Modern Healthcare in the US

[iNow]

Through its use of satire and the presentation of a concept in another context helps to illuminate some of the key problems facing healthcare in the US. Some of this has been improved slightly since the implementation of the ACA, but most of it still rings true.

 

This video presents what the experience would be for an air traveler if booking your trip worked the same way as our "modern" healthcare in the US. The crazy part is that you don't have to strain to imagine how awful this would be.

 

 

 

 

Is there any chance we get this fixed or improved in the current political climate? Other systems in other countries seem to do this all much better, but are there important problems and limitations with those that we should be aware of in the US? What do you think?

 

 

http://www.vox.com/2014/5/22/5739702/the-insanity-of-the-american-health-care-system-in-one-hilarious-video

In health care, prices exist in something of a black box the cost for a given service can vary wildly across hospitals. Need a hip replacement? That'll run you $11,000or maybe $125,000. The reported variation in appendectomy prices is even worse: $1,529 to $182,955.

 

It's somewhat impressive that those studies were able to report prices at all. A different set of researchers reached out to Philadelphia hospitals to try to get a quote for an electrocardiogram, a super routine heart monitoring procedure. Only three of the 20 hospitals could name prices (which ranged from $127 to $1,200).

[Ten oz]

Unfortunately we view capitalism through a religious like prism. Asking how much it will cost, how much can be made, who benefits, how it impacts GDP, and etc will always come before actually helping anyone. With that in mind we need a different approach. The socialist and nonprofit models in Europe simply won't work. I think the govt should work towards flooding the healthcare market with trained service providers. Basic supply and demand. If we had too many trained Doctors, nurses, technicians, and etc it would drive the costs down.

The govt already has massive drives to recruit military, police, fire fighters, and all sorts of other personnel. All those govt jobs come with various paid college benefits. That is a one of the primary recruitment tools. Those paid college benefits can be used for anything. If those programs were adjusted to steer people into college programs related to the medical industry rather than any degree of choice the balance of supply and demand could be shifted within a generation.

Edited May 31, 2014 by Ten oz

[iNow]

The socialist and nonprofit models in Europe simply won't work.

This cannot simply be assumed as factual nor is it really accurate given the evidence at hand. See also: Germany; France; Canada; Great Britain; Taiwan; Singapore, and others...

[Ten oz]

This cannot simply be assumed as factual nor is it really accurate given the evidence at hand. See also: Germany; France; Canada; Great Britain; Taiwan; Singapore, and others...

Those systems work great in those countries. I am not claiming otherwise. I just don't believe they would work in the United States. There are a great many reasons why I don't believe they would work here but the simplest reason comes down to anger. We are a angry nation. Europe doesn't execute it's citizens we do. Europe doesn't lead the world in imprisoning citizens we do. Europe doesn't lead the world in military spending we do. Here in the states we are willing to spend billions punishing "bad people" but aren't interested in spending a dime to help sick people. Our culture is different, more aggressive towards its own, angry. That is why the average American has a stronger opinion about gun rights than they do climate change. We are the only country to ever drop an Atom bomb during war and we aren't even a little bit sorry about it.

[physica]

Does the NHS work in the UK? I've worked in the emergency room for 4 years and I can tell you corruption here is rife. I've lost count of how many consultants use NHS resources for their private practice. Working class cannot afford to go private but the tax they pay helps wealthy people have cheaper private healthcare, is that fair? Also the NHS lies on its stats. It claims to be one of the most cost effective healthcare systems in the world. However, what it fails to tell people is that most of its doctors are training for 10 years or more. They still get a good wage but it's paid through the education budget because it's technically training. Therefore the government can boast about how much they spend on education and how effective the health service is. We also have spoilt brat syndrome. I've worked with many German doctors who fly over to the UK do an agency shift and then fly back to Germany. Discounting the cost of the flight they still make more than if they did an extra shift in their own country, however, us UK clinicians are always moaning about how little we're paid even though our french doctors across the water are on half the wages we are. Also there's no cash incentive. Trying to get someone to actually do their job in a UK hospital is very hard. Because there is no free market you can be completely incompetent and treat your patient like complete trash and you'll still be in a job. This security only aids the spoilt brat syndrome. I have met many doctors and nurses who think they're complete gods and are always telling patients that they are wasting their time etc. Nearly 2 thirds in a poll think that the NHS delivers poor service and is failing.

