Questions about single payer National Healthcare (peek inside)

[Bread and Circus]

If a single payer national healthcare system cut physician salaries by as much as 30% to 50%, would that be fair? Would it even be a good thing?

If a single payer national healthcare system cut nursing salaries by as much as 30 to 50%, would that be fair? Would it even be a good thing?

Would you personally be willing to pay a new and separate tax to pay for the new healthcare system? If the tax was more than you pay in insurance premiums, would you still be amicable to this new tax?

---

disclaimer: In principle I support the advent of a single payer National Healthcare system as a physician, a consumer, and as a citizen. I feel it is in our best personal and national interests to do so. I also think you could really leverage the politicians to make it happen if you created a "movement" to support it. In particular, I think you need to get the physician and nursing community on board. However, you will NOT be able to do that if they face a cut in income (it's just a fact). I personally make about $72,000 a year (I keep my practice small and personal) so it wouldn't affect me much (I make jack shit as a family doctor considering the average is $140,000 per year or more). Hell, I might even make more with a NHC system but that's not the point of the questioning. What I'm driving at is raising some of the issues that you would have to face to create a large coalition in order to make it happen. It's all about money in the end. With such a dramatic change, there will be winners (the American people at large), and losers (big Insurance, Big Pharma, other for profit medical institutions). It's not going to be an easy fight and don't expect the leadership to come from the politicians. It's going to come to pass as a movement, from us. Please take the time to honestly answer the above questions, I'm just curious about attitudes here.

---

Also, please answer AS IF there is a possibility of healthcare worker salary cuts. Not whether you think there will be or not. That's not the question. That question is a researchable one and I'm working directly with PNHP on it. They don't have the data, yet. Interesting though, the PNHP director communicated to me that the highest paid family doctors in the world are in the UK.

[blondeatlast]

1. "If?" The loss might be more than made up in drastically reduced administrative and

labor costs--and would very likely enlarge and enrich the labor pool of nurses as well (which, as the sufferer of a harsh chronic illness, I would very much welcome).

New and separate tax? Hell, yes I'd pay.

I suggest you check out http://www.pnhp.org/

and am rather alarned that you seem to not have yet...

Did you just come up with these points on your own?

[Bread and Circus]

5. I am part of PNHP and I was on the phone to the executive administrator

of it just yesterday. Discussing these among many other issues. Interestingly, she did not have a significant wealth of hard numbers in regards to these questions. It was a great discussion though and the exec said she is going to get more information out there on this topic. She was NOT aware of Democratic Underground though, but I told her about it.

I have read the phnp proprosal, which I like, however it is not specific as to how physician and nurse incomes might be affected. They definitely don't want to cut healthcare provider incomes, but that's not to say it could happen. Even if it weren't to happen, that's not to say that healthcare providers might be skeptical of a change if they thought they'd take a pay cut.

Please answer my questions though, again, I'm curious about attitudes surrounding the subject.

[blondeatlast]

8. I did answer your questions. I may not be a physician, but have

been advocating single payer for YEARS.

And you didn't respond to my point about administrative costs.

I don't see why physician incomes should be cut at all and hopefully, nurses' salaries will increase and the pool will grow--I know who does the real work in healthcare.

[Bread and Circus]

13. Thanks for your reply, you didn't really answer the questions

directly but I appreciate the time.

Of course the system will save money on administrative costs, but that doesn't necessarily mean the money will be redistributed back to the healthcare workers, nor am I saying it should. But again, that's not what the thread is about.

If there's any "meme" I'm trying to push is that you are never going to get NHC to become reality if you don't get the hundreds of thousands of nurses and doctors on board. We need to setup and challenge the memes that have kept it from becoming a reality. Part of that is knowing what the memes are at a deeper level. It's questions we should be asking of ourselves, of each other. So that we can take it to the street and have the data and the moral authority to wage it.

[blondeatlast]

16. Would it be fair for the doctors?

Maybe not to the doctors, but for the millions who can't afford quality care, I'm willing to say yes, it's fair.

