Sorry for quoting so much of the post but as a fellow Canadian I wanted to comment on a couple of your points. Before I get started I want to point out that health care in wealthy nations unsustainable due largely to advances in medical technology. For example an MRI machine costs millions of dollars and it is not even close to being cutting edge technology. Much of the technology that makes many of the treatments we take for granted possible is apallingly expensive.

First off I do agree that our system has some major flaws. In Canada about 40 cents of every tax dollar goes to health care so using your numbers you pay around $5600 per year for health care, now if you were one of those horrible people who dares to make more money you would pay over $11,000. Now I know there are plenty of people saying well wait a minute my insurance costs me $16,000 sign me up for the $10,000 health care but it is not that simple. For one all governments here ration healthcare. It is commonplace for surgeries to be cancelled because the heath region decided to save money and not hire that extra nurse. Entire wings of hosptals sit unused as patients are shuttled from hospital to hospital in ambulances (at their own expense) as their beds are suddenly deemed 'closed' due to staff shortages caused by holidays and sickdays.

In the U.S. if you need an MRI you get wheeled to the MRI machine and get an MRI. In Canada they send you home and you hope you don't die before it's your turn. Once you are diagnosed in Canada then you typically get exceptional and relatively prompt care. In the U.S. if a hospital wants an MRI machine they go and buy an MRI machine. In Canada if a hospital wants to buy an MRI machine (or any other half assed new technology) they have to launch a massive fundraising campaign and hope that some of those dirty dirty rich people will make a donation.

The solution seems obvious just start up some private diagnostic clinics... but no wait someone might make money, and the major health care unions may be excluded... damn it seemed so promising. Let me point out that in one city in Canada we have a site (taxpayer funded) where addicts can go to 'safely' inject themselves with drugs.(I know it's off topic but I'm making a point) I believe they are provided with the drugs but I do not know that for certain and thus do not want to state that as fact. In this same city there is a group of prostitutes attempting to set up a brothel in time for the 2010 Olympics. So in Canada it is easier to start up a brothel and drug house than to start an MRI clinic. Go figure.

The point I am making is that our system like the US system has become stagnant and unweildy due to political ideology and lack of political will to change the status quo. In both cases major improvements could be made to the systems greatly improving the lives of everyday normal working people. There is a saying here that people typically get the government they deserve. As the people affected by these systems it is our responsibility to demand the nedded change and elect governments who will make the change.

As for your point about Alberta's taxes being lower because of their massive oil reserves you are only half right. The provincial government in Alberta does not spend nearly as much money meddling in people's lives as Quebec gvernments do. (ie your mandatory subsidized daycare programs.) Alberta also has no debt and they do not spend billions subsidzing inefficient companies who refuse to change their business practices. (ie Bombardier). Please do not interpret this as flaming you or your province Quebecers are clearly content with their way of doing things as Albertans are with theirs and the ability of provinces to more or less run their own affairs is part of what makes this country great.

Basically yes.

The one difference is that I feel that the only possibilty for real change is for a strong leader backed by a strong congress to come out and say, we think country X's healthcare system is the best in the world and our plan is to do just what X does. Then as long as public support could be achieved and stay focused for a reasonable period of time then we could just make it happen as "the will of the people". But of course this is pie-in-the-sky and can never happen. What you've talked about would take decades and multiple administrations and congresses and an unprecedented attention span by the public. In other words it's even less likey than my pie-in-the-sky idea.

This makes *real* change pretty much impossible and we may as well be resigned to lip service which is more likely to make things worse rather than better. I live in Massachusetts and in some misguided effort to make any change there is now a state law that requires everyone to have health insurance and all companies to offer it to their employees. Failure to abide by this law results in a tax penalty that gets larger each year. This has done absolutely *nothing* to lower any costs. The health insurance companies *love* it because it forces more people into their plans and generally into individual plans as opposed to cheaper group plans. No costs have gone down in fact all insurance has gone way up this year. The insurance companies are getting richer, Massachusetts collects a few tax penalties and everyone else is business as usual.

If this is what we get at the federal level then we're all fracked.

