The Peaceful Coexistence Of Healthcare Matter And Antimatter

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The Republican mind is a complex thing, awesome to behold and to contemplate.

Contemplate, for example, the passionate Republican opposition to the central health care reform proposal the Obama administration is advocating (at least, they seem to be advocating it, as of now): a public plan.

Here’s the NYT, capturing the passion perfectly:

The public plan concept has excited intense opposition from Republicans, insurers and big business. Stuart Butler, a domestic policy expert at the conservative Heritage Foundation, calls it “a nuclear minefield on the road to universal coverage.”

The beauty of the Republican opposition to the public plan is that it is simultaneously based on two diametrically opposed propositions. In lesser minds, the two propositions would collide like anti-matter meeting matter, thereby literally blowing your mind. But the Republican mind has evolved to the advanced state where it can simultaneously subscribe to two absolutely opposed concepts without suffering any collateral damage.

One the one hand, Republicans passionately argue that a public option must be opposed at all costs because it is doomed to failure, it would be unable to attract any voluntary participation. This is because who in their right minds would want the government running health care, the stupid incompetent government that couldn’t run absolutely anything without turning it into dust and ashes? Who in their right minds would want bureaucrats making decisions about their medical options? Who in their right minds would want to voluntarily embrace a system that would lead to interminable wait times for everything, that would effectively ration health care?

When Republicans passionately argue thusly, people with an IQ exceeding their age are not allowed to bring up the question of why Republicans need to fervently oppose a voluntary option that is predestined to fall flat on its face. If these Republicans actually believe what they are saying (and they must, right, because they are all honorable men?), they should just want to stand quietly to one side — repeating over and over again the mantra that they only want Obama to fail, not America or Americans — till Obama’s pet plan totally bombs in the marketplace. Then they can step back onto centerstage, and dance delighted little jigs on Obama’s political corpse, with hobnailed boots.

On the other hand, Republicans passionately argue that the the stupid incompetent government’s public plan would be so efficient and attractive to consumers that the health insurance industry would turn into dust and ashes:

But critics argue that with low administrative costs and no need to produce profits, a public plan will start with an unfair pricing advantage. They say that if a public plan is allowed to pay doctors and hospitals at levels comparable to Medicare’s, which are substantially below commercial insurance rates, it could set premiums so low it would quickly consume the market.

Although the numbers are disputed by public plan advocates, the Lewin Group, a health care consulting firm, recently projected that a plan paying Medicare rates would prompt 119 million of the 172 million people who are privately insured to switch policies (while also providing coverage to 28 million of the 46 million uninsured).

This time around, people with an IQ exceeding their age are not allowed to bring up the question of how come it’s not scandalous when Medicare pays doctors and hospitals at Medicare levels but it would be scandalous if a public plan did so. Or the question of what’s wrong with bringing down premiums. Or the question of what’s wrong with forcing private insurers to negotiate lower rates with doctors and hospitals and simultaneously tighten their belts when it comes to administrative and overhead expenses (perhaps by dismantling part of the vast free-market bureaucracy dedicated to coming up with excuses for denying claims by foul means). Or the question of what’s wrong with performing a little cosmetic surgery on private insurers’ bloated profits.

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Here’s a little bonus aside, at the end. If you thought New York Senator Charles E. Schumer was bought and paid for only by, and cravenly beholden only to, investment banks and hedge funds, he’s inviting you to think again:

Mr. Sheils (John F. Sheils, a senior vice president at Lewin) estimated that only 12 million people with private coverage would migrate to a public plan if Congress provided protections for insurers, along principles suggested by Senator Charles E. Schumer, Democrat of New York. Seeking to broker a deal that might attract Republican support, Mr. Schumer is promoting many of Mr. Nichols’s proposals (Len Nichols, the director of health policy at the New America Foundation), including that a public plan be subject to the same regulations as private plans and that it pay providers at higher levels than Medicare.

This guy’s not only a Democrat, he’s regarded as one of the pillars of the Democratic establishment. And here he is, quietly working to scuttle real healthcare reform from within. Unapologetically, and in full public view. And under the bald-faced pretext of attracting Republican support.

Someone forgot to tell him, I guess, that healthcare reform is being considered under budget reconciliation rules, that Republicans (or bad Dems) can’t filibuster it, that only 51 votes are required, that there’s no need to dilute the heck out of the bill just to get Republicans on board.

It’s great to be a fundraising king, isn’t it?