For the nurses? Most experts say that nurse salaries would rise and the demand increase as a way to save on administrative costs. Fair if they go down? Hell no, not for nurses, but my advocacy has been for increasing the nurse pool to cut costs.

New and separate tax? Yes, I'd be more than willing; look how much I spend in Iraq every day. Taxes are the price of a free and just society.

More than I pay in insurance premiums? Yes; because it would actually be a boon to small business and help them compete while assuring that my neighbor who owns a small business and can't afford health care (and who's son just had a 100K kidney operation) had access to the same quality healthcare I had.

Sorry if I'm a little sharp, this is MY issue and I've heard and debunked all the arguments already.

If you're sincere, welcome aboard.

[Bread and Circus]

17. awesome, thanks. Energy reform is my issue, but healthcare is #2

and election reform is #3. They are all in a close dead heat :)

[Donnachaidh]

2. oh let's take it back to *the poor doctor's" argument

My answer to all three is YES.

As the average working class person is told time and time again -- YOU are NOT guaranteed a set income. Welcome to the REAL world.

I've had at least three doctors pull this same jaded BS question out, and tell friends or family members they would lose money if the country went to universal health care.

Those SAME three doctors cry up their sleeves about THEIR income -- but somehow ALL of them manage to buy land and build LARGER modern offices for themselves and their practices. On their poor meager little 150K salaries?

Why is it that *all* doctors who argue against universal health care cannot seem to crack that 150K ceiling? :sarcasm:

Oh yeah -- my heart goes out to them as they are breaking ground on offices. Uh huh. :sarcasm:

[blondeatlast]

3. I suspect that's the next talking points we'll be hearing--methinks that a meme is being floated

around the internets...

[Bread and Circus]

9. I'm not floating a meme, I'm just trying to get some progressive thinker

feedback.

[blondeatlast]

12. Okay, sorry. Now would your respond at leaswt to my points re: administrative costs? nt

[Bread and Circus]

15. It's simple, if you cut out administrative overhead, you will save money

And that's proven time and again in any advanced society that has a single-payer national health care system. People who don't work in the healthcare industry cannot really fathom the waste of time and energy there is in our system and the amount of open palms there are when it comes to delivering healthcare. The numbers don't do it justice.

[blondeatlast]

18. I think they can if you educate them a bit. I've been insulin dependent for

almost 40 years starting in the 60s and have been through many, many different types of insurance plans, mostly employer benefit plans, but also including a hideously expensive private plan as well as state aid.

I know the tremendous amount of paperwork and hoops health providers are made to jump through and the patients often have to do much the same when they are least able.

Ask your most care-intensive patients like me (I have secondary complications, too) and they DO know.

The enormous bloat has got to go regardless. Eliminating it benefits providers, patients, and employers.

Very simply, SP/UHC is good for everyone but the financial industry.

[blondeatlast]

4. PNHP

http://www.pnhp.org/

[Bread and Circus]

7. read post #5

[annabanana]

6. A) I don't think the Dr & Nurse salaries would be much impacted

I think there is enough bloat represented in the insurance industry and the advertising budgets of the huge pharmmceutical companies to MORE than make up the differences you're proposing

and

B) Even if the Dr's salaries went down, they wouldn't need a staff of 7 to keep up with the paperwork currently required by the myriad plans & multi-layered co-pays that they have to sort through now. (To say nothing of the time spent fighting with the patients when the insurance companies find a loophole to keep from paying for some procedure that the Dr. has deemed medically necessary.)

And, re: increased taxes? see A

[blondeatlast]

11. Exactly. I'm more than willing to let my doctor (and each one of them is RICH)

make the money they make since they will easily be able to cut administrative costs.

The trouble is convincing physicians about that because you know that they aren't being told this.

I'd love to see more, better paid nurses anyway.

[napi21]

10. You should have heard the DR. Thom Hartmann had on a few days

ago. She was licensed to practice medicine in both the US & Canada and has been paid under both the US "insurance system" & the Canadian National HC System. I'll do my best to relate some of the things she said.