 

http://www.dailymail.co.uk/news/article-94561/Public-unhappy-NHS--poll.html

 

Also it's government money so corruption is on a whole new level. There was a scandal earlier on in the year where NHS managers were taking out half a million pound redundancy payouts each and then getting employed by another NHS hospital within 2 months. The most depressing thing is that nothing happened because the regulation is so poor that what they were doing wasn't against the rules.

 

I agree we should flood the market. Overregulation creates a monopoly, we should trade with Cuba and take advantage of their world class doctors who will work a lot harder for a lot less. However, the medical profession in the UK is too selfish. We claim that Cuba isn't up to our standards yet anyone who gets over 50% in any degree (no science needed) can become a doctor in 4 years here. I've met many doctors who failed their physics of maths degrees pick medicine because they couldn't get into grad school. Still we have arbitrarily stick regulations to inhibit any true competition and bully the public into giving us their hard earned cash (this is why I'm switching to physics).

Edited May 31, 2014 by physica

[John Cuthber]

"Does the NHS work in the UK?"

Yes, rather well.

For example it costs roughly hale what the Americans pay, and yet we have a better life expectancy.

I don't want to start a "ours is better than yours" argument, but it's clear that the NHS is far from being a failure.

 

 

For the benefit of our cousins across the pond the Daily mail has a reputation for telling sensationalised versions of stories.

 

Also, when you say

"anyone who gets over 50% in any degree (no science needed) can become a doctor in 4 years here."

you seem to overlook the fact that they will have to study a lot during those 4 years and, if they don't pass the exams they don't get to be a doctor.

 

Then you fail to mention the requirement for doctors here to undertake ongoing exams and tests.

 

The biggest problem I see with our NHS is that recent governments (about the last 15 years or so) have been trying to make it more like the system in the US.

They think it should be a business and make a profit. So they brought in a whole lot of management consultants and such.

The absurd state of affairs is that the NHS now employs more management consultants than clinical consultants.

That's the sort of thing that happens when you try to expose a de facto monopoly to artificial competition.

[physica]

Have you sat these medical exams? They are multiple choice. My girlfriend is a GP, she sat her registrar exam in front of a computer alongside people taking their theory driving test. The MRCP is a regurgitation of medical memory tested via multiple choice. My supervisor for one rotation was a medical professor in gastroentrology. He had a phd and multiple publications but he was stumped at the concept of distribution and was always calculating means. There's a reason why st georges, nottingham, swansea, exeter and other med schools accept a 50% pass in an art degree as acceptable for a 4 year degree in medicine, it's because it requires very little scientific acumen. We only train the amount we can employ, if we let in multiple people who couldn't hack the medical training or job we'd be graduating a very small amount of doctors. The system in the US isn't perfect and it's no example of a free market. It's very highly regulated (which is my main grype). If we want an improved healthcare system we need to flood the market. Medical courses are popular, Art graduates can do them in 4 years, make them self funded and train more than we need. Then I won't have to see patients that aren't really an emergency in A and E because the gp who's earning £100 an hour in the urgent care centre isn't assessing them, red streaming them across and sleeping for most of the night. Instead he will be working for his money because they're will be more people getting ready to take his job if he doesn't do it.

[John Cuthber]

"Have you sat these medical exams? They are multiple choice."

No, but the last time I heard, they used negative marking in those multiple choice tests.

So, you get 1 mark for a correct answer but -5 marks for a wrong one.

 

Under those conditions 50% is a very high standard to live up to.

 

Incidentally, re

"it's because it requires very little scientific acumen."

Yep, there''s not a lot of science in medicine, it's largely a massive memory test.

So what's wrong with accepting people who are not scientists?

 

Incidentally, nothing we say about the UK's NHS has a lot to do with the topic so I think we had probably better keep quiet now, before the Mods notice.

Edited May 31, 2014 by John Cuthber

[physica]

ok but one correction, the royal college of anaesthetics uses negative marking but the others don't and if a anaesthetics trainee got questions wrong in that exam then they need their head examining. I've seen many anaesthetic registrars revising PV=NRT for that. Considering that this is GCSE gas laws I don't think it's harsh to negatively mark. Multiple choice seems the most logical as there are so many doctors to examine, however, I maintain that overregulation and government created monopolies are the main problems for any healthcare system. Standards are not so high that we need reams of regulation, all this does is create monopolies so urgent care GPs can sleep for most of the night, get paid £100 an hour to do it and then complain that they don't get paid enough.

