rickyp wrote:steve

What countries pay less to doctors because they put them through school?

Try reading the study again. The US, even when purchasing power of the dollar is factored for, pays doctors more than any other nation.

Oh . . . my . . . stars! Can you be any less able to read and still qualify as "literate?"

I said "socialism leads to meritocracy? Sure."

Dan responded with some explanation of what you allegedly meant (having consulted either a Magic-8 ball or rabbit entrails--he didn't specify which) and said it wasn't necessarily socialism.

That's why I asked what countries pay less to doctors after picking up their school bills. Those countries have . . . socialized medicine!

So, your response is a complete, absolute, bonafide non-sequitur. The fact that "most of those other nations pay all or part of the cost of the education of their doctors" does not change that.

I don't think it's a bad thing the US pays more than other countries for doctors. In fact, I prefer that field to be well-compensated. I would rather have the best and brightest attracted to medicine.

A pure meritocracy simple means that the best students compete for the positions based upon their scholastic records. When the students aren't disqualified because they can't afford tuition or books etc., all students compete on an equal footing.

Where does this exist?

In the US, for all your whining about legacies, there are any number of reasons why unqualified, under-qualified, or marginally qualified candidates get in. Racial quotas are but one.

But, the idea that everyone goes to school for free does not create a meritocracy. One need look no further than our public school system.

In the Universities and countries you're citing, do they ruthlessly cut out the lesser performers? At what rate? Are their graduates and doctors world-renowned as the "best" and "brightest?"

If you want to claim "meritocracy," prove it.

I'm not sure why you have trouble comprehending this.... The fact that students who do pay their way can be excellent doctors is a non-sequitar.

Um, in regard to what? You said the government picking up the bills establishes a meritocracy. That is "an elite group of people whose progress is based on ability and talent rather than on class privilege or wealth." Simply having their bills paid for them does not mean you will get the most able and most talented. Some of those are quite able to pay their own way. When all personal investment is removed, you will have more people in the system, more restrictions, and less merit-based advancement. That is always true.

The more competition there is, the better the final product.

If you really believed this, you would never support socialized medicine.

And when you remove affordability as a factor the competition pool becomes largest.
(Its really the basic reason the Finnish education system is better... More competition for positions in teaching schools... )

Theoretically, artificially, correct. In the real world, what does the government do when it pays the bills?

Insist on "fairness." Like what?

Gender equity? Quotas? Balance in grading? Retention programs?

In any event, why don't you start another Healthcare forum? We know you love socialized medicine. We know you think the US spends too much. We know you think government is the solution.

However, what you don't seem to know is that our government is the problem. Yeah, really. See, our government passed something we call "Obamacare." We don't like it and the President doesn't even want to talk about the tax increases and deficit increases that will accompany it.

So, you can keep babbling about the marvels of paying doctors (and med school dropouts) for going to school in order to save money on salaries. I'll stay focused on actually returning competition to the real world of medicine.

rickyp wrote:Lets say every time you get down in the weeds and examine the subtle differences (the few hours difference in the definitions of live birth for instance), the US improves its relative performance... does the end result still justify an expenditure of 5 to 7 points of GDP more than the compared nation?

Well, since I don't consider it government's duty to provide healthcare the difference is without distinction to me.

However, if you are using flawed figures to make your argument, it makes your argument flawed. He is trying to say that we spend more money on healthcare for a lesser result. When apples are compared to apples, this is demostrably false. Therefore, his argument is invalid.

freeman2 wrote:It seems to me if you're going to blame the government for being the cause of high health
costs without commensurate health care benefits, then you should be able to explain how other western countries are able to deliver health care at a cheaper cost to everyone while at the same time doing better than we do with regard to the overall health of their people (life expectancy, infant mortality, etc.) I understand why health insurance companies and pharmaceutical companies would blame the government for high health care costs, but given that other countries with socialized medicare do a better job of delivering health care I don't understand why anyone would think that government is the major culprit here.