In the US a DR. is only reimbursed for 15 minutes of time spent with a patient, no matter if he actually spent 5 minutes or 45 minutes. It is assumed they should be able to do all they need to do in 15 mins.

In Canada, a Dr. is reimbursed in 15 minute increments. If a particualr patient requires 20 mins or 1 hour, THEY believe in some cases, it's more beneficial to spend more time up front will result in fewer visits later.

End result is that the individual Dr. doesn't lose and income, and in many cases, they actually earn a little more, but are under less pressure and stress.

She explained and dispelled a lot of the myths that are floating around the US about the Canadian HC System. It really was a GREAT program.

[Bread and Circus]

14. That's awesome, and that's what I'm encouraging PNHP to talk about

because there are myths out there and we need the facts to fight them. I believe the whole NHC saga is about human attitudes and financial interests. We have to know what the attitudes are, if we are to even begin to truly fight this through to the end. Healthcare reimbursement is but one facet.

[Gormy Cuss]

19. The first two questions are loaded.

Asking whether one supports cutting someone else's salary by 30-50% is fair will elicit a kneejerk negative response. If instead the question used real salary levels the response may be less (or more) sympathetic.
For example, if the average surgeon's salary is $600,000, cutting it to $300,000 would strike most Americans as not too high a price to pay for national health.

If the average family practitioner's salary is $140,00, the thought of cutting it to $70,000 would garner a bit more sympathy, but $70,000 is still considered a good salary and more than many households earn with two full time workers.

Nurses are a completely different consideration. First, it's widely held that nurses are underpaid and overworked. Unless the average nursing salary contradicts that assumption, there would be little support for cutting their salaries.

The answer to your last question is yes, because unlike health insurance premiums the tax is buying me a product that will be there regardless of my job and will be 'fair' in the sense that the rate I pay isn't determined by how well my current employer negotiates with private insurers. Of course, employers should be taxed for this program too because it is to their benefit as well.

[Giant Robot]

21. Thank you for the rational reply

I disagree with how the OP proposed your questions for discussion. No one will *want* anyone's salaries cut or new tax burdens to secure anything. But we will accept it as necessary for the common good, if it gets explained in a rational way, and we can see the benefit to us, i.e. a national health care plan. I do not doubt that doctors, being smart folk, will figure out how to ensure that there incomes are minimally impacted. As someone else suggested, reduced admin costs could certainly balance this out. But asking, Is it fair to have doctors salaries cut so that you can have a national health care plan just begs for kneejerk reactionism that those proponents of it, myself included, do not want or need.

But, if the OP really wants those questions answered, then, yes it is fair. There are between 40-50 million citizens without health care. Then we look at the number of people who are underinsured. Then the people who have good insurance, but still can't afford the bills that come in. So I am guessing that we are looking at about a third of the country in this estimate of people. As Spock said, "The needs of the many outweigh the needs of the few or the one." It's fair. Suck it up. We are all in this together and will pay for it together.

So yes I am in support of new taxes to pay for this. I think reasonably that will be the only way to get it going from the monster that our current system is. We ALL need to suck it up and pay for this if that is what we want. I would be happy to pay more in taxes if it helps out others who have no health care now, AND helps lower the bills that come into me. For example over the year, my family has spent well over $2000 in health care, and we have GOOD insurance! If that bill goes away and taxes are levied in its place, fine. Its a wash for me and a big win for someone else. Go team!

[Gormy Cuss]

22. For me, it's rather simple. If your kid breaks her arm, the first thought in your head should be

"Will she be okay?" not "How the hell am I going to pay for this?"

[Giant Robot]

24. Right now I am thinking

How the hell are we going to pay for our daughter's birth? Which was about a grand out of the two grand I mentioned. And my wife can't see the nurse practitioner she likes and feels comfortable with, because her insurance does not pay for it.

And like I said, we have good insurance.