Edited May 31, 2014 by physica

[Sensei]

I am not sure why it's in politics..

 

The main problem is that doctors demand money for healing patients.

They are thinking about it BEFORE they even get to medical university!

They want to be "well paid" and quickly rich.

Medic should not be just a job, to earn money, or (in current western standards) "a lot of money" (> $100k ?!? Insane!).

 

It's kinda like wanting to be a priest because people will give money 'on a tray'...

 

Nobody who wants/demands money should become medic or priest!

 

Only people who truly wants to help other people should become medic. Without any money behind this.

Who demands money for saving somebody life demands full condemnation!

 

There is nearly not a week here without some scandal about "ambulance not send" to somebody who called for help, but because his/her injures/state was not health dangerous (by judge of call), and he/she died. All because of money.

Ambulance management not let ambulance to go, to save money for possibly false alarm, that later it appeared to be true alarm..

All because of money!

 

Ambulance stations should not be private businesses aimed at earning money.. !

Hospitals should not be private businesses aimed at earning money.. !

Outpatient clinics not be private businesses aimed at earning money.. !

 

If government has to pay every month pension/retirement we have obvious conflict of interest with government paid medics - if patient lives longer, government has to pay him/her more money, if he/she lives a lot longer, he/she will get more money than he/she paid in the past.

So from government financial point of view, patient that pays for medical care whole life, and then after retirement dies as soon as possible is the best "client".

 

All because of money!

 

Other systems in other countries seem to do this all much better,

 

We have queues long for several years reservations to free doctor, that you would rather die than to live to see him..

At the end who has more than 50 usd (typical 1h price per visit) is going private (10% of minimum gov income per month for visit, so such doctor will earn 100% of minimum gov income in single 10h day! And up to 20-30 times more than regular people per month)

Retired people (without money) (usually who need doctor the most) have to wait several years for visit at specialist.

To get to specialist you need to get referral from general doctor.

So actually you need to meet two doctors one and then another, even if you know what kind of disease you have.

Even if you met 2nd doctor multiple times.

Edited June 1, 2014 by Sensei

[iNow]

I just don't believe they would work in the United States. There are a great many reasons why I don't believe they would work here but the simplest reason comes down to anger. We are a angry nation.

Not that I accept your assertion here as true, nor do feel it even remotely explains why single payer universal healthcare would not work in the US, but just for the sake of the discussion let's pretend for a moment it is and does...

 

If anger is such a profound characteristic of our citizens, then just imagine how much less angry people would be if quality healthcare was not something treated as a privilege available primarily to the rich.

 

Imagine how much less angry people would be if they no longer had to choose between paying their mortgage, putting food on the table, clothing their children, paying for fuel in their cars, and paying for health coverage.

 

Imagine how much less angry people would be if they were no longer bankrupted due to unavoidable illnesses and unforeseen sicknesses, and if obtaining treatment were as straight forward as booking a flight online (as per the video in the OP).

 

Of course it would work and of course single payer care would be both welcomed and successful. We even have a great data point in support of my assertion. It's called Medicare, and everyone who is on it loves it, especially since they still have the option of purchasing private insurance to supplement or enhance it.

 

Our problem is not healthcare, it is the Rube-Goldberg overly complex mishmash of a framework that comes from the private sector in this space... A space that is irrefutably better managed in the public sector (as is so clearly evidenced by the aforementioned countries, as well as others such as Australia). No, the problem is not anger, it is politics and ignorance and people consistently voting against their own self-interests.

 

The populace of the United States is not quite as different as you seem to believe. We are much more similar and have much more in common with those other nations than we are dissimilar or unique. There is no reason that the high quality healthcare systems so successfully delivered in other nations could not also be successfully delivered here. If you disagree, then you are going to have to come forward with a much more coherent and better supported argument than, "people in the US are too angry."