That's the point both kryo and pigeon have been making all along and it certainly has validity. But then your point about MRI scanners is not a very good one because pretty much *every* hospital in the US already has one (or more). So it's a "sunk" cost. Of course there's maintenance and I assume that they eventually wear out but there is a *lot* of equipment out there and those kinds of shortages are not something we'd be likely to see for a long time. In fact there are probably 10 seperate companies within a 50 mile radius of where I live that do nothing but provide MRI scans. The MRI machine and the technicians to run it are the companies sole assets and they pretty much keep the machine running from 6 in the morning to 12 at nignt 7 days a week 365 days a year. The one thing we *don't* have to worry about in this country is delay for acces to MRI, or CT or any of a number of high end medical technology. But then I have no clue what this "tender" system is that you mention so obviously there would be differences and potentionally even large differences.

Plus I never assumed that if we took Germany's system as an example that we would necessarily spend *exactly* what Germany spends.

Basically I look at modelling a new system on someone else's current system an attempt at picking up the "low hanging fruit" in other words do the things that are easiest and make the biggest difference first and to me that's elimination of the health insurance industry and removing the employer as the source of most insurance. I think that's the hard part and most everything else would follow from that.

But like I said I highly doubt there will be any significant change regardless of the method used to decide how such change is to be done. Then if nothing really happens I won't really be disapointed and if some real positive change does occur I will be happy to admit I was wrong all along.

Hmmm.... You make claims of misinformation based on authority, but an undergraduate medical student that has authoritative knowledge about healthcare systems elsewhere in the world leaves a few questions. What healthcare systems did you study?

It's obvious that any doctor would take offense at my opinion that they make way too much money. It's even more obvious that a medical student that is currently piling up huge loan debt with merely the hope that someday he'll be able to pay off that debt would take even more offense at this statement.

Also I can't really claim that the source of my opinion in this regard is any real studied analysis of the totality of doctor’s compensation. What my opinion comes from is from the evidence that I've seen over the course of my own life which is anecdotal evidence at best. However as I mentioned this is truly my honest opinion.

Basically I see the homes and neighborhoods that an ordinary Internist Primary Care Physician lives in and there is no doubt in my mind that each and every one of them is a millionaire a number of times over. And when you begin to consider surgeons and the specialty fields, you’re talking about some *real* money.

And how hard do these doctors work to live so high off the hog? Well again I haven’t done an exhaustive study on the subject but to take my own Primary Care Physician as an example, he takes the entire months of July *and* August off *every* year. Name me *one* other occupation where you get a deal like that.

Now I admit that the years of education and training that doctors are required to put in do indeed warrant a higher than average income. I have a PhD in Electrical Engineering which required a bit of education as well, but clearly doctors put more time into becoming doctors than I put into my doctorate and so I do believe they deserve a premium over what I earn. However my issue is that in my estimation, based on simply the lifestyle that the average doctor lives they must be earning somewhere near 3 times what I earn and it’s this level of income that I object to particularly when I factor in that yearly 2 month vacation.

In comparison I work a 60 hour week as a matter of course and am expected to put in excess of 80 hours per week during time of “crisis” and believe me there’s a “crisis” 3 or 4 times a year, every year, year after year. And I’m lucky to even get to take my two weeks of vacation that I earn a year. Most years I lose close to half of my vacation pay because I feel my job would be in jeopardy if I took all of my 2 weeks vacation.

Add to that the reality of the commercial environment where in fact your job *is* in jeopardy pretty much every day of your life. Companies these days (i.e. for the last 10-15 years anyway) are constantly downsizing, outsourcing or at the very least considering the option. Most of my 30 year career has been spent worrying about the health of my current employer and trying to figure out when it’s time to jump ship to avoid the crash.

Basically it’s a life of musical chairs and as anyone that’s unemployed now can attest, you *really* don’t want to be without a job when the music stops. I’ve had 9 different employers over my 30 year career and no job has lasted longer than 5 years, the average length of time is closer to 3 years (obviously 30/9). And I never facetiously jumped ship, I only changed jobs for more money *once*, every other time it was due to concern over the health of the company and this is born out by the fact only two of the 9 companies that I’ve worked for are still in business and one of them is my current employer. Also every single one of that went out of business did so less than a year after I left. So far I’ve been lucky with the musical chairs but sooner or later my luck is bound to run out.