[Bread and Circus]

30. Nice response, thanks.

They aren't "loaded questions". Rather, they are there to provoke some thought. Your post is just the kind I'm looking for. Well thought out.

[Gormy Cuss]

36. They are loaded in the sense that it's a framing for those opposed to single payer

or other national health. In terms of how individual voters will react to the issue, the first two questions don't matter unless they or their close circle of friends are doctors or nurses. Witness the way many people will say they support living wages yet when pressed to make a choice between paying the lowest price for consumer goods and paying a slightly higher price for ones made locally or in union shops, most people will say that they'd pay more even when being interviewed in the Walmart parking lot.

The key to public support for this is to personalize it. Part of the reason there is finally a groundswell of interest is that MOST Americans are unhappy with their health insurance coverage. Your third question is the core issue: are we willing to pay for it yet?


on edit: I would like to thank you for your posts on this issue. It's nice to have a doctor on board for this topic.

[stirlingsliver]

20. Screw The Doctors!

Screw the overpaid, over-coddled doctors!

I have had it with doctors.

They seem to order tests that are not needed.

Their only desire seems to be to run up patient's bills are much as possible.

Doctors have become "vendors" -- not healers!

[Bread and Circus]

31. This is a different matter, but let me illuminate.

We order excess services for three main reasons.

1.) Defensive medicine. You are more likely to be blamed for doing too little, than too much.
2.) If the physician somehow financially benefits. This doesn't occur as much as you think because "kickback" mechanisms are severely prohibited by law.
3.) Patient demand. If someone goes into a doc's office and don't get the tests they want, it often becomes a problem. Ordering tests that aren't necessary but make a patient feel better is often a path of less resistance.

Generally, ordering more tests doesn't really give us any personal benefit, and often means more work. However, when I order something that nails the diagnosis for a patient, it gives me a good feeling. Believe it or not, many of us really do care about our patients.

[hunter]

23. What a bizzare post...

Why the disclaimer "...In principle I support the advent of a single payer National Healthcare system..." ???

The way you frame the question in this post expresses an opposition to a single payer National Healthcare system.

Personally I don't think there will be any movement on this issue until our economy collapses under the combined burdens of climate change and endlessly rising energy and healthcare costs, but it could happen sooner if U.S. doctors (especially!) abandoned archaic notions of social status and started acting more like unionized employess. The financial powers running this nation see doctors and nurses as the same sorts of foolish altruistic professionals as teachers are -- people who will put up with a lot of abuse to work for less money than the actual value of their work in society.

You don't say exactly what sort of medicine you practice, but the origin of the word concierge is "fellow slave."

My own disclaimer is that outside of DU, I pretty much live in the world of public healthcare -- professionally, as a consumer, and as a citizen.

[Giant Robot]

25. I agree with a lot of what you say in your post

I think a better way to frame this kind of conversation would be, "How can we have national health care with a low impact on people's salaries."

This OP just seems to have opposition to it that leaks out in the questions that s/he asks. I am not sure that medical professional's salaries will be impacted in this manner. But certainly going with this assumption certainly leaves the impression in most folks that they do not want to hurt other's salaries so much, so we cannot have national health care.

[Bread and Circus]

42. What the heck is this supposed to mean?

" You don't say exactly what sort of medicine you practice, but the origin of the word concierge is "fellow slave.""

Now, that's what I would consider to be a bizarre statement. I don't have a consierge practice, if that's what you are getting at. I'm just a plain old family doc in traditional solo family practice.

[hunter]

53. Not many of you guys left...

Sorta like the American Family Farm. The big corporations have taken over, but profit from the illusion.

For what income you claim to make, there would be ZERO incentive for anyone to become a doctor except altruism. Who needs the hassle? Becoming a Physicians Assistant or Nurse Practitioner would be the wiser thing to do. There's not the long years of misery getting through medical school, residency, huge student loans, and very stressful working conditions. Oh, and how about that malpractice insurance? But it's your calling, so you put up with that while some sociopathic MBA health industry executive laughs at your efforts, and enjoys his multi-million dollar bonuses and twenty-something mistresses at his vacation house on the beach.