Comments

  1. Anon Medical Student says:

    I agree that costs need to be cut. I gather that people have this perception that physicians and drug companies are greedy evil people who want to rip off the hard working American people. I, for one, am not like that. However, there are a few realities that one should take into account:
    1. From upcoming students: what intelligent and sane person would put themselves 200-400K dollars in debt (without taking into account interest) while having minimally 11 years (where they are paying and not making income) or maximally 16-18 years of education in hopes to come out of training to be fighting for years and years to pay back such loans. Additionally, during this training when the average American works 40-60 hours a week, this physician will be working 80+ hours a week, not seeing their family and having very little of their own time to enjoy any part of life that most people find essential to their lives. The answer is no one. So, in reality, if you want to cut costs by paying physicians less, ok, but you need to either bail us out of our debt and reduce our training and on the clock time or prepare to be treated by less qualified people as fewer intelligent people would make such an immense sacrifice for themselves and their family. I have no problem with the proposed paycuts, but bail me out of my educational debt and let me work the average work week that most Americans work.
    2. If you want good drugs at a cheap price, raise taxes on all people to make government research and development of drugs. Pharma companies have to pay smart people to come up with the idea, do the research and push these drugs through FDA trials. The government does not do such things. No company can function and keep their investors investing if they lose money on all their products. Furthermore, those highly trained researchers, those PhDs in pharmacology, biochemistry, molecular engineering, etc are going to go elsewhere to make money to support their family. If they have to struggle their whole lives to pay off loans, why would they choose that life.
    3. Take away your rights to sue physicians and pharma as neither can afford to pay for law suits anymore
    4. Be prepared to wait longer – that is the reality. You want your ACL fixed – well if there are more important surgeries to be done, something not so emergent such as your ACL will have to wait. Michael Moore can cherry pick his data all he wants, but the proof will be in what you see to come. Furthermore, Michael Moore, the President of the US and the celebrities who cry fowl against the medical industry really do not have a right to do so and make the kind of money that they do either. Their salaries all should be brought down just as people are proposing to do so with physicians and pharma – it is only fair.
    5. Patients must take accountability in their own health: You want to reduce costs? Well, if you choose to smoke despite being told of the risks year after year, should the government pay for your lung cancer surgery, chemotherapy and hospice? What about the diabetic who refused to take his/her insulin or oral hypoglycemic meds and will not make dietary and exercise changes? This would reduce the costs of their healthcare, but who will force them to accept this responsibility? What about the alcoholic who comes in month after month for falls+subdural hematomas or eventually cirrhosis/liver failure/liver cancer? What do we do about this?

    There are many questions to be answered and people need to think very carefully about what they want their healthcare to become.

  2. Barry says:

    I understand the struggle of the medical student to pay for their educations, they are not alone however. Any one who’s parents aren’t paying for their advanced education are in the same boat. Education costs need to be brought down. I’m a true believer in public education being extended to include at least 2 years preferably 4, of advanced education. Private colledges would still be out there, but would have less enrollment, may be making them lower their costs. Lose the sports programs and let the NFL NBA and the rest, start minor leagues, like the baseball league does and get that crap out of our education system.
    Offer more affordable loans for the continued education required by the medical field.
    In all, the costs all need to be brought down to make education more affordable for all. Then the need to make 6 figure salaries right out of the gate unnecessary. Let the new Drs. prove themselves as one of the best to pull down the higher salaries, just like any other trade.
    The healcare costs are completely out of control, and the claims that they need to be that high are hard for me to swollow. I am a tradesman, I have worked on Hospitals, and when I see private rooms being built that have wood work in them that cost more than my house, just in one room, I have to wonder where all that cash came from. I assume it came from over charging. Profit, at the expense of the insurence, insurence at the expense of the company, or worker. A public health care plan may not be the best plan out there, coverage may not be like what I have now, but it could be cheap enough I could buy it, then purchase a supplimental plan that would bring the coverage up to what I now have and still cost me less every month. The cheaper plan may make insurence companys take less profit, to invest in real estate and the like, and drop their costs, forcing the hospitals to take less profit for the elaborate private rooms in their hospitals, and start a steam rolling effect without starving any one, just lower the profit margins.
    I suggest you follow the Lobby money if you want to know who is going to vote wich way on this issue.

  3. Anon Med says:

    In response to Barry:

    1. In order to simply be an MD or DO, you need to go to 4 years of undergrad and 4 years of medical school. Even in a “cheap state school,” you are going to find yourself in minimally 160,000 debt not including insurance. That is best case scenario if you are paying your way through. If you are not best case scenario, you are looking at 30-40K a year for school alone (not including living expenses or interest). At this point, you are talking about much more total debt. Often, young physicians find themselves hundreds of thousands of dollars in debt during the time when they are trying to start a family and will make 40,000 annually to pay loans and support their family. So to say that anyone in higher education has bills and it is not just doctors is crazy. There is NO other profession out there which mandates students to take on that kind of debt.
    2. When was the last time you worked 80-100 hour weeks? They say that 80 is the limit, but that is a limit for in hospital work. This does not include out of the hospital work and studying. You demand better access and to do this, you have to have doctors working these kinds of hours. The alternative is to let whoever wants to be a doctor come to medical school. This will drive down the overall mental capacity of the profession and people who should not be in charge of taking care of peoples’ lives will do so. In this reality, you will have to give up your right to sue and assume the costs.
    3. Why does it cost so much money at a hospital? Profit for the hospital? In most public hospitals with state funding, this is not the case. Many of these hospitals lose money each year. One of the main reasons is the uninsured. When people come in and have to be treated but cannot pay for services, the hospital has to make up the money by charging paying patients higher or else the hospital will shut down. The very fact that you talk of these “personal rooms” makes me think that you do not go to state hospitals. I am working at the VA right now, which is a very good predictor of things to come as it is 100% government run. There are often 4 people to a room. There is no privacy. This is what will bring down costs.
    4. Barry, if you want to be part of the solution, you, like me and all other people must accept responsibility. This means you need to do all the things which medicine currently believes will promote a healthy life style and reduce the risks of you having to come in for unnecessary medical care. We need to all do the following:
    a. No drinking alcohol, using tobacco, using drugs
    b. Reduce high fat and cholesterol intake. Meaning reduce intake of red meat, eggs, dairy, desserts, non-skim milk, etc
    c. Increase fiber intake (veggies and whole grain breads – no more white bread)
    d Reduce the sugar you take in
    e. Exercise with daily cardiovascular activity for at least 30 min
    f. Do not use your cell phone in the car
    g. Do not ever speed and always wear your seatbelt
    h. At 50 years old, you must get a colonoscopy
    i. Reduce salt intake
    j. other recommendations are out there, but ill stop here

