can be 100 hours if the next is 60) and limited single shifts to 30 hours. The ACGME established further restrictions in 2011 which, among other things, reduced the maximum shift lengths to 16 hours for first-year residents (otherwise known as interns) and 28 hours for more experienced residents. quote:Most fundamentally, duty-hour restrictions did nothing to reduce the overall workload of residents, meaning the reforms simply require residents to do the same amount of work in less time. Or as the ACGME spokesperson put it, “ACGME requirements … outline the local institutions’ [minimum] responsibilities” to residents, but ultimately “resident pay, benefits, and working conditions are the responsibility of the local institution.” (It should be noted, moreover, that the ACGME is not involved in the design or implementation of the match.) See, the real problem isn't some federal restriction on total hours: it's the total lack of power residents wield and the fact that, paid like poo poo, they represent maximally-profitable hospital labor for their (usually for-profit) employers. Who, let's remember, the Federal government empowered to act as a defacto monopoly, creating a situation where residents have no real choice but to submit to this system if they want to finish their educations. Moreover, quote:This problem of “work compression” arose independent of the ACGME’s reforms, as medical staffing has generally not kept pace with the rising burden on the nation’s health-care system. For example, the number of patients admitted at teaching hospitals rose 46 percent from 1990 to 2010, a period during which the number of residency spots increased only 13 percent. Accordingly, as the doctors and researchers Lara Goitein and Kenneth Ludmerer have noted, “by the time ACGME restrictions were implemented, residents were already doing much more, in less time and for more and sicker patients, than were previous generations” of doctors. The burdens placed on prospective doctors are so severe that, despite comparatively high wages (everyone knows doctors get paid loads, right?), there's an ongoing shortage. And of course, the actual working hour restrictions are widely ignored: quote:Residents are regularly expected to (and frequently do) work beyond their allotted shifts, with up to 83 percent of them saying that they are either unable or unwilling to comply fully with the rules. Non-compliance is so widespread that medical experts openly fret that duty-hour restrictions may be “promoting a culture of dishonesty” among doctors, given that large majorities of surveyed residents admit they falsely under-report their hours to their programs and the ACGME. quote:A 1999 ruling from the National Labor Relations Board determined that residents are “employees,” not students, under federal law and therefore may unionize. Nevertheless, union membership among residents remains low—hovering between 10 and 15 percent since the 1999 ruling. The problem is, residents eventually finish their residencies and move on. It's a hard sell to get them to organize into unions when the job is seen as temporary. Also doctors are loathe to go on strike, the ultimate threat that all unions must possess in order to effectively force recalcitrant management to accept reforms. But - and here's where this becomes directly relevant to the discussion - we do not have to rely on the federal government in order to regulate health workers' hours: quote:Given the limited impact duty-hour reform has had in reining in the excesses of medical training, perhaps government oversight is in order. Regulation need not be on the federal level. In 1984, in the wake of the high-profile death of an 18-year-old college student in a Manhattan emergency room staffed by overworked residents, New York state instituted the nation’s first mandatory duty-hour restrictions. And even since the 2003 reforms, several states, including Pennsylvania, Massachusetts, and New Jersey, have considered, though not enacted, more stringent rules. And this notion has broad support among voters: quote:The American public overwhelmingly supports restrictions on residents’ working hours. A recent poll conducted by an independent public-opinion survey firm found that nearly 90 percent of Americans believe residents’ shifts should be 16 hours or less, and over 80 percent of those surveyed said that they would request a new doctor if they knew their physician was on the tail end of a 24-hour shift. So in conclusion, if California wanted to it could totally put a stop to the practice of medical professionals working insanely long hours. It only requires the will to do so and, of course, a recognition that this would cost someone money - either the profitable medical industry would lose profits, or the patients would have to pay more for the same care, or both.
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Jul 8, 2017 02:52
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And of course, a single-payer system is designed to shoulder just such an increased financial burden on the sum of us, thus drastically reducing its severity to any of us.
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Jul 8, 2017 03:28
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