There's a big world beyond the libertarian utopias of Reason magazine and the and the fossilized visions of the AMA, and that world ain't pretty. In the scheming of the big healthcare industries doctors are are just another number, another irritating sort of employee, and insurance forms are just a different sort of time card.

That guy working in some expensive big city hotel, the guy you ask about restaurants and tours and stuff, he might just make more money than some of the doctors attending meetings there, and with a lot less hassle.

[HamdenRice]

26. I understand your question, but I think the premise is faulty

I am not a doctor but I have a doctor and nurse in my immediate and extended family. Right now, they are desperate for a new national health care system.

Here's why I think the premise is misleading: the doctor's income already has been drastically cut, as have the incomes of most of her colleagues. They see nhc as a way to stop the collapse. Right now, the doctor, who works as an attending in a big urban, profit and research oriented hospital, is getting stiffed by insurance companies on 2/3 of what she bills, or because the hospital treats uninsured. Her income has been falling for years as a direct result of unscrupulous practices by the health insurance industry. Her perspective is that the system is simply on the verge of collapse and that in terms of her income, the system makes her income too unpredictable. In other words, even if doctors' incomes fell, they would be stabilized and predictable, and many people really desire stabilized incomes so they can engage in financial planning.

The nurse works in a different urban hospital and in a highly unionized environment, supposedly with full coverage. But she and her son have some chronic but mild health issues, and they too are constantly getting stiffed by their insurer. She would gain more as a consumer than she could possibly lose as a health care worker.

So while you are asking a valid question, I don't think it's a realistic one. At this point, most doctors I know are trying to figure out how to prevent the insurers from taking everything from them and reducing them to serfs, without decision making authority over their own patients, time management, prescriptions or income.

[Bread and Circus]

32. I have no premise. It might be that physician/nurse salaries could go up.

I asked a hypothetical question, that's all.

I'm amazed at how "politician-like" the responses are and how many don't want to state succinctly how they would feel if the scenarios were true.

What further amazes me is how much people want to over-simplify what is an amazingly complex topic.

[HamdenRice]

37. I don't think it's politician like -- it's that most have read Paul Krugman

or are aware of his editorials. He's a very well respected economist who has looked at the numbers in great detail, and he doesn't see any likelihood of nhc forcing down doctors' and nurses' compensation.

I think that the reaction to the hypo is based on the empirical data showing the hypo to be unlikely, not on the political desire of not wanting to consider the hypo.

On edit: I notice downthread you say you have had trouble getting the data. Try looking up Krugman's columns; he has written extensively about this and his insights are kind of assumed within the blogosphere like DU.

[Bread and Circus]

39. I love Paul Krugman, one of my favorites :)

got any links?

[hunter]

38. You have no premise?

:eyes:

Your framing of the question is entirely against a single payer national health plan. It is not neutral in any way, and it's not even disguised as some concern trollish sort of "hypothesis."

Ah well, doctors who won't sully themselves with the dirty ways of politics and big corporate spin are going to get run over like all the rest.

Currently health care in the United States is rotten and obscenely expensive. Even people with money get astonishingly crappy and inappropriate care. This is clear evidence that private industry cannot provide public services any better than government agencies. In most cases private industry does it worse.

[suffragette]

27. I imagine we'll hear this quite a bit from people opposing

a single payer national healthcare system.

I watched a miniseries about Tommy Douglas on CBC not long ago.
When he was working to make national healthcare a reality there, this argument and the idea that doctors would somehow lose control of decision making were used to try to prevent the change to a national healthcare system.

From http://www.cbc.ca/greatest/top_ten/nominee/douglas-tommy-know.html

The move to universal Medicare was fought tooth-and-nail by members of the medical community who feared that the plan would undermine their profession. Both the Canadian and the American Medical Association contributed to the opposition Liberals in an effort to de-rail the program. In 1961, after Douglas had moved on to the new federal NDP, Saskatchewan's medical community waged a prominent public campaign against Medicare, claiming it would force doctors and specialists out of the province. Despite this, and an eventual strike, the Medicare bill was passed in a special session of Parliament on July 1.