    Barry, are you going to do all these things every day? Do you want your government to tell you to do these things? They will serve to bring costs down. They will reduce your risk for coronary artery disease, heart attacks, strokes, diabetes, some cancers, etc. Do you want to pay for the person who refuses to stop smoking, but demands chemo/radiation therapy and surgery for their lung cancer? Just like with the housing market and the economy in general, it is easy to blame politicians and bankers for things, but there is a certain amount of responsibility that the American people must bear for this problem we have now. Yes, the banks may have given you loans they knew you could not afford, but the reality is that you should have know what you can and cannot afford too and not have bought something you cannot afford (you general, not you Barry). We must all be responsible with our finances as we are all responsible for our actions as adults. What some people are suggesting with socialism/communism is that people are unable to be responsible themselves and need the government to regulate them. That may be true, but I would be very cynical to believe that – and I am not that cynical.

    5. Unnecessary tests: often doctors must order tests and imaging when the likelihood of a positive result is extremely low so that you cannot come back later and sue them for missing it. Barry, are you willing to give up this right to sue if something is missed? If so, this will bring down the costs.

    6. Doctors should earn their right to ear a 6 digit salary. Maybe so. If 8 years of school and 4-7 years of residency training (where we lose money during school and are paid 40,000 a year for 80+ hour work weeks) does not count as working their way up in the world, I am not sure what does. Even still, if you really feel this way, then you salary and everyone elses should also be capped. Celebs should not make millions, politicians should not make millions, the president of the US should not make his 400,000 a year, lawyers should not make 6 digit salaries, etc. I know it is easy to point fingers at docs and say they are evil because they can have a high income potential, but every doctor works his or her rear end off to make what they make. They are the only ones who are having the public demand salary caps. Additionally, if you think it is unfair and think you have what it takes – go to medical school and see for yourself what it takes. No one is stopping you. I worked with a resident who is in her 60s. She was able to do it at that age, so you can too!

    7. drugs cost too much – read my previous post, but in summary, if you do not like it, we should all pay higher taxes to make government sponsored drug research and development. would you like to increase taxes and government spending more? if so, then this is a viable option

  4. matt says:

    you make some reasonable points, but i don’t think you need to repeat barry’s name in every paragraph, we understand that you’re replying to him. no need to personalize it and/or be condescending.

    would you like to address the protectionism inherent in medical licenses and its impact on doctor’s earning power? why must nearly every other profession play on a global field while doctors are largely protected from foreign competition? is it fair to pay you 6 figures when doctors from india, russia, mexico and elsewhere would do it for much less?

    They are the only ones who are having the public demand salary caps.

    come on. seriously?

  5. Anon Med Student says:

    Matt,

    You make points. First of all, I will not repeat your name multiple times. Additionally, I apologize if it sounds like I am intending to speak down to people. I am in no position to talk down to people. I am merely talking out of frustration for all the hard work I am putting in and all the debt I am accumulating in the process of trying to become a physician. Lets talk global salary competition first:

    1. It is wrong in any field. Outsourcing any job from the US for cheap labor is wrong – plain and simple. The cheapest way is not always the best way. In the short run, yes, we save money. In the long run, we damage our economy as a whole, we lose the strength of our industry at home and people lose their jobs. It is crucial to think about the long term outcomes of decisions when it comes to the economy.

    2. Salary caps. The only places I see people demanding caps are with professional sports, CEOs and physicians. No one calls for the capping of the salaries of lawyers, of our politicians (beyond their already high tax payer generated salaries), our celebrities (who so often stand on soap boxes screaming about the injustices of society while they live in a world most of the people in the world could not even dream of), entrepreneurs (who have the potential to generate high incomes) etc etc. Is there are reason that our president should make 400,000 a year? This is WAY more than most Americans, yet he is not proposing a pay cut and no Americans seem outraged by it.

    3. Salary caps – I am personally opposed to it as I feel like the government should not be able to control our earning potential – hard work and intelligence should dictate this. However, if we are inevitably proceeding down the pathway of socialism or communism, then we should all be equal. Once more I will make my demands:

    a. We train for much less time
    b. We work 40 hour weeks
    c. We take no overnight call (or call in general)
    d. We get free tuition
    e. We cannot be sued for anything
    f. Patients concerned about the “change of shift” problems which may come about will have to accept this as part of the system
    g. Patients will have to accept that it will take much longer for them to be assessed given that the resources will be far overshadowed by the soon universal access to health care
    h. salary caps hit lawyers, politicians, entertainers and business people alike
    i. teachers, soldiers, police and firemen/women are paid more
    j. we work no weekends (as many people in the US do)

    Will you agree to such terms?

  6. matt says:

    You make points.

    that’s funny.

    I am merely talking out of frustration for all the hard work I am putting in and all the debt I am accumulating in the process of trying to become a physician.

    lots of people put themselves into debt for many reasons. not sure why doctors are special.

    as far as outsourcing, i’m not arguing the merits for the purposes of this discussion. just pointing out the disparity in levels of protectionism.

    The only places I see people demanding caps are with professional sports, CEOs and physicians.

    in #3 above, you conveniently left out athletes and CEOs. that’s what i was responding to.
    past that, people talk about capping lawyers pay all the time, it’s called tort reform. politicians are constantly under attack for how much they earn.