[physica]

We have to stop thinking that a centralised healthcare system is all bells and whistles. Here in the UK the competition is virtually non existent so the innovation here is mostly trash. Take heart disease prevention for example. Inflammation seems to be the underlying process to heart attacks with the inflammation oxidizing the cholesterol. The USA developed the high sensitivity CRP test to be used as opposed to cholesterol levels to assess people risk of developing a heart attack. 10 years later and the NHS still doesn't even recognize it. The depressing thing is that the NHS uses it in it's cardiac research to maintain international appearances but try getting a patient on hs CRP tests to prevent a heart attack in the UK and it just wont happen so we're about 10 years behind on that front. American clinical practice is the envy of the world, there medical technology innovation is second to non. The issue is with excessive regulation, you have that you have a monopoly and then you have people charging what they want. Cuba has world class doctors highly disciplined doctors. They train them very well because they are the country's commodity. They have more doctors working abroad than the world health organisation. They trade doctors services with countries for oil and other products. Open the door to them and you will flood the market with doctors willing to work a lot harder for a lot less.

 

Not so long ago there was a NHS scandal commonly known as the mid staff scandal where patients were left in corridors and nurses were allocated trolleys in the corridor, only after many needless deaths was the trust investigated, the depressing thing is that the managers implicated in that trust didn't get touched and some even got promoted. People moan about the power that huge corporations have and how they can throw this power around and hurt people. What do you think a centralized healthcare system does? Working in the NHS is like working in a religious order. This year a 5th of the NHS budget is set asside for patients claiming for abuse etc due to medical scandals.

 

http://www.telegraph.co.uk/health/healthnews/10189204/Jaw-dropping-rise-in-NHS-claims-after-scandals.html

 

To show the delusion that's in the medical profession in the UK there is a great recent court case of a surgeon David Sellu. He left a patient with a perforated bowel for 24 hours whilst he did private surgery on other patients and a private clinic. When he operated on that patient 24 hours after he knew they had a perforated bowel (no evidence that he checked on them for 24 hours) they died. He got 4 years for manslaughter. The link to the judge's opinion is below:

 

http://www.judiciary.gov.uk/judgments/r-v-sellu-sentencing-remarks/

 

However, medical professionals in the UK practice with such impunity that doctors and nurses here think that it's a travesty he got sentenced and wrote to the judge saying that he's a nice guy. Here's the support website that they created with the royal college of surgeons statement that it was unacceptable that he got jail:

 

http://davidsellu.org.uk/wp-content/uploads/2014/03/Presidents-article.pdf

 

http://davidsellu.org.uk/supporters/

 

With this attitude it's not surprising that biggest serial killer the world has ever seen is a British doctor called Harold Shipman who is estimated to have killed 150 patients before getting captured, some as young as 41. I've worked in the NHS and I have taken a huge financial blow to retrain and study physics because the NHS is trash. If you have half a brain cell working in it is so depressing. Trust me you do not want a centralized healthcare system, it will do what it wants and if anyone gets held to account for what they do the doctors and nurses will act as if you've committed war crimes.

[John Cuthber]

It seems the problem there is this

"He left a patient with a perforated bowel for 24 hours whilst he did private surgery on other patients and a private clinic."

That's a problem with a greedy doctor prioritising work on the basis of cash rather than clinical need, not a problem with a national system.

In principle, the NHS can ensure that doesn't happen by simply paying the Dr a salary which doesn't vary much with the nature of the work he does on any particular day.

If he's getting paid the same whatever surgery he does, he is more likely to consider clinical need than his wallet. (Of course, he might just choose to only do the "easy" stuff, but let's credit them with some professionalism. )

The reaction of the profession to his sentence is a problem with the RCS rather than with the NHS.

 

Do you think that, had both patients been private, the outcomes would have been very different?

Do you think he would not have been found guilty, or that the profession would not have rallied round one of their own?

[physica]