Douglas would later point out that despite the medical community's protestations, the vast majority of medical professionals stayed put in the province. In fact, in the first year of widespread Medicare the average annual income for doctors increased by an average of $3,000.


Interesting that the AMA played such a strong oppositional role in Canada, maybe out of concern that once adopted and proven in Canada, it would also be adopted in the U.S. Instead, it's been a long time coming and both patients and doctors have had to be at the mercy of non-medical people (the insurance industry) determining what is appropriate medical treatment. How ironic.

So, back to your premise. It seems disproved by the above actual raise in income. If you really want to help PNHP counter this as a possible argument, maybe that's the true starting point - locate the data from the countries that have national health plans that debunks the meme.

[pitohui]

28. a doctor's right to obscene pay is not more important to my right to life itself

this post should be alerted and removed, it is nothing but right wing talking points start to finish

doctor/nurse pay has ALREADY fallen hugely since the 80s but don't let reality or anything interfere w. your little crusade to protect INSURANCE co. money grabs

[Bread and Circus]

33. Wow. I thought this was Democratic Underground.

Honestly, I support a single payer National Health Care system. I've done nothing to support any RW talking points. All I've raised are honest, hypothetical questions. What surprises me is how uncomfortable people are in answering them.

[Name removed]

41. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Bread and Circus]

43. You sound like a bully

You can't just shut people up for asking questions.

[yardwork]

46. I'm a bully and universal health care will cost too much.

Wring your hands some more.

[Bridget Burke]

29. I agree that "the question is a researchable one"....

Please get back to us after you've done some more research.

And explain why Single Payer would necessitate such large salary cuts. Especially for the nurses.

[Bread and Circus]

34. Research has proven difficult, I've thus far been unable to find...

credible information on the internet.

I called and spoke with the executive director at PNHP yesterday. She couldn't answer the question directly but she really appreciated our conversation, as did I. Her promise was that they were going to do more research on the topic and get the information out on the web.

I feel like you didn't even read the content of the post, or only read a few sentences. I've not suggested any pay cuts would happen. I just wanted to know how that would make people feel if they did.

[Bridget Burke]

35. Yes, I read your post. n/t

[Name removed]

40. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Bread and Circus]

44. This isn't the kind of discussion board for people to shout people down

[Name removed]

45. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Bread and Circus]

49. You are wrong, though you may not know it. Read all of my posts

here and then read your own sig. Then tell me you are living up to the spirit of your sig. What part of "free and open society" doesn't apply here?

[yardwork]

51. What part of "You are perpetuating lies while pretending to be concerned"

don't you understand? Do you think I was born yesterday?

[Bread and Circus]

55. No, I just think you are being hateful and I'm not sure why.

[Lydia Leftcoast]

56. As of last year, the Iraq War was costing $10 million per hour

That's about $2800 per second, or about as much as a person with a pre-deductoin and pre-adjustment household income of $30,000 pays every year.

[some guy]

47. answers

If a single payer national healthcare system cut physician salaries by as much as 30% to 50%, would that be fair? Would it even be a good thing? I don't know if it would be fair. I do think in at least one rspect it might be a good thing. It might have the effect of dissuading people who become physicians for the money to choose a different field, tilting the field more toward those who choose the profession for the ability to help others. i.e "bad" doctors who are more interested in becoming wealthy or 'playing god' might opt out.

If a single payer national healthcare system cut nursing salaries by as much as 30 to 50%, would that be fair? Would it even be a good thing? I don't know if it wouldbe fair. I'm less inclined to think there are very many nurses who choose the profession to become wealthy or 'play god' than there are doctors who do, so less inclined to think reduced incomes for nurses would be a potential good thing. (I hope that made sense)

Would you personally be willing to pay a new and separate tax to pay for the new healthcare system? Yes, if necessary.
If the tax was more than you pay in insurance premiums, would you still be amicable to this new tax? Yes.