    However, if we are inevitably proceeding down the pathway of socialism or communism

    i really can’t express how fucking sick i am of people misusing these words.

    in fact i will not agree to your terms. i’ll say again, well-trained doctors from around the world would do your job for a fraction.

    the funny thing is that i don’t have much of a beef with doctors. obviously it is the insurance companies that should get most of the blame in our inefficient health care delivery system. you’re certainly entitled to defend all the money you want to make, but you’ve no more a claim on it than anyone else.

  7. anon medical student says:

    Matt,

    You make good points.

    1. Lots of people put themselves in debt, so why are doctors special. My answer to this is the reason for why people are in debt is important in determining why this is important. I will go back to may main point. During college, as a premed, you are forced to work to make great grades, do well on the MCAT and build a good resume. Many people in other majors are not forced to do the same. For example, I could wake up one day, decide I want to go to law or business school and take a test. Thats all it requires. Next comes medical school which is without a doubt the most time consuming higher education track one could complete. I will not say it is the most difficult, but that it requires the most effort and dedication overall. Then comes residency. This is the time when the debt collectors demand payment, when interest continues to accumulate and when you work 80+ hours a week, sleeping in hospitals, having no weekends off and get paid 40,000 to do this each year. Then comes work where most people continue to work very hard to make the salaries they enjoy. This is investing in yourself and a good reason to go into debt. This is vastly different than going into debt for gambling, for buying a house you could not afford, for living outside of one’s means, for drug addictions, etc etc. Additionally, and more importantly, this investment in one’s self not only benefits the physician financially, but it benefits the population as a whole. Americans demand well trained intelligent people to treat them when they want it. I am not talking about the rich person who wants cosmetic surgery or something like that. I am talking all walks of life – from the homeless man to the rich man (or woman in either case) – people demand to be treated when they come to the doctor/ER and expect to be fixed ASAP. Again, physicians are smart people who could easily chose another career if being a physician meant you had to work crazy hours, train for ever and be in debt forever. Physicians are people, too – people who want to have families of their own and want to send their kids to college and live in a nice community. They have every right to the American dream, too and should not be forced to be slaves to the system. If you are in another field and feel like you have had as much training, spend as much time at work and are as in debt, please enlighten me as I am unaware of such a profession.

    2. In terms of protection – it is not outside the scope of this discussion. It is narrow, short sighted vision that leads to things like outsourcing and to the mess we are in now. What pads the bottom line now may not be the best in the long run. For example, the writing has been on the walls for decades about the oil problems. Car companies elected for whatever reason to promote large, fuel inefficient vehicles and as a result, they have major problems on their hands now. Lets be clear – outsourcing is never a good idea for a nation – never. Furthermore, and skipping slightly ahead to a similar comment:

    “in fact i will not agree to your terms. i’ll say again, well-trained doctors from around the world would do your job for a fraction.”

    I have worked with plenty of foreign medical grads. Do not be confused – they come here with the expectation of making money. In fact, that is the reason they leave their country. Most of them want to go into the more lucrative fields such as dermatology, radiology, orthopaedic surgery, etc, but cannot get into the fields. These fields are very competitive among American medical grads and so the foreign grads often find themselves going to other fields such as internal medicine and family medicine. Less American grads want to do primary care because the pay is much worse (making it harder to pay back loans), the hours are not great and the paperwork and headache of fighting with managed care is terrible. Additionally, their job is in danger as alternative care providers such as PAs and NPs can do parts of their jobs at less cost. Yes, this brings down the cost, but makes the consumer get care from a less trained person. If you are ok with that, then that is you choice. Many people refuse to see PA/NPs while some prefer them. Mark my words on this though – in socialized medicine, there will still be a two tier system and the government insured will be seeing more PAs and NPs.

    3. I left out CEOs/sports – accidental, but the point stands by them as well. It is absurd that celebs (including athletes) get paid what they are paid considering what they do. Some will argue that it is that they are the best and therefore deserve it. I would argue that these celebs have very little right to stand on their soap boxes and demand change and the such when they live on a planet that most people worldwide (including physicians) cannot even imagine. I am not for capping anyones’ salaries however, as I am a believer in you get paid for how hard you work, how good you are and how essential and irreplaceable you are. This brings me to my final point:

    You are so sick of people misunderstanding/misusing the words socialism and communism. Well, we are calling it what it is I am afraid. If everyone is equal despite what kind of work they do and how hard they do it, then there is no incentive to work hard and no incentive to innovate. This is why communism has failed every time it has been tried in history. Saying that you do not like wealthy people and want to redistribute their money to the less fortunate without their consent is not capitalism. It is a form of stealing. Again, no one will bust their butt to be equal when not busting their butt gets them the same thing. Innovation and progress comes from motivation to push forward and succeed. Again, who would go through all that sacrifice to become a physician to make the same amount of money as someone who does not work at all? Is that fair? Having the government take over industries, regulate all commerce, put private health insurance out of business and say all people should be equal is not capitalism and will destroy the drive that makes out country great. With all due respects, if you really sit down and think hard about this and are honest with yourself, you will see this, too. I do not know your age, but if you are out of college at this point and are financially independent, you will know how expensive the world can be and how hard work can be sometimes.