Compare this to the entirety of the healthcare industry where there is absolutely no competitive pressure on anyone. For god’s sake even the *clerks* do pretty much nothing all day and then take umbrage if you show the slightest impatience for them to get off of what is obviously a personal call. If you ever wander by the typical nurse’s station in an average hospital what you’re most likely to hear are the nurse’s discussing their boyfriends and which one has the bigger penis. I swear to god that I've overheard this exact conversation, and at Lahey Clinic no less, best care in the world. Also if you're interested ask me about how Lahey's incompetance toe tagged a friend of mine.

I also object to the concept that the doctor’s time is so god awful valuable and yet my time is superfluous. Excuse me, but my time is both valuable as well as critical to keeping my job so that I can continue to afford the ridiculously high health insurance premiums that keep the system such as it is treading water. There have been many times that I have eschewed medical service simply due to the time off from work that it would require.

You hear about how many hours’ doctors put in, well I just wonder where it is that they put these hours in *at*. It’s certainly not in their office, just try getting an appointment before 9:30 or after 3:30. And it’s not that they’re making rounds either because I know for a fact that my Primary Care Physician makes his rounds on Tuesday only in the mornings and yet he takes the entire day off from appointments. Like I said *two months* vacation each and every year and a 4 and a half day 9am to 4pm work week. Great job if you can get it.

Look, I’m sure there are some doctors that work quite hard, and are dedicated to their patients’ well being, it’s just that I’ve personally never met such a doctor.

So hopefully this gives folks some idea as to the basis for my claim that I feel doctors make *way* too much money, but I’m willing to hear evidence to the contrary and perhaps you might even convince me that doctor’s simply make too much money, as opposed to *way* too much money.

So yeah, this is a topic about which I have a certain degree of passion. Please explain to me where I'm "blatantly false". I can possibly accept that my opinion is wrong, however no one can claim that I didn't come by my opinion honestly.

[edit] For those that are already or trying to become doctors you should keep in mind that this is how at least *some* people view your chosen occupation, whether rightly or wrongly. From your point of view it is of course wrong and you must certainly hope that I represent a *very* small percentage of folks that feel this way. But if this can help you avoid the "god complex" then perhaps it's done some good. Also if it's any solace I feel pretty much the same about lawyers except that lawyers don't hold my health hostage in order to ensure their own wealth. [/edit]

I can't speak for my generation, only for myself and it's *not* a term I would use except under the most extreme of circumstances and it wouldn't be because someone happened to be even rabidly conservative. For example I despise Ann Coulter but would never call her a Nazi. I would reserve the word only for those that I mentioned like White Supremacists that take pride in the word.

My personal opinion is that a doctors education should be free and paid for by the government assuming of course the applicant is sufficiently qualified. That then justifies the doctor being a government employee with a high but still reasonable income and a fiduciary responsibility to those that funded his/her education i.e. the taxpayer.

No I don't, I think teachers in general get paid too little.

Actually I do *not* know this from personal experience, if I did then perhaps I wouldn't be so harsh.

I never said get rid of the ones that are in it for the money, I just want them to become accustomed to giving an honest day’s labor for an honest day’s pay. It’s no less than I require of myself.

Forget Norway!

 

If Kenya were to physically as well as hypothetically urinate on Norway, this is the approximate trajectory ...

That was obviously sarcasm on my part.

Yes, there are many people who are in it for helping people; as you well know from personal experience, there are many more who are not.

Next time, please read the entire sentence. Perhaps I should have made it two entirely different sentences.

Yes, there are many people who are in it for helping people. As you well know from personal experience, there are many more who are not.

That is the way it should have been read. I just hate writing like that, it makes me sound like I'm still in grade school. Grammatically, both wordings say the exact same thing.

Removing the income incentive IS effectively getting rid of them. If they wanted to work harder for less money, they'd do something else.

 

Thanks for the list, Mumble.

 

First problem, health.  Lard asses drinking a six pack of beer with their microwave dinner and chain smoking between meals.  Look at the population statistics in other countries.  The fat, beer bellied lard ass with lung cancer should be told to pay for it or piss off.  Your health is something you should look after, not something I should pay for.  If we were a reasonably proportioned country filled with non smoking individuals that walked to work every day and had a glass of wine with dinner, our costs would be a fraction of Frances.  It's surprising just how low that number is, the average yank is a fucking grease ball by most countries standards and we're only twice as high as the socialists are.

