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Medicare for All and the Myth of the 40% Physician Pay Cut


#41

Thanks Scott, we are generally in agreement. In my day some children were “red-diaper” babies…a term out of use these days. I have also been an adherent of a “socialist”, Common Good, society, with the same focus by government - a reality that has never been in the US per se - vulture capitalism and corporatism being the status quo.
I looked at the percentages of hospital function, and was way-off target in my beliefs as to government, non-profit and for-profit institutions…I had assumed ignorantly that far more were corporate for-profit…my bad. So something has elevated the costs to hospitals and care costs to the current obscene levels…what? The insurance industry is a prime suspect, but I don’t want to exhibit my ignorance any further. Peace!


#42

Return to the letter and meaning of the “Hippocratic Oath.” The dislocation of opiates in pain treatment is a prime example. While I feel for the foolish experimenters and addicts, their plight should not reflect upon people who have depended on opiates for pain relief, short and long term.
Sometimes taking decades to get it right only to be cut off because a few rich kid families have had to deal with overdoses and suicides. The opiate users that deal with chronic pain often have been of a last resort medication use. The only one left to them. Sadly many doctors have knuckled under to the CDC and FDA’s so called guide lines, denying their patients the pain relief that both doctor and patient have been using, and in return saving patients from suicides due to pain medication denial.
As far as I am concerned you can hang the pushers, but some consequence should befall doctors who violate the Hippocratic Oath. They are knowingly and intentionally doing harm. G


#43

Exactly on the money gandolf! Opiates have been a safe, efficacious, medication in cases where necessary, and used with knowledge and wisdom. The abuse came from greed and ignorance; from complicity between big-pharma and doctor feel-good. The difference between pain relief for those in critical need, coupled with the care and understanding to do so thoughtfully and safely, and ignorant recreational use is a wide gulf.
The WOD was, and still is, a money-maker for many and misery and/or death for others…


#44

Your assumption regarding the proportion of for-profit hospitals was entirely reasonable! It just happens that I have been following this topic for 30 years, since before I took my first college-level econ class. The “protection racket” (as I prefer to call it) has plenty to answer for, some directly, some indirectly. As we hippies used to say, “It’s the system that’s the problem.” We were right then and we are right now. So was Walter Kronkite, who reportedly said that the American health care system was neither healthy, nor caring, nor a system. I don’t know when he said it, if he did. He died in 2009 or 2010, and I’m pretty sure I was saying it by then, along with many others. And the system, such as it be, that is the problem is capitalism.


#45

(https://www.deseretnews.com/images/article/hires/655231340/655231340.jpg)


#46

I will need to find a l copy of one of those infamous Reagan cancer stick ads and frame next to my Pres. Jimmy Carter ad. Imagine a sitting president openly speaking out for the decriminalization of marijuana and siding with NORML.

The first time I met and talked with Keith Stroup (NORML) this ad of Carter’s entered the discussion, and I discovered that Keith co-wrote that historic speech of Carter’s with another person, and the ad came from that speech.

And in the speech, other than decriminalization of marijuana, he also argues for need for rehabilitation resources, job training, and to look at opiate and alcohol abuse as well (boy–did he nail that opioid addiction 25 years before oxy hit the market).

So in essence, he recommended the basics for what Portugal did just years ago.
http://norml.org/about/item/president-jimmy-carter


#47

Also, 3.5 million people die each year of smoking related cancers/disease.


#48

Here the word ‘Myth’ is misused. Something is a myth if it is widely believed, but can’t be proven. Unicorns are a myth. Here, that Single-Payer would force a big cut in physician pay is not, yet, a myth because we don’t yet have Single-Payer and can’t actually look. To jokingly recall one of the famous things Nancy Pelosi said, “We won’t know what’s in it until we enact it.” (Not a good way to enact laws, btw)

That said, we can look at other nation’s Single Payer systems. I’ve read that by the 1980s the Soviet Union’s doctors were about as well trained as American RNs. I’ve read that Britain’s finest medical students emigrate. The shortage in doctors is made up from less well trained immigrant Indians and Pakistanis. And author T.R. Reid wrote in ‘The Healing of America’ that French doctors are less well paid than most other doctors, and accept not getting so well paid. Reid rather liked that.