I think this is a fair marker. This is a huge part of our economy, so I don't think it can be easily explained, but one thing that you have to look at is how much money the US spends on elderly health care towards the final stages. Partially for cultural reasons, and partially for structural market reasons, the US spends a disproportionate amount of its health dollars in the final year of life, in many cases in cultural denial of the course of life. I wonder whether our spending would be disproportionate to the rest of the world if you factored this aspect out. The US can certainly spend more on prenatal and early childhood health care than it does.

In many cases no cost is spared when it comes to end of life healthcare. Many doctors are not in favor of this, but are trapped in a system where they can get sued if they don't, and they can get wealthier if they do. In most cases this is on the government's dime because of medicare. If you have considerable assets in the US, you will be approached by attorneys and estate planners on putting together paperwork (heath care proxies and DNR instructions) so that ridiculous end of life measures are not partaken, partially out of fear that it will cost your heirs big time, and partially because it's not worth it when you factor in quality of life with quantity of life and how you spend your final days. But if you are not wealthy, there's a much better chance that you won't have such documents. This seems to me to be a function of Medicare and Medicaid, and not free markets.

In any case, if you are a Democrat, you have to ask yourself why Obama did not bend the health care cost curve down as he promised and correct some of these problems. He came in with more votes than any other President, a majority in both the house and senate, and a huge mandate to govern. I don't foresee the Democrats having a better chance or a solider mandate to reform our health care system in another generation. Why doesn't Obama own any of these shortcomings in our health care system?

ray

This is a huge part of our economy, so I don't think it can be easily explained, but one thing that you have to look at is how much money the US spends on elderly health care towards the final stages.

This is not unique to the US.
If you want to isolate the things that make the Us the most expensive, look for things that are unique.

Here's one:

We asked doctors in all these different countries: How much is your malpractice insurance? Will you ever be sued? And [they had] very low insurance rates, and no, they don't ever expect to be sued. So how do those other countries maintain quality in medical care?

If you take Germany, for example, the doctors are employees of the hospital, and the whole hospital is accountable for everything that happens in its walls. With us, we have the strangest system: A hospital is a free workshop for an independent businessman or -woman called the doctor, who can go in there and order nurses and everyone around and cause costs, etc., but is actually sort of independent. The hospital isn't really accountable for the work even of the anesthesiologists and the radiologists, because they're freestanding entrepreneurs. That system is much more difficult to control, quality-wise. In the other countries, where doctors working in a hospital are employees, there is internal quality control

.
source: http://www.pbs.org/wgbh/pages/frontline ... ctors.html

archduke

Well, since I don't consider it government's duty to provide healthcare the difference is without distinction to me

.
If someone shows up at the emergency ward, and they have neither health insurance nor the independent mens to pay for their care, would you trun them away? Just asking...

However, if you are using flawed figures to make your argument, it makes your argument flawed. He is trying to say that we spend more money on healthcare for a lesser result. When apples are compared to apples, this is demostrably false. Therefore, his argument is invalid

True. But my point was that if the numbers are so wide in one area (over all percentage of GDP, and actual dollar to dollar comparsions of costs) and in the other are quite small....
the insistence on orange to oranges is somewhat meaningless.
Here's an orange to oranges comparsion on costs:

http://www.businessweek.com/blogs/money ... _pric.html

ray

This is a huge part of our economy, so I don't think it can be easily explained, but one thing that you have to look at is how much money the US spends on elderly health care towards the final stages.



This is not unique to the US.

What is your source for saying that the extent of these expenditures is not unique to the US? I do know that a huge % of medicare spending is for the last year of life. Do you have a source that compares that end of life spending for other countries?

If you want to isolate the things that make the Us the most expensive, look for things that are unique.

Here's one:

We asked doctors in all these different countries: How much is your malpractice insurance? Will you ever be sued? And [they had] very low insurance rates, and no, they don't ever expect to be sued. So how do those other countries maintain quality in medical care?