 

Second problem, controls.  We fund the research while the rest of the world benefits from it.  Those countries with the lowest costs are squeezing the drug companies the most.  Check their margins, find the development and manufacturing costs, compare them to the price changes.  Those rich drug companies don't exist anymore if the US starts paying the prices that France is.  That's just the US, forget adding in the rest of the countries that are still paying somewhere in between.  Yeah, we could get the latest and greatest cutting edge pharmaceutical for half the cost, but it would be the end of most development.

 

As for the wonderful commentary on health care being a public good in line with civil protection and education, get a clue.  First, your health is primarily influenced by your own choices.  You do not choose to get mugged, hit by drunk drivers, or raped and murdered.  You choose to eat at McDonalds every day without using your legs for anything but holding down a foot rest.  Yes, shit happens, but shit happening doesn't elevate health care as a whole to a public good.  As long as taking care of yourself isn't a requirement for getting that state funded care, we're fucked.

 

Considering the police arrive after the fact to nearly every crime reported, are themselves equally criminal, if not more so than the general population, and have a conviction rate well below 100% of those they catch after the fact...  Even if it were a public good, giving the US government control shows a lack of mental competency on the part of the deciding party.  There isn't a single government controlled entity that hasn't been a colossal fuck up with the arguable exception of the military.  I say arguable because at present it appears relatively effective, they've botched every real war we've been in throughout history though.  Their biggest mistake was the training program that taught soldiers to fight by charging gun emplacements with infantry all the way up through the Korean war.  The infantry charge died with the musket as anything but a suicidal tactic and they never figured it out.  Depending on the US government to protect and care for you just gets you killed most of the time.

Thanks for the post. It's a fresh take on the topic in this thread and one that I think bares a lot of truth.

Nonetheless, that pales in comparison if you consider the crap that most americans eat. Our food in general may have all sorts of chemicals with unknown effects, but that is hardly an excuse for the fast-food mentality that has gripped the nation. But frankly, even given that, it's extremely obvious that a combination of excersize and eating well are one of if not the single most important factor in individual health. There are exceptions, obviously - notably genetic disorders and genes in general. Now I think that the hundreds of untested chemicals in our food and water are a threat, it seems like a generational threat, and doesn't really cause many immediate health issues. In a way that's even more dangerous, because it means that it won't be considered a problem until the damage has already been done...

I agree with psychoak that people have no basic civil right for you and me to pay for their health if they refuse to take responsibility for it in the first place. Why should we have to pay for a chronic smoker's emphysema, considering he was well aware of the risks of smoking but continued to do so? Addiction is hardly an excuse, anyone can stop smoking if they are determined enough. On the other hand I have no problem for paying taxes in order to help pay to treat someone's breast cancer, or most forms of cancer.

Basically, I think the ideal public healthcare system would only cover medical problems that aren't the result of negligence of one's own health. Costs of any complications that arise due to poor life decisions despite being aware of the risks, like horrible eating habits and no excercise, or smoking, would be personal costs. Such a system would never work, though, because there's the impossible problem of determining what is covered and what isn't.

Like psychoak said, one of the most important things we need to do, maybe even more important than fixing our healthcare system, is to convince americans to start taking care of their own health again. Prevention is much more effective and much less costly than treatment.

I agree

There is a lot that could be done.  One is tort reform.  When lawsuits are so prevalent that doctors actually leave the profession or region there is a problem.  There is a difference between negligence and cost effective prevention/diagnosis.  Cutting the wrong leg off is negligence or incompetence.  Not ordering the 6 most expensive tests for a 99.999% diagnosis vs a 99% diagnosis could be the difference of several thousand dollars.

The second is knowing what you are paying for and determining how to pay it.  Last time I went to the doctor he ordered a 660 dollar test for myself and my girlfriend.  After the tests came back we found out it that it did not matter what my tests were (baby DNA testing).  Next time I will wait before I pay for a test so I can make sure it is necessary.  

Also there is nothing wrong with a multitier health care system.  Not everyone needs a specialist and not everyone needs the ultimate in healthcare.  Many generic drugs are witin 95% of the effectiveness of name brand and cost 4-5 dollars for a monthly prescription.  Not everyone needs the premier healthcare system where you pay 5-10 times as much.  Good is good enough and if you want a second opinion then you should go for it.  Yes, healthcare is plenty expensive, but there are things we can do as a consumer to reduce the cost for ourselves.