Just weeks ago another article on Common Dreams referred to the same Koch-Mercatus study to claim that even the Koch-s found that Single-Payer would save the country money, compared to what we have now.

The mistake in both that article and this article was in deliberately misreading the Mercatus study. That study found that Single-Payer would save the country money, IF every presumption that Sen. Sanders’ bill makes was true and it worked perfectly. But it wouldn’t take much for things to go wrong and costs to exceed what we currently pay.

Dr. Paris asserts in this article that the necessary budget savings can be found by eliminating insurer administrative costs and profit. Worthwhile to note that he thinks budget savings of 40% will be necessary. And yes, insurer administrative costs and profits can be eliminated under Single-Payer. But that is simply a matter of labels. Those costs very likely will pop up again under other labels. Dr. Max Gammon many years ago studied the British National Health Service, and wrote it up in ‘Health and Security’. He found that the British NHS suffers from a lot of its own administrative bloat, and that it “acts rather like a black hole in the economic universe.” It always wants more money, but the extra money you give it disappears into it, with no observable improvement in performance.

I think it likely that Dr. Paris would join, even organize, a ‘National Physicians Association’, modeled after teachers’ NEA, to lobby for increasing and more increasing public funding of healthcare. Expect such money to go into the gaping maw of the system, as Dr. Gammon described of Britain’s system.

Note, too, that our existing Medicare system already has a serious fraud and abuse problem. Expect more of it under a Single-Payer system.

Oh, yes. This can be traced back more than 100 years, to when the early AMA persuaded state legislatures to enact licensing laws, restricting who can practice medicine. This was supposedly for our own good, that doctors really were qualified to practice medicine. But it also set up a gatekeeper, who managed the number of doctors in order to keep pay for doctors up there. Just good old monopolism. Their effective limits on how many students could get admitted to American medical schools is why a sizable number of students went to study in the Caribbean, such as in Grenada in the 1980s (justifying Reagan’s invasion of Grenada). We have had, in the past 50 years, some loosening of the government’s restrictions, allowing Physician Assistants and Nurse Practitioners some room to work. But more can be done here. Ditto, by the way, with pharmaceutical drugs. If a drug is good enough for Europe or Japan, why can’t it be sold here, plainly labeled as to who has approved it?

That should include open eyes to what isn’t working in their systems. Perhaps what we need is some humility, and some freedom to work out our own solutions, as individuals, cities, counties or states, rather than assuming the hubris that something enacted in WashDC will solve our problems, and/or that only if something is enacted in WashDC can our problems be solved.

Discussing a specific example, regarding restraint in using health care resources…

ERs are for when ‘life or limb’ are at risk. Eight years ago I had a hiking accident and broke my leg. It took me over two hours to butt-scoot half-a-mile back to the trailhead. Other hikers offered to call the Rescue service. I did a quick calculation, figured that I could get to the trailhead by the time they could get to the trailhead, and refused the offer. I seriously considered going home, skipping the ER, and going to see the doctor during usual hours the next day. If someone had been with me to help provide sane thinking I would have gone to a 24 hour pharmacy, gotten some crutches, and then skipped the ER, etc. (Know where your nearby 24 hour pharmacy is.)

Now, did Lamonte7 need to go to the ER, or could it have waited?


#49

The road rash i washed and put some ointment on. Wasn’t bleeding too bad.

I went for the shoulder the pain the chest when i was breathing. They took an x-ray gaveme a sling and sent me to an orthopedic doctor next day.

I did save the system money tho. My rotator cuff is still torn, no pain, i just can’t rotate my shoulder. Never went for the surgery.