That's the interesting thing, the patient that died was also a private patient. This issue isn't private vs NHS, It's centralized vs independent. I'm saying that there's plent wrong with the NHS and a system like this isn't going to help the USA. Government created monopolies like the medical care in the UK create an untouchable clinician culture. The delusion that surrounds this case illustrates that clinicians in the UK think it's an injustice. Clinical negligence is overlooked in the UK far too often that the royal college of surgeons stands by this guy, the biggest serial killer in the world to date is a UK doctor and a 5th of the NHS budget is spent of compensation for patients. Even if it was a NHS patient who died (which it wasn't) surgeons on the UK make more than enough to live on. He wasn't exactly doing private work so he could eat this week and make rent. People shouldn't die because of his greed. The public shouldn't be bullied into giving more money to pander to his greed. The only solution to a healthcare system (private or not) is to flood the market. We seem to moan about monopolies in other markets but when it comes to healthcare we don't seem to mind. I've worked with surgeons who own a series of properties, drive mercs and still complain about how much they're getting paid. With government created monopolies and excessive regulation we develop a ungrateful brat culture in the medical profession. In the UK and the USA the medical profession has been very clever. It has vastly exaggerated the difficulty of practicing medicine and scared the public into thinking that you need to be a complete genius to be a doctor and that malpractice is because someone doesn't know what they are doing. The excessive regulation greatly restricts the recruitment resulting in only a handful of people being able to practice a particular field of medicine. Because of this they can charge though the nose. When you actually lift the vale and go through the process yourself you realise that the training is very ad hoc, lots of memory tests, not really understanding anything but saying this approach kinda works, tons of multiple choice exams and plenty of seniors who actually failed physics or maths and switched to medicine because it was easier. Then you start working and you realise that malpractice happens because someone didn't follow the guidelines or didn't bother to chase something up or didn't listen to someone, not because they weren't smart enough to carry out the task. I'm going to repeat my main point, you need to flood the market. Developing a trash institution like the NHS will only move the healthcare back in the USA. Their clinical practice is way more advanced than here in the UK. What they need is a competitive market as opposed to a few people who know that they are the only ones who can provide that service. If they got serious competition they would then have to lower prices and improve delivery so they wouldn't lose their customers.

[John Cuthber]

If you flood the market with doctors- for example, by buying them in from elsewhere, then the laws of supply and demand mean that the price will fall.

So there will be people who previously made good money being doctors and now make rather less.

 

The ones who are able enough will leave to make money elsewhere- as lawyers or whatever.

Of course some will stay because they consider it a vocations.

 

So what are you left with?

Lots of doctors among whom, many of the brightest have left and to whom you have added lots who previously wouldn't be thought of as good enough.

On average that means you end up with worse doctors.

 

Now, if I'm ever taken ill, what I want is a good doctor rather than a bad one.

 

Do you understand why I might not like your "solution"?

 

There is no evidence to support the idea that you can "flood the market" without adding lots of not-very-good doctors to it.

Are those NVG doctors more likely to spot the next Shipman?

 

And, re "Their clinical practice is way more advanced than here in the UK."

They have twice as much money. If you doubled the NHS budget you could improve the system considerably.

 

Also this

"If they got serious competition they would then have to lower prices and improve delivery so they wouldn't lose their customers."

implies that a customer has a choice of supplier.

So, after I get hit by a car, do you expect me to decline the first ambulance because it's run by the "wrong" healthcare provider?

 

That's the problem; health care is not a market in that way (though the availability of doctors largely is).

Edited June 1, 2014 by John Cuthber

[physica]

Your skimming my main points. Malpractice is usually down to someone not chasing something up or listening to someone or not following guidelines, not because they were not smart enough to do it. It's because it really isn't hard to follow guidelines. That's why art grads with 50% can be treating patients within 4 years of enrolling. Google is also a major help. Also you're more likely to get people who actually want to do the job as opposed to the cash it will give them. Clever people don't always run to the pay check, there's plenty of maths and physics academics that are testament to that. Helping people is a good enough hook. Plus you don't need smart people in medicine. Go to an academic department in medicine now and I can tell you they are far from smart.

 

 

I work in emergency. A private supplier is a lot easier than people think it is. Look at Bulgaria. They have competing ambulance firms which to respond quickly because the first one on the scene gets the patient. It is not very complex to make a simple law that caps prices that ambulances charge. Fear of this is simply a symptom of people who don't work in the field, they think that managing healthcare is insanely complex and thus don't trust it unless it has a huge government stamp on it. I tell you many of the paramedics often think that it's a waste of time picking up most of the patients they deliver.

 

In terms of prosecuting Shipman I agree but the internet and rep gets more advanced as the years go on. If a doctor has terrible mortality stats you won't choose to go to that doctor as opposed to the NHS where you have little choice. A flat huge wage attracts doctor who are in it for money. Now you will still get people in it for money but at least they will work for it.

Edited June 1, 2014 by physica

[John Cuthber]

"Helping people is a good enough hook."

OK, that's the problem solved then.

Or are we back to talking about money?

