From personal experiece, when my GF was in the hospital half of the nurses were noticeably foreign (or least had strong accents), yet none of the doctors or sugeons we met with. I’d have to assume lobbying/ current doctors just don’t want more competition.
A significant portion of high prescription drug prices in the US is a result of price caps in other countries. We have basically been subsidizing the rest of the world’s prescription drugs for years. If other countries would pay their fair share, there would be no need to reduce R&D.
I don’t have statistics to back it up, but I don’t think anyone would argue that more education = higher-skilled doctor. Plus you’re looking at it in an NPV vacuum - if you got your undergrad degree in 3 years instead of 4 would you happily accept lower compensation just because it lowers the up-front cost and gives you an extra year of income?
I do agree that tort reform is long overdue, however to play devil’s advocate now you’ve reduced incentive to be a lawyer because that’s been one of their cash cows. To a lesser degree it mirrors the argument for a flat tax - sure it dramatically reduces tax prep costs, but how would the unemployment situation look if tens of thousands of accountants suddenly become (even more) useless?
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Average physician salaries will have to come down (US physicians currently make more than almost every other country in the world on an absolute basis and do make the most relative to per capital GDP on a PPP adjusted basis).
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Prescription drug costs have to be capped (see prior post on US payors subsidizing the rest of the world).
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Malpractice awards have to be reined in. I have no idea how other countries’ malpractice laws are set up, but the cost for malpractice insurance is prohibitive in the US. I feel bad for victims of malpractice, and no you can’t put a price on someone’s life or the quality of their life, but the things people sue for and the awards they sometimes receive have gotten out of hand.
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US medical school costs must be reined in. Physicians in other countries emerge from medical school with a fraction of the debt US physicians have. Lower med school costs would offset lower salaries.
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Patients need to be accountable for their use of the healthcare system. If you sprint to the emergency room everytime you get a runny nose, you need to be held responsible for the excessive costs.
If I got a medical degree in 5 years instead of 10 years, I would absolutely accept less money (at least for the first few years of my career)! Same if I got a law degree in 3 years instead of 7 years.
3 years vs. 4 years for undergrad is kind of too small of a difference to compare. But to answer your question, I actually did finish undergrad in 3 years, and got a master’s degree instead of going to work. So basically, I lost a year of income in order to get more education. Of course, there were some other factors - i.e. staying for four years is “normal”, my friends were still in school (including my gf), and I had a lot of financial aid, so school was cheap.
“however to play devil’s advocate now you’ve reduced incentive to be a lawyer because that’s been one of their cash cows”
Some people will definitely lose, but it’s for the greater good. No one (other than finance people) is crying about finance reform, even though thousands of finance people are getting fired.
Guys, this is extending COVERAGE, not treatment. These people, pre-existing conditions or no, are already treated by the healthcare system. They are not splinting a broken arm in their garage. They go to hospitals just like you ro me. They just, by and large, do not pay for it.
Brainwash I think you are stating that the number people going to the ER will be similar, which I agree with.
I am referring to the fact that there is already a shortage of primary care and other specialties such as Dermatology. If you increase demand by 10% (30-45 mill people), when these doctors already have full schedules… wait times for appointments among other things will get worse.
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Salaries are high because of low supply of doctors. But I don’t think there is an obvious way to increase supply while at the same time keeping quality high. (Information asymmetry, extremely inefficient mkt for doctors, low feedback mechanisms)
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Why would other countries ever pay their fair share? Their goal is to achieve their self interest…
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No idea.
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Med school costs are not really that much more than a private university education. They’re more, sure, but the diff is not that great. State med schools are not that expensive.
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This is kind of a straw man. I don’t think most people abuse the medical system for frivolous things. I think most people try to avoid going to the doctor and put it off as much as they can. Some do sure, but I don’t think this is the vast majority.
Gotcha. The answer is that most people who go uncovered are going to be moving into a higher deductible health plan and will likely avoid a lot of the preventative measures until they are really sick. Half of my family (the crazy half) is pretty much uncovered and this is exactly what they are doing. You are not going to see a 10% increase in dermatologist visits. You probably won’t even see anything close to it. Same goes for breast cancer screening, colorectal cancer screening (ewww), etc.
^ if the US capped drug prices, other countries would have to choose between increasing their caps or watching R&D grind to a halt because pharma companies could no longer pass the costs onto US consumers. I have no idea which they would choose. US could simply say that pharma companies cannot charge more in the US than the negotiated cost in the EU or Canada.