    PS – Final final point: No one is ENTITLED to anything. Entitlement is for royalty and we do not have this hear. You must work hard to get what you want. That is how things work here. So to say:
    “you’re certainly entitled to defend all the money you want to make, but you’ve no more a claim on it than anyone else.”

    is a little funny. No physician is just entitled to their salary. They train hard, excel and work hard when done training. They do not claim it either – they earn it and no one else earns it since they do not do the work, so only the physician who did the work earns it.

    Therefore: If you think this is unfair and think you can do it, I again make the challenge:
    Take out loans, go undergrad, excel in the required courses:
    Biology 1 and 2 + labs, Physics 1 and 2 plus labs, Inorganic Chem 1 and 2 plus labs, Organic 1 and 2 plus labs, Physics 1 and 2 plus labs, take the MCAT, do well, make a strong medical school resume/CV, apply/interview, then take out more loans, go through medical school, do you residency and then you, too, can earn the same salary – it is a piece of cake, right?

  8. matt says:

    the problem is, you’re just re-stating things you already said. i heard you three times before.

    i know med school is hard. people do it because they choose to, no one is making them. law school is hard, b school is hard, getting an advanced math degree is hard. there’s still nothing special about med school relative to the other professional schools. if med school costs too much here, people (including US citizens) should be able to get their degrees in places where it costs less. but you’ll take the protectionism on doctors and their salaries, and call everything else communism/socialism. if you can’t see how singularly hypocritical this is, i think you should probably stop digging.

    i get that you think outsourcing is bad – except for doctors, because of course no one is as well trained as they are here…

    Again, who would go through all that sacrifice to become a physician to make the same amount of money as someone who does not work at all?

    i never said everyone is equal when it comes to work or pay. NO ONE IS ARGUING THAT IN THE PUBLIC ARENA IN 2009. NO ONE. you’re throwing around words that you don’t understand and accusing people of making arguments they simply aren’t making.

    i don’t mind that doctors make money, i don’t care what anyone makes in a vacuum. but when doctors benefit from government protectionism (and there’s simply no arguing that) and then turn around and lobby for lower taxes that prevent funding health care (a basic human right) then, well, fuck them. this goes for any of the richest americans, but doctors should understand better than anyone what happens when people go without treatment.

    finally, i don’t have to go to med school or take on debt to understand what it means. you harp on this again and again, but it really has no relevance at all to the current situation.

  9. anon medical student says:

    Matt,
    You make points.

    I harp on this because you do not get it. We work harder than ANY of those other professions. I am tired of having to tip toe around it – it is a fact. Compared to med school, law school, business school and most graduate programs are absolute jokes. Some of the material may be difficult in other schools, but they in now way require that amount of dedication or time (not to mention debt investment). I harp because you seem to not understand this. If you went through it, maybe you would.

    If you think it costs too much here and people should go elsewhere, then come back, you do not understand a thing about our medical system. People come here from other countries to get educated and then they go back to apply what they have learned. It does not work the other way. If you train outside of the US, you are selected against systematically. That is a fact. Before you lecture me about the health care system, get your facts straight.

    I will harp again on what I said – I am not for outsourcing in ANY fields. Work should be done in the US to keep people employed. Outsourcing for anything – from making shoes, to food, to reading CT scans is a short sighted, fiscally irresponsible thing to do and those who do it should be penalized financially for doing so – either by government regulation or by the American people refusing to use their goods and services. In the end, outsourcing of any kind hurts us all.

    In terms of you saying that no one is arguing about redistribution of wealth, which in its essence is not capitalism and is more like socialism or communism (the concept of redistributing wealth), you need only to look around you. It is everywhere. Have we gotten to a point where it is necessary? Maybe so. However, I am going to call it what it is. If a doctor trains harder than any other people and works harder than other people, he or she is more valuable to society and does a job that few people could do and by the law of supply and demand, they get paid more. It is simple economics. To ask them to train as hard and work as hard and not compensate them is asking to redistribute their earned wealth. Now, you go a step further and argue that docs enjoy government protectionism and demand lower taxes. Here is the truth:

    The government does NOT protect doctors – not from pay cuts nor from lawyers. Tort reform is a joke in many places and we are told in medical school that most physicians will be sued. For example, I worked in a derm office where a patient had a melanoma removed and was told he was at a higher risk for a second melanoma and needed annual checkups – this was documented in the chart. However, the patient ignored the warning. 5 years later, he had another melanoma that had spread to his brain (he is going to die from this). He sued the dermatologist for this saying that it was his fault. He was not going to win this suit, but the point was that the dermatologist then had to pay me a salary to go through all of his charts and call any patient who was diagnosed with a treated for melanoma or a squamous cell carcinoma that did not come for followup and ask them to make an appointment. Most people told me they were fine and asked if business was so bad that we had to plead for people to come to in. He had to pay me to do this because of choices patients make. Ah, but I digress. The main point is the government does not protect us from a law suit crazy society. In terms of our salary, they are indirectly set by the government. The government sets medicare reimbursements for services and the private insurance sets their reimbursements around what medicare does. So, when the government says we no longer will pay you X for this procedure, but will pay you 1/8th of X, the government decreases the physician’s income and private insurance follows suit. So, to answer your question – no – the government does not protect doctors. Now the fact that they set reimbursements so that the average salary of a doctor is above 100,000 may be what you are referring to as “protection.” Again, not to beat a dead horse, but value of work is set at how trained one is, how many other people can do that same job and how much people are willing to pay for having that job done and done well. The government and society value the physician’s salary at above 100,000 because he or she meets that criteria.