[iNow]

There is always room for improvement, including within the NHS. What Physica seems to continually miss (be intentionally obtuse about?) above, however, is that even with its flaws the NHS system is vastly superior to the US system (you know, the actual thread topic) across nearly all measures, including cost, availability, and outcome.

[imatfaal]

physica - can you provide a few details (rather than pure anecdotage) of your criticisms of the various aspects of tax-payer funded free at the point of service health care in the UK?

 

Quite a fair proportion of your comments seem to be strongly exaggerated for effect - for instance the first five instances of 4 year graduate medical programmes in the UK I looked at showing that two of them had been replaced with graduate entry into the 5 year programme, two required a 2:1 or better in a life science degree, and the other was Cambridge (please don't tell me they are enrolling fools - JC and other oxford men may disagree!) I don't know how much things have change since I started medical school - but we had negative marking in year one

[Ten oz]

Not that I accept your assertion here as true, nor do feel it even remotely explains why single payer universal healthcare would not work in the US, but just for the sake of the discussion let's pretend for a moment it is and does...

If anger is such a profound characteristic of our citizens, then just imagine how much less angry people would be if quality healthcare was not something treated as a privilege available primarily to the rich.

Imagine how much less angry people would be if they no longer had to choose between paying their mortgage, putting food on the table, clothing their children, paying for fuel in their cars, and paying for health coverage.

Imagine how much less angry people would be if they were no longer bankrupted due to unavoidable illnesses and unforeseen sicknesses, and if obtaining treatment were as straight forward as booking a flight online (as per the video in the OP).

Of course it would work and of course single payer care would be both welcomed and successful. We even have a great data point in support of my assertion. It's called Medicare, and everyone who is on it loves it, especially since they still have the option of purchasing private insurance to supplement or enhance it.

Our problem is not healthcare, it is the Rube-Goldberg overly complex mishmash of a framework that comes from the private sector in this space... A space that is irrefutably better managed in the public sector (as is so clearly evidenced by the aforementioned countries, as well as others such as Australia). No, the problem is not anger, it is politics and ignorance and people consistently voting against their own self-interests.

The populace of the United States is not quite as different as you seem to believe. We are much more similar and have much more in common with those other nations than we are dissimilar or unique. There is no reason that the high quality healthcare systems so successfully delivered in other nations could not also be successfully delivered here. If you disagree, then you are going to have to come forward with a much more coherent and better supported argument than, "people in the US are too angry."

I believe the Western European models work. I wish we could apply a nonprofit model to our system. It is just that I have watched this battle play out for a long while and have concluded that what is lacking is will and not a more perfect solution. It is the same problem we have with climate change. It isn't that there isn't enough evidence or it hasn't been explained clearly enough the problem is people don't care.

FDR tried in 1933 - http://www.jstor.org/discover/10.2307/27551992?uid=2460338175&uid=2460337935&uid=2129&uid=2&uid=70&uid=4&uid=83&uid=63&sid=21104096981747

 

Truman in 1945 - http://www.trumanlibrary.org/anniversaries/healthprogram.htm

 

Eisenhower in 1955 - http://www.presidency.ucsb.edu/ws/?pid=10399

 

Lyndon Johnson settle for Medicare but want more in 1965 - http://www.ontheissues.org/celeb/Lyndon_Johnson_Health_Care.htm

 

In 1972 Richard Nixon tried to push National Healthcare - http://www.presidency.ucsb.edu/ws/?pid=3757

 

In 1996 Bill Clinton tried - http://www.clintonlibrary.gov/188

 

The problem is not lack of good ideas. The problem isn't that we haven't have a charismatic enough president to pitch it. The problem isn't whether the idea comes from a democrat or a republican. Once a person acknowledge those facts then the question becomes; what is the problem? Why haven't we moved on this issue?

I agree we have a bad system. I agree the western European model is superior. I however don't believe as a country we have the will to change it as demonstrated by all the previous failed attempts. There is another problem, a pre-existing condition you might say, that prevents us from moving forward.

If you flood the market with doctors- for example, by buying them in from elsewhere, then the laws of supply and demand mean that the price will fall.

So there will be people who previously made good money being doctors and now make rather less.

 

The ones who are able enough will leave to make money elsewhere- as lawyers or whatever.

Of course some will stay because they consider it a vocations.

 

So what are you left with?