All secondary education costs in the US are too high, so to say that med school isn’t that much worse doesn’t really say anything.
Oh one other HUGE thing is consumers need ot be able to compare the costs of procedures.
I remember trying to figure out the price of MRIs at different places. I was always told things like
“We need to run it through your insurance to figure that out” (they do do this after you have the MRI) WTF???
As far as I could tell it was literally impossible to compare MRI costs ahead of time at hospitals vs outside imaging centers. Maybe I could have contacted the insurance company directly… then they could’ve called different places… then forevere later i would’ve known… then arranged an appt…
^I am in complete agreement with you there. There is no transparency in the cost of treatment, only in the cost of insurance. The funny thing is…imagine if health insurance was illegal and you needed to take out a loan or pay cash when you needed to go to the doctor/hospital. Where would healthcare costs be? Would healthcare be more or less affordable? Nice thought experiment.
True, it is unlikely that many people are splinting their broken arm in the garage, but there are certainly people with long-term health issues who are not seeking treatment because they cannot pay for it. There is now really no reason for those people to not seek treatment. I have no idea how many of the 40MM uninsured fall into that category, but there will be some and 1% of their annual income is not going to come anywhere close to covering the cost of their treatment under the current cost structure. That money has to come from someplace, and the only someplace is my and your pockets. I have no issue with providing quality healthcare to people who cannot otherwise afford it, but if you’re going to make me pay for it at least try to do something to make it more affordable.
That’s what the individual mandate is for! Under the Obama law, insurance companies need to accept customers with pre existing conditions. To offset the cost to insurers, Obama gave them a bunch of new customers - people who are now required by law to purchase health insurance. In other words, part of the subsidy is raised by forcing new customers to “engage in commerce”.
Of course, I’m sure that rich healthy people will see higher premiums too. And yes, costs are too high in general. Seriously, it’s crazy.
I got STD tests a few months ago (clean!). Cost was near $500 before insurance. This is for a routine test that practically every sexually active person should be receiving. I really couldn’t believe it.
The irony is that a lot of people may find that it’s cheaper to drop their health insurance and pay the 1% “tax”. Median household income in the US is somewhere around $50,000. I suspect a lot of those households are paying more than $500 per year in health insurance premiums.
I read the Roberts decision and about half of the dissent. Roberts basically agreed that it wasn’t justified under commerce clause power, which I think is a good thing. However, he used some weird argument to say it was a tax for constitutional purposes (on a very flimsy reason) and not a tax for the purpose of some random legislation that requires that a court can’t hear a question about a tax until it has been paid. Roberts argument was really no different than if we have two interpretations and one is constitutional and one is unconstitutional, pick the constitutional one. The dissent basically calls Roberts out on how much non-sense that is (in multiple different senses) and calls the mandate a mandate (and the whole act unconstitutional as well).
I think if the Democrats sold the bill as a tax, then there’s no way it would have passed.
It is because in the U.S. they make it very difficult for foreign doctors to come here and practice.
Did you study econ? Health economics are quite a bit different from real economics, people generally don’t get any additional utility from having unnecessary tests or surgieries but that happens often in the United States.
Anyway I’d like to point out that as it stand the United States has the most expensive healthcare system in the industrialized world, while single payer systems with universal access world wide operate at half the expense as a %gdp basis with either similar or superior health outcomes.
Yes, you need transparency and goods and services whose quality are readily evaluated and substitutable before traditional free market mechanisms produce optimal outcomes.
Yes, state intervention can screw things up, but when you have unequal information, barriers to entry, and difficult-to-evaluate quality measures the choice starts being which kind of distorted mechanism is least unacceptable.
IMO, I’d bet most countries would let R&D get screwed. From a political viewpoint, increasing caps loses votes. Now the absence of “some medication that could exist if some scientist in a distant country discovered it” probably won’t really be linked to each country’s politicians.
I’m pretty sure the average brazilian wouldn’t give a damn if R&D stalled elsewhere - we have a law here that basically ignores patent rights for medications (so local firms can sell meds without doing any R&D at all) and most people love the idea. I don’t think the average person even realizes somebody must be paying that bill - they see it as a law that diminishes the evil huge profits from the healthcare companies.
Which is really a disgrace. Because a lot of politicians in a lot of countries couldn’t care less about what happens more than 4 years ahead we may be on the verge of killing or severely holding back healthcare R&D, which is actually a pretty big blown on mankind, in my opinion.