Having answered your questions, I don't necessarily agree with some of your premises. I don't believe there is a need for a new and separate tax, nor that it would be more than I pay in premiums (and deductibles/co-pays) currently.

[Bread and Circus]

48. Sweet, thanks for the reply. I agree with you on all points.

For the record, here's what I think would happen with a national health payer system, as proposed by PNHP:

Primary care salaries would go up (supposedly the best paid family doctors are in the UK - $200K per year adjusted)
Specialty salaries might come down
Nursing salaries would stay the same but there would be less room for high end nursing income
Drug costs would come down
Administrative overhead would come down
Consistency of good care would go up
Alot of people in the insurance industry would be looking for new work
There will be some form of tax to pay for the system, however we would overall save money and the average family will have reduced out of pocket costs.

Despite what many people here want to insinuate about me, I'm very inspired to make a NHP a reality. It's one of the most important challenges of our time. However, we need to seriously analyze all the aspects of the equation as well as challenge the precepts of our own argument. Through the challenge, we will become stronger.

[some guy]

52. except for

people looking for new work, I could acept all the other things that you think would happen. Looking for a job is one of things I least like doing in life, so I never wish that circumstance on anyone. Some of those people would presumably be able to find new positions in the governmental 'insurance' sector, as that would necessarily increase due to expanded number of people 'insured.'

So that wouldn't be a total calamity. When I use 'insurance' and 'insured' I am thinking in terms of Mr Kucinich's idea of expanding medicare to cover everyone, so expanding that program from covering the current x million people to 300+ million would necessarily require some increment in the number of people who currently run the medicare program. 'Insurance' and 'insured' were just handy words, not perhaps the best choice of terms.

I try not to guess at people's motivation for asking questions, so I just answered them as they were asked. I'll trust we're on the same side, because 'd like to see NHP become a reality.

:hi:

edit: clarity

[Vinca]

50. Re the salaries -

if a physician didn't have to foot the bill for health insurance for his or her employees it would amount to a serious savings in cash. Ditto for hospitals having to provide health benefits for nurses and their families. In addition, the physician might be able to streamline staff if there weren't dozens of different insurance companies and claim forms to deal with. The physician might be able to see more patients rather than playing phone tag with insurance company employees paid to deny treatment. Some insurance industry people might lose their jobs, but all I can say about that is "boo hoo." Thousands of people have lost their jobs in this country because business can employ workers off shore who have their health care paid for by their governments.

Editing to add this site for your consideration - http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_82_E There is a link to physicians' salaries in Canada by province and specialty. One example: Family Medicine doctors range from $168,148 to $252,063. Of course there would be an adjustment for the dollar, but it still looks like a decent living.

[Lydia Leftcoast]

54. Phrase it like this:

1. Doctors: Would you take a small decline in salary never to have to deal with an insurance company again?

2. Patients: Would you pay extra taxes if it meant that you never had to deal with an insurance company again?

[tkmorris]

57. The question is pointless

The two things aren't related. Not really. You pose the question as if the adoption of UHC would result in changes to salaries in some way that was beyond our control, and thus we should evaluate if it would be worthwhile. That supposition is what is faulty. Under UHC doctors, nurses, and other medical professionals would be paid WHATEVER WE, THROUGH OUR GOVERNMENT, DECIDE TO PAY THEM. If their pay was too high before, we can reduce it. If it isn't enough, we can increase it. Or whatever we choose. If we are smart we will pay them exactly as much as it takes to get the best balance between value for care and getting the best quality individuals to provide it.

Furthermore your assertion that the data is somehow missing is just silly. UHC is common throughout the developed world, go google up some info. It isn't being kept secret.