Lots of doctors among whom, many of the brightest have left and to whom you have added lots who previously wouldn't be thought of as good enough.

On average that means you end up with worse doctors.

 

Now, if I'm ever taken ill, what I want is a good doctor rather than a bad one.

 

Do you understand why I might not like your "solution"?

 

There is no evidence to support the idea that you can "flood the market" without adding lots of not-very-good doctors to it.

Are those NVG doctors more likely to spot the next Shipman?

 

And, re "Their clinical practice is way more advanced than here in the UK."

They have twice as much money. If you doubled the NHS budget you could improve the system considerably.

 

Also this

"If they got serious competition they would then have to lower prices and improve delivery so they wouldn't lose their customers."

implies that a customer has a choice of supplier.

So, after I get hit by a car, do you expect me to decline the first ambulance because it's run by the "wrong" healthcare provider?

 

That's the problem; health care is not a market in that way (though the availability of doctors largely is).

This implies Doctors account for the bulk of the money in the system. They don't. Lavish Doctor pay is not where our healthcare money is going. If anything more Doctors, technicians, nurses, and so on would improve their work conditions which would have an all around positive impact on how they feel about their chosen profession. As it stands today why would anyone want to be an emergency room Doctor? The hours and work load are deplorable.

More doctors, specialists, and so on would mean more attention and time spent with each patient. This alone would cut down on many of the more expensive things like X-rays, MRI's, prescriptions, and all types of tests that are ordered often because doctors don't have time to spend with patients. It is easier just to order a bunch of tests and move on.

True story. I ruptured my left Achillies playing basketball two years ago. I knew immediately what it was. I went to the emergency room. Upon check in I identified my Achillies as the problem. Prior to seeing a Doctor they wheeled me in for X-ray's ,then had a nurse put me in a splint, I was offered me pain pill every ten minutes, and ultimately after about 6 hours saw a Doctor who promptly told me sports injuries weren't her thing and scheduled me an othopedic appointment. Three days later I went to my appointment. The doctor asked me what I thought was wrong. I told him I had a ruptured achilles. He took one look at it and said, "yep". I had surgery a week later. Point of my story is that thousands of dollars were spent (paid by my insurane) wheeling me around the emergency room when ultimately they had no one there who could properly diagnose me. Had a orthopedic been available when I arrived a lot of money and time could've been saved.

[physica]

physica - can you provide a few details (rather than pure anecdotage) of your criticisms of the various aspects of tax-payer funded free at the point of service health care in the UK?

 

Quite a fair proportion of your comments seem to be strongly exaggerated for effect - for instance the first five instances of 4 year graduate medical programmes in the UK I looked at showing that two of them had been replaced with graduate entry into the 5 year programme, two required a 2:1 or better in a life science degree, and the other was Cambridge (please don't tell me they are enrolling fools - JC and other oxford men may disagree!) I don't know how much things have change since I started medical school - but we had negative marking in year one

 

ok so we have st Georges (2.2 (50%) in any degree for 4 years) For those in the USA st Georges is in London and one of the oldest med schools in the UK

 

http://www.sgul.ac.uk/courses/undergraduate/mbbs4/entry-requirements

http://www.sgul.ac.uk/courses/undergraduate/mbbs4/course-structure

 

we have Nottingham (2.2 (50%) in any degree for 4 years)

 

http://www.nottingham.ac.uk/ugstudy/courses/medicine/graduate-entry-medicine.aspx

 

we have Kings college London (2.1 (60%) in any degree, 2.2 (50% for 4 years) with masters for 4 years) This college even allows nurses with a pass in a nursing diploma (a diploma is if they we not smart enough to pass the nursing degree.

 

http://www.kcl.ac.uk/prospectus/undergraduate/medicine-graduate-professional-entry-programme/entryrequirements

 

we have Swansea (2.1 (60%) in any degree, 2.2 (50% for 4 years) with masters for 4 years)

 

http://www.swansea.ac.uk/undergraduate/courses/medicine/mbbchgraduateentrymedicine/#entry-requirements=is-expanded

 

These med schools haven't been closed down so I'm guessing that they're graduating safe doctors

 

 

There is always room for improvement, including within the NHS. What Physica seems to continually miss (be intentionally obtuse about?) above, however, is that even with its flaws the NHS system is vastly superior to the US system (you know, the actual thread topic) across nearly all measures, including cost, availability, and outcome.