    Healthcare is a human right that is undeniable. That is a politician’s phrase. No where in the constitution does it say health care is a right. Again, no one is entitled to anything – this you said yourself. Here is another fact of life that I have said before – medical treatment costs money. Lets say you have some illness and want treatment. Aside from the doctor’s bills, you will also have to pay for medicine. There are different tiers of medicine. In an effort to cut costs, people without insurance are often given lesser and cheaper meds. Is that fair? Do people not have the right to the best care here in the US? Politicians would lead you to think so. In an ideal world, this would be how it would work. Medicine would cost nothing, doctors would work for free, hospitals would not have bills to pay and when you get a cold, you come in and demand a 4 day stay at the hospital. That is not reality however. No system could ever sustain something like that because there is a limit of resources – and their lies the problem with spending what you do not have.

    Lastly, your point about doctors should know best about what happens when people are not treated:

    Newsflash – and I have harped on this before – this is a two way street. Doctors are not miracle workers. People must practice preventative medicine including the ban of smoking, drinking or drugs. People must ban the consumption of red meat, desserts, dairy with fat, cholesterol, etc. People must exercise as recommended. Diabetics must take their meds. People with high cholesterol or hypertension must take meds. At age 50, people must get a colonoscopy. Are you going to do all of these things? Most people will not. This would save enormous costs and in a fair world, people would do this. However, as we know, this is not a fair world.

    I dont know if you are on your own financially or not, but you sound a lot like I did in the beginning of college. It is easy to be super liberal and not think about the consequences to the ideas you propose when other people pay your way. I am not saying it is best to be far off to the right, cram your religious and moral views down other peoples’ throats and let the poor and the children die on the side of the street. What I am saying is that everyone must work, everyone must try their best and those who work hard should reap the benefits of their work. A society should help those who cannot help themselves, but should not promote a society of apathy.

  10. matt says:

    words words words…hard work…socialism…i want mah money…

    like i said, you’re just repeating yourself. you don’t understand the inherent conflicts in your own argument, and i hope that doesn’t say anything about your doctoring ability.

    best of luck.

  11. anon medical student says:

    Ok Matt, I am going to ask because debating with you is like debating the religious right – you do not back up anything you say and you are always right in your mind regardless of the fact that you never make a point. This clearly means that you are brainwashed by someone else who has told you what you think you know about the economy, about socialism and about how the world works. So I ask again – what do you do and moreover, are you financially independent? I am guessing you are a student.

    There are no conflicts in what I say – I stand on one side of the line and repeat the same thing because people like you seem to not understand anything about hard word, about the economy and about health care in general. Once more, here is where I stand – you get what you put in. If you are a college student who puts in nothing and your parents are paying your way right now, you simply do not understand that. If put in something and someone else gets the rewards of your work because they do not work or do a job that pays less for whatever reason, that is distribution of wealth and hence socialism which eventually can lead to a complete and equal distribution of wealth (controlled by the government), which by definition is communism. Moreover, if I make my money from work and do not willingly give it away, it is a form of stealing. This is different then paying taxes because I benefit from my paying of taxes, just as the rest of the country does from my taxes and from them paying taxes. However, by saying that we need to fix healthcare and I will do this by taxing 50% of the top earner’s salaries while not increasing the percentage of tax for all else because they can afford to pay this tax – that is no longer just taxing, but this is stealing. This brings me back full circle – I and many of my colleagues will probably not put in such intense hours, work overnight, work on the weekends and work through holidays to make very little money and to be taxed so much that we have no hope of paying off our debt or of living a lifestyle that all Americans aspire to live. I do not mean having a huge house or a nice car or something like that. What I mean is the ability to have and support a family, to send our children to college so that they can get the education they need to contribute to society and support themselves (without need of government financial support), to hopefully have some security in retirement and to live the normal life that most Americans aspire to do (food, shelter, live in a nice community, clothes, occasional vacation etc).

    Will this affect my doctoring ability? No. Doctoring ability comes from some natural talent, but more from dedication to your studies and to your patients. My distaste with people who take our physicians for granted and expect them to be their personal slaves does not affect how I perceive patients. I went into medicine because I want to help alleviate patient suffering and because of my desire to understand how the human body works. That is what drives me.

    Again, I challenge people like you to go the medical school route to see what it is like to get there. You say you do not need to do that to understand, but let me tell you – YES YOU DO. If you do not go through it yourself, you will never understand.

  12. matt says:

    Ok Matt, I am going to ask because debating with you is like debating the religious right – you do not back up anything you say and you are always right in your mind regardless of the fact that you never make a point. This clearly means that you are brainwashed by someone else who has told you what you think you know about the economy, about socialism and about how the world works.

    projection is not just for movie theaters.

  13. anon medical student says:

    “Projection is not just for theaters.”

    You are very clever. Did you come up with that on your own. OK then, I am going to lump you in with the religious right or stupid people. You make claims without backing up any of them and you refuse to answer any of the questions posed to you. I assume that I am correct that you are a student and your contribution to society is your blogging and so you feel empowered. That is great – I remember being in college and being irrationally liberal. I will leave you then with what my grandfather said to me when I argued with him about matter such as this. I thought I was so clever because I went to college and I knew things. Turns out, his 70 something years of experience amount to a heck of a lot more than my 4 years in college. Anyway, he said some rendition of the age old expression which I will paraphrase:

    You are heartless if you are young and excessively conservative. You are brainless if you are older and excessively liberal.

