Free Health Care For All...

[Cow Poke]

Well apparently these other countries have doctors. Although I read that there is a doctor shortage in New Zealand.

Despite that they are paying some doctors NZ$400,0000 a year!

OK, so who's paying them? The government? Is "private practice" going away? I have 3 doctor friends who absolutely HATE the "new system" - it has been outrageously expensive, time consuming, and controlling. One of them retired early, and just does "physicals" for a local manufacturing plant. One of them had to merge with a larger practice, and the last guy is seriously debating retirement.

[Sparko]

OK, so who's paying them? The government? Is "private practice" going away? I have 3 doctor friends who absolutely HATE the "new system" - it has been outrageously expensive, time consuming, and controlling. One of them retired early, and just does "physicals" for a local manufacturing plant. One of them had to merge with a larger practice, and the last guy is seriously debating retirement.

It seems confusing. The second article talks about

"Pinnacle Midlands Health merged three surgeries and formed Tokoroa Medical at the start of 2014 because older GPs were retiring and there were no doctors wanting to take over management of the practices. Of the 400 doctors surveyed in 2006, 73 per cent were owner operators compared with 50 per cent last year."

So I am not sure if that is a private practice or government run. Maybe Starlight can fill us in on how doctors get paid in NZ.

[carpedm9587]

and we have them. Hospitals have to give care to anyone, regardless of their ability to pay. At least emergency care. And there are