We all know there is a tremendous amount of waste in the current system, enough so that if we choose to pursue UHC it is possible for consumers to realize substantial savings while medical professionals see a rise in incomes across the board, while also providing coverage to every man woman and child in the US that lacks it currently. We KNOW this; it isn't disputable.

The question isn't whether incomes for medical professionals would fall, or rise, as we can control that however we want to. You might just as well ask if UHC would be worth it if implementing it caused it to rain every Saturday, or if it made all the kittens in the world disappear.

Your username is curious. Bread and Circuses is a reference to a notion most notably spread by Robert Heinlein, wherein it is supposed that if permitted to a Democratic society will vote themselves bread and circuses, ie they will demand that the government provide everything for them while they sit on their unmotivated butts. It is a silly notion, but I can forgive Heinlein for it due to his background, the timeframe he grew up in, and the fact that his books make great reads if you can manage to overlook his politics. He also outgrew the idea somewhat in his latter years. The triumvirate of this board, that username, and the subject of this discussion is not lost on me.

[blondeatlast]

59. Indeed--it was the phrasing that made me think "industry." nt

[blondeatlast]

58. OOOOOOH--I love this, gang... (link to another DU thread):

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=1120331&mesg_id=1120331

[Cleita]

60. There was a doctor on Thom Hartmann's program yesterday, who worked both in

Canada and the United States. He said in order to be adequately paid in the USA, he can only spend six minutes with a patient. The Canadian, single payer system allows him fifteen minutes with a patient for comparable compensation. Also, he had a reduced staff in his office for billing because they only needed to send one bill a month to the government office that was the payer. In the United States he had to have several billers just to keep up with the myriad insurance, HMO and government programs, so his overhead was higher. So that blows the argument that doctors would get 30% less. I was going to post the link to the archive but you have to be a member.

As for big insurance and big PHARMA, they will survive just fine like the tobacco companies have by diversifying into other products. Also, they will probably look for new victims like tobacco has, which is not a good outcome, but we have to start somewhere. I see you are familiar with PNHP.

[supernova]

61. While lower MD salaries are an admitted possibility

there's a couple of reasons MDs get the rap of being greedy. It's not just that their specialties are in demand. (And I'm sure you know this better than I do.)

1) There are all those Medical School loans. Let's face it, going to Medical School is expensive. And my hat's off to anyone who achieves an MD degree. :applause: Unless your family is already wealthy, you're gonna owe out the wahzoo by the time you can hang up your shingle.


2) Malpractice premiums are outrageous. And no, I don't think it's all because loony-tune patients continually sue unscrupulous docs. I think it's because insurance companies like big profit so they choke MDs on their premiums and also turn around and tell the public that grandma can't sue that nut case doc down the street who took out her right eye, instead of the cancerous left eye. So, no I don't support malpractice award caps, just in case you were wondering.

So, coming out of medical school, you NEED to earn a lot of money just to come out even at first. Forget about feathering your retirement bed at the golfing community of your choice.

Here's my take on it.

Even though, salaries might come down, suppose malpractice premiums were anywhere near what you would call normal or affordable? Suppose that new CAT scanner for the Radiology lab didn't cost as much as it does now? Suppose with the savings, you could afford another nurse and maybe another front office person to help with scheduling and patient relations in general?

Suppose drugs were affordable so you or your staff wouldn't be pressured to listen to the lated drug sales call in exchange for the samples that you now pass out to patients whom you know can't afford the drugs you think they need.

Suppose it took a lot less money to run the entire system? In short, there's a whole lot of hot air in the entire chain that needs to be let out and I don't think it has much to do with MD or nurses' salaries, how often people want to use their health care, or ridiculously large malpractice awards (which are exceedingly rare).

[Cleita]

62. Well, in other countries, med school is tuition free to

the best and brightest, so you don't have to have a trust fund or get in hock for ten years of your life to become a doctor. Many also provide the mal-practice insurance as part of their licensing. This is another boon to single payer health insurance. Doctors have to be certified and licensed by the governments who they get their money from. Incompetent, or criminal doctors are more easily decertified because they will be known by their actions.