    When you leave school, get a job, pay your own bills and try to support your family, we will see what you have to say then. Enjoy your fantasy world while it lasts because reality is coming for you soon enough!

  14. sarabeth says:

    Lesson to Matt: never try to argue with a flaming idiot.

    Especially a narcissistic flaming idiot.

    And arguing with a longwinded narcissistic flaming idiot has to be the classic triple whammy.

    I think this guy telegraphed all three personality traits in his very first comment.

  15. anon medical student says:

    Sarabeth:

    Let me dissect out what you have said as it has just as much meaning as what Matt had to say.

    1. Anon, you are a narcissist.
    - Is that because I believe I am better trained than you to understand medicine? Or is it because I have had to work longer hours than you? Is it because while you are at home sleeping in your bed or spending you weekend out by the pool, my colleagues and I spend out nights sleeping in this hospital ensure availability to all of our patients? No, it is because I am stating the truth and this bothers you. Lets say you or Matt work at a local bar, restaurant, interning at a law firm or whatever – are you willing to pay to do this and do it 6-7 days a week for years and making sure you are always available? No. There is nothing narcissistic about it – we work harder than most people and sacrifice more. Short of you being a marine, dont try to tell me you sacrifice and work harder because you are a liar if you say such a thing.

    2. I am flaming? Do you mean that I am literally on fire? Are you making a derogatory comment about sexual orientation? Do you mean that you are just flaming the fire arguing with me? I will assume it is the third option as the other two make you out to be an idiot and I do not want to assume you are one. Yes, you and people like you flame the fire. You are looking for something for free. That is ok – that is human nature. We all would like things for free, but if everyone working for free means that some work really hard and some do nothing all day and act as parasites – which is unfair and is the reason why a pure, true communistic society never works. The last time people worked for free with no personal gain at all was slavery and the people who go into medicine are generally too intelligent to allow themselves to become slaves. Now, does that comment where I assume the average physician to too intelligent to be a slave point out my narcissism? I think not – it is a fact that most if not all physicians are relatively intelligent people.

    3. I am long winded because I type such long responses. You are right about this one. I am long winded because I am so irritated by people like you. You work hard and you hard work will pay off. That is the American dream. Families of immigrants know this as they fled from true hardship to come to the land of opportunity. They work their butts off when they come here. People like you, on the other hand, feel that you are entitled to everything because you grew up here and never knew hardship. I grew up here too, but I recognize you must work hard to succeed in life. However, plenty of kids I went to high school with who had everything handed to them ended up doing nothing with their lives. In fact, many of them went on to get hooked on drugs and some even ODed and died.

    ** NOTE ** I am not anti-drug and that last comment was not meant to sound like I am some unrealistic super conservative person. This is another story all together though.

    4. Your comment had no point to it. You simply said anon student, you are (insert negative word here). You see? You and Matt do not make actual points. This may be because you do not understand and that is OK. Some day you may.

    5. My plan for a good healthcare system that people can afford:

    I know health care is outrageous in terms of cost. I am not denying that. However there are a few key points that must be understood.

    PROBLEM: Healthcare is a commodity, not a right. It costs money to provide healthcare. These costs include the cost of having a highly trained person work on you (physician). Additionally, you may work with many other allied health care providers, many of whom went through long training as well. Then you have to pay for rental of the health care facilities, such as the hospital, ER or whatever. You also pay for imaging that you need done (and machines cost in the millions often). You have to pay for the medicine you use and the research and development that drug companies put into making this medicine. You pay for the administrators who make sure that everything runs smoothly. You pay for the materials used in you health care. More importantly, you often pay (especially at the hospital) to offset the cost of money lost on the uninsured, the poor and those who will not pay their hospital bills for whatever reason. Unfortunately, health care facilities and workers have bills to pay as well and so they cannot take more losses than income and they therefore have to raise prices to compensate for those who do not pay.

    SOLUTIONS
    1. Tort reform: If you bring a lawsuit against a physician just to try to make a quick buck and it is found to be a frivolous lawsuit, the plaintiff, in all cases, should be solely responsible for paying for the court costs and the lost work time of the physician. In turn, physicians would stop having to order unnecessary tests to protect themselves from lawsuits. This would also drive the malpractice insurance costs down so that doctors did not require as high of salaries. In some states, certain specialties are required to pay tens of thousands of dollars annually just for insurance – which must come out of their salary.
    Additionally, malpractice suit payouts must be capped at a reasonable size.

    2. Physicians should have income lowered somewhat. However, this means physicians should not be required to incur as much debt as they do. In turn, this means the cost of healthcare should come down. First, taxes need to be raised to subsidize the costs of medical schools. Second, see number 1. Third, doctors should not be required to work more than the general population. What this means is that the supply of doctors must increase exponentially to allow them to have enough doctors so people can work 40-50 hour weeks like the rest of Americans. When you work more hours, you deserve to be paid for them.

    3. Patients MUST assume responsibility as well. This means you MatT and you Sarabeth must:
    a. Not smoke
    b. Not drink
    c. Not do drugs
    d. Wear seat belts always and never speed
    e. Only be permitted a certain blood glucose and cholesterol level. To do this, you must exercise and eat as prescribed by your doctor or a nutritionalist.
    f. You must take medications as prescribed
    g. You must undergo all recommended screens. There is a list of screens recommended, but they include mammograms and pap smears (at the right age) for you Sarabeth and colonoscopies for you both. There may be a digital rectal exam recommendation for you as well Matt, so if your doctor wants you to do it, you will have to do so.