If you take Germany, for example, the doctors are employees of the hospital, and the whole hospital is accountable for everything that happens in its walls. With us, we have the strangest system: A hospital is a free workshop for an independent businessman or -woman called the doctor, who can go in there and order nurses and everyone around and cause costs, etc., but is actually sort of independent. The hospital isn't really accountable for the work even of the anesthesiologists and the radiologists, because they're freestanding entrepreneurs. That system is much more difficult to control, quality-wise. In the other countries, where doctors working in a hospital are employees, there is internal quality control
.
source: http://www.pbs.org/wgbh/pages/frontline ... ctors.html

Ricky, from that same interview:

Does our malpractice regime add significantly to the cost of American medicine?

The average cost of malpractice [insurance] premiums as a percent of national health spending is around 1 percent. The cost people attribute to the system is what is called "defensive medicine": that doctors will order tests or do procedures not because they're convinced clinically they should do it, but they always have in mind: "I'm sitting in a courtroom and they say, 'Did you do this test?,' and if not, the jury would nail me."

The AMA [American Medical Association] has estimated it could be up to 10 percent [of tests]; we don't really know what it is.

Don't you have to ask yourself why Obama didn't reform the tort system as part of his health care initiative? Would it be fair to say that he was beholden to the legal profession for contributions? He basically chose the legal profession over dealing with our large deficits.

Ray, I found a source for the UK which shows a similar level of proportional spend on over-65s. When I get in I'll append it to a post that counters ARJ's assertion that methodology is the difference (also with link).

I notice in both a comforting myth of American Exceptionalism. You guys care more than those barbaric furriners do about ickle babies and old people, and doing so is the only reason that you look expensive and not particularly effective next to us. Oh, and we are probably deliberately massaging the figured just to make America look bad anyway.



It's one way of dealing with reality, I guess, to fall back on myth.

danivon wrote:Ray, I found a source for the UK which shows a similar level of proportional spend on over-65s. When I get in I'll append it to a post that counters ARJ's assertion that methodology is the difference (also with link).

I notice in both a comforting myth of American Exceptionalism. You guys care more than those barbaric furriners do about ickle babies and old people, and doing so is the only reason that you look expensive and not particularly effective next to us. Oh, and we are probably deliberately massaging the figured just to make America look bad anyway.



It's one way of dealing with reality, I guess, to fall back on myth.

Thanks on the detail. On the big picture, you are not getting my drift. I'm saying that the US overspends, but that it is not because capitalism is evil; rather, we've created a crazy health care system, partially because of medicare and medicaid. But rather than only blame capitalists (which is Freeman and Ricky's line) I think that some of the blame falls on trial lawyers and the system that has been created by both Republicans and Democrats, including Mr. Obama -- who promised to deal with it by bending the cost curve down and taking the best ideas of both parties -- but failed. Remember that this whole discussion on runaway health care costs was offered as some sort of rationale for Mr. Obama's wasted stimulus spending (or at least as far as I can tell that is why we are talking about health care in this thread).

rickyp wrote:If someone shows up at the emergency ward, and they have neither health insurance nor the independent mens to pay for their care, would you trun them away? Just asking...

As much as I wonder which men you think need to be paying (do you think women need to be attached to men via relationship to pay for bills? You sound pretty Neanderthal-ish), I need to answer your question.

Uninsured or non paying people, when they arrive at the ER for service, should be treated for the emergency care only. If the medical professionals determine that the malady is not an emergency case (i.e. cold, etc...) they can and SHOULD be turned away. There are medical clinics that can see those needing assistance. Can we please return this forum to the Obamanomics focus? I will start another forum for RickyP to post about Health Care if it would help.

rickyp wrote:If someone shows up at the emergency ward, and they have neither health insurance nor the independent mens to pay for their care, would you trun them away? Just asking...

Well no. First I would tell them to use the current system of medicaid as it is set up. Which is to ask the hospital to apply to medicaid to cover them.