Both systems can be improved by flooding the market. There isn't enough competition and availability. The medical advancements in the USA are amazing, it's the cost and the availability that's the issue. If you think poor people should subsidize rich people's private healthcare (as we use NHS facilities for our private practice here) then by all means push for a government system. If you want to see real development reduce the regulation and flood the market. Maybe then it won't be like pulling teeth to get junior doctors to actually earn their pay packet.

 

Point of my story is that thousands of dollars were spent (paid by my insurane) wheeling me around the emergency room when ultimately they had no one there who could properly diagnose me. Had a orthopedic been available when I arrived a lot of money and time could've been saved.

Again you need to flood the market.

Edited June 1, 2014 by physica

[John Cuthber]

Well, I had a look at the first link.

It does not mention 50% anywhere.

It does talk about a score of 50 in some Australian based test but that's not what we were on about.

And what it says is "We have received and analysed the results for GAMSAT 2014 entry and can confirm that the overall minimum cut-off score to be selected for interview is 60,"

 

So it gives the criteria you need to meet before they will interview you.

That's a whole different kettle of fish from what they want before they let you in.

 

The others also don't seem to mention a percentage.

 

So, your evidence doesn't seem to support your claim.

Edited June 1, 2014 by John Cuthber

[physica]

2.2 for a standard degree is 50%, the application test is a multiple choice test on A level sciences and verbal reasoning. The main point is that the academic credentials are not that important. It's more about if you fail to chase things up and following guidelines etc, that's why there's an interview. So let's get a case study to emphasize it. Let's say someone is studying physics and gets a 2.2 (50%) in their degree and they want a graduate qualification within the next 4 years. They would not get in to graduate physics with a 2.2 but they could settle for medicine. That describes about 30% of the people in my department.

Edited June 1, 2014 by physica

[Ten oz]

Again you need to flood the market.

 

I agree.

[John Cuthber]

2.2 for a standard degree is 50%, the application test is a multiple choice test on A level sciences and verbal reasoning. The main point is that the academic credentials are not that important. It's more about if you fail to chase things up and following guidelines etc, that's why there's an interview. So let's get a case study to emphasize it. Let's say someone is studying physics and gets a 2.2 (50%) in their degree and they want a graduate qualification within the next 4 years. They would not get in to graduate physics with a 2.2 but they could settle for medicine. That describes about 30% of the people in my department.

If I had got 50% in my exams I would have been lucky to get anything better than a fail.

 

Still there's good news, we agree on this bit

"that's why there's an interview".

 

It's because, one way or another, the exams don't tell you everything.

But I'm still puzzled.

If, as you say ,"et's say someone is studying physics and gets a 2.2 (50%) in their degree and they want a graduate qualification within the next 4 years. They would not get in to graduate physics with a 2.2 but they could settle for medicine."

How come the market isn't already flooded?

Why haven't we got a stack of doctors who didn't make the grade to do post grad physics (or lots of other subjects)?

 

Here's another possibility.

You actually need to be "clever" to be a doctor (OK that's debatable- but let's run with it).

Also, there's not that many "clever" people about.

Some of them, at 18 decided to do physics or English or whatever.

Three years on they get their degrees- with a spread of grades because, for example,they found the bar more interesting than the library,

Some people had decided at 18 to do "medicine" and have degrees in things like Human Anatomy, but there are not enough of them to fill the jobs for doctors.

 

Is it surprising that the medical schools look at the people who have degrees (who cares what the subject is) and who want to be doctors (who cares what the motivation is).

They strip out the real dross- thirds and fails and interview the rest to see if they are likely to make it as doctors- are they "clever".

Some will be.

 

Now you can look at "clever" as meaning any set of skills or traits you want. It could be logic- though I accept that's not a big part of medicine.

It could be learning a hell of a lot of facts or it could be something else.

 

The process you deride is one by which those people with the skills to go into medicine (as judged at interview) get the chance to do so, even if it wasn't their choice at 18.

 

Where are you going to find the other people with those skills to "flood the market"?

Medicine is already rather well paid- so you can't offer these people more money. If, as you suggest, it's not that difficult then there's already disproportionate money on the table and you don't think it's getting enough takers.

 

It's a prestigious job so that's going to attract people.

 

How are you going to recruit the "flood"?