    Now, if you and all Americans comply with this aggressive preventative care, you will save billions and billions of dollars annually. However, if you choose to say, smoke cigarettes, despite warnings of the risk of cancer, COPD, atherosclerosis and more, you cannot be eligible for the costs to treat such conditions which you selfishly decided was worth the risk. Again, there is a limited amount of money in the pot and quite frankly, if you decide to be a smoker Sarabeth, but someone’s little 4 year old boy has leukemia, this child deserves that money and you do not. We are all in this together.

    4. Medications and Innovation: none of this comes free. If you want the smartest researchers continuing to bring you meds and medical tools to help better your life, they have to be paid. If they are paid by private companies, it will be profit driven. However, if the government paid, then it would not be so profit driven and would be more affordable to the population. This means taxes must be raised to pay for such research and development because right now, the only one paying for drugs to go through FDA trials for approval to be used on humans are the drug companies.

    5. Catastrophic medical conditions: Everyone must be ensured for this (unless you are self inducing the catastrophe or you life expectancy is so short that the costs outweigh benefits – as some countries with socialized medicine already do). This means that there must be a universal plan of some kind.

    6. Patience: As a patient, you will have to be ready to wait more. Things will not get done as fast as there will be a great abundance of people with access, but not enough providers. This will mean that more emergent situations get treated first while less serious conditions wait. Unfortunately, this is a team effort and you will have to be ready to sacrifice, too (and wait more than you do already).

    7. Fairness: If you are going to cap doctors’ salaries, the same should go for other professions including athletes, actors, politicians, President Obama, lawyers, CEOs and anyone else who makes more than a set amount. You have to make this a fair situation to everyone.

    Sarabeth and Matt – I am sorry to have to be so mean, I do not mean to make you feel bad. I am just explaining this to you from a perspective you dont understand. Healthcare is a national issue and we are all a part of this. In order to make it work, we need to work together.

  16. sarabeth says:

    Let me dissect out what you have said

    Stick to dissecting frogs, buddy. (I don’t think anyone is listening to you here. so you’re just talking to yourself.)

    By the way, you are pretty deluded if you think anything you wrote has made Matt or me look bad or feel bad.

    And only a flaming idiot wouldn’t understand the meaning of the term “flaming idiot”.

  17. anon med says:

    Oh goody – my favorite time of the day. You know, I never paid much attention to blogs, but I came across your wonderful, fact full, intelligent blog and decided to have some fun.

    Once again, your ignorance radiates from all around you and your words. Again, you have not answered any of the questions and instead made childish comments. You and Matt have comment equivalent to “You are stupid. You are fat.” Honestly, I thought you all were at least in college in that you would have the intelligence to talk about current events. Apparently, I assumed too much. Thats ok though. You must have had a hard day today. Let me guess how this went:
    Woke up at 1130 AM (late night at the bar and mom and dad’s credit card is without limit so you got hammered). Then, you went to your political science class where, in your hung over state, you thought you had a moment of enlightenment and decided to sound off to the world about the latest injustice. You came home, ate some organic something or other that you paid triple for because you, the ignorant hippy consumer believe that organic means better, when really organic simply means that it contains carbon atoms. You did not care though because Mommy and Daddy gave you their credit card to pay for it. Next you went to your blog and typed you garbage of the day. You found my post and upset by my logic, you decided to attack me with “And only a flaming idiot wouldn’t understand the meaning of the term “flaming idiot.” Bravo, lets begin:

    1. “Stick to dissecting frogs, buddy.” Wow smarty pants – clearly no science classes for you since 7th grade biology. Way to go! Yes, in medical school, we learn about human anatomy by studying frogs.

    2. “(I don’t think anyone is listening to you here. so you’re just talking to yourself.)” Well, clearly as you and Matt have responded now a number of times.

    3. “By the way, you are pretty deluded if you think anything you wrote has made Matt or me look bad or feel bad.” No, I do not think I made you both look bad – you both do that pretty well on your own. However, your lack of saying anything about the content about this debate and my making logical points makes you look pretty bad. I mean imagine this in a presidential debate. Obama answers the question in a well thought out speech, then it is McCain’s turn and he responds to the question of what to do about the problems in Iraq by saying to Obama “You are a flaming idiot.” Yeah, that is what you and Matt are like, so I guess in this case we both (you and I) have made you look foolish this time. In fact, I would liken your responses (and Matt’s) to comments by Sarah Palin. I think you three should have your own news show or blog and then let the whole world laugh a little. Afterall, laughter is good for your health and this way you two could actually contribute to society in a meaningful way.

    3. “And only a flaming idiot wouldn’t understand the meaning of the term “flaming idiot.” Way to dodge this one! I did not see this strategy coming – dont answer the question and instead insult him? Wow – brilliant. Reminds me of a 4 year old child at kindergarten.

    Now, back to the main point – read my previous points…but just in case….

    Cliff Notes for Sarabeth and Matt:
    American dream = work hard, get rewarded for hard work. No one is a slave to another person. If unable to work because of things out of your control, then society can help you.

    In conclusion, thank you Matt and Sarabeth for your lovely discussion and your incredible blog showing such a great point of view (this is sarcasm). I am done with this debate as no debate is to be had with you.

  18. matt says:

    >I am done with this debate as no debate is to be had with you.

    we’re going to hold you to that.