Barring that, I would say no have the hospital treat them but explain to the patient they will be responsible to pay for all cost incurred in treatment if they do not have insurance. Then it would be up to the person to ask what the costs would be.

Archduke Russell John wrote:Well no. First I would tell them to use the current system of medicaid as it is set up. Which is to ask the hospital to apply to medicaid to cover them.

Barring that, I would say no have the hospital treat them but explain to the patient they will be responsible to pay for all cost incurred in treatment if they do not have insurance. Then it would be up to the person to ask what the costs would be.

Sounds all very proper. Does the same apply if they present in an unconscious state? What if they unhelpfully die before being able to be presented with the bill?

Oh, and an additional:

What if they present with the symptoms of a treatable yet virulent communicable disease and can't pay? Do you turn them away and just treat the (insured) people who end up catching it from them? Surely if individual health is not a government responsibility, public health is?

danivon wrote:What if they present with the symptoms of a treatable yet virulent communicable disease and can't pay? Do you turn them away and just treat the (insured) people who end up catching it from them? Surely if individual health is not a government responsibility, public health is?

You treat them and bill them.

See the other thread, ARJ.

The government sure can pick winners and losers, can't it? I'm so glad to have Uncle Joe and Uncle Barack as my investment brokers. They really know the market!

The parent company of an electric car battery maker that received more than $100 million in government funding from the Obama administration has filed for bankruptcy protection, the company announced Thursday.

Alex Sorokin, the CEO for lithium-ion battery manufacturer Ener1, said the company suffered when demand for the batteries dropped as fewer Americans than expected opted for electric cars.

"This was a difficult, but necessary, decision for our company," Sorokin said in a statement on its website. "We moved aggressively to reduce costs and shift focus when the marketplace did not evolve as quickly as anticipated. Our business plan was impacted when demand for lithium-ion batteries slowed due to lower-than-expected adoption for electric passenger vehicles."

EnerDel, a subsidiary of Ener1 dedicated to making batteries for electric cars, was awarded a $118 million grant from the Energy Department in 2009 as part of President Obama's economic stimulus package and green energy push. Ener1 said that the bankruptcy filing and newly announced company restructuring would allow its subsidiaries, including EnerDel, to "continue normal operation."

The filing came exactly a year after Vice President Joe Biden visited an Ener1 manufacturing plant in Indiana where he proclaimed the company was the "start" to reshaping the way Americans drive and "the way Americans power their lives."

"A year and a half ago, this administration made a judgment. We decided it's not sufficient to create new jobs -- we have to create whole new industries," Biden told the plant workers then. "We're back in the game."

Hey, if we weren't "creat[ing] whole new industries," why, the benefit might all go to China! Can't have that!

How many more failures like this do we have to see before we realize how wrong-headed this is?

Is the failure permanent? Or is it a retrenchment that will allow the company to continue to operate and respond when the market does get larger?

Ener1 said that the bankruptcy filing and newly announced company restructuring would allow its subsidiaries, including EnerDel, to "continue normal operation

."

An equal and interesting comparison. Romney's vision for bankruptcy of GM and Chrysler versus the bailout that is working and has kept a lot of people employed... Which one strikes most people as the least disruptive to the thousands of families employed at the two companies? Which is "fairest? Theres that word again...

rickyp wrote:Is the failure permanent? Or is it a retrenchment that will allow the company to continue to operate and respond when the market does get larger?

Ener1 said that the bankruptcy filing and newly announced company restructuring would allow its subsidiaries, including EnerDel, to "continue normal operation

."

An equal and interesting comparison. Romney's vision for bankruptcy of GM and Chrysler versus the bailout that is working and has kept a lot of people employed... Which one strikes most people as the least disruptive to the thousands of families employed at the two companies? Which is "fairest? Theres that word again...

Since you don't know . . . you can fantasize. Liberals like to do that.

And, here's something you don't understand: what Romney proposed was legal. What Obama did was not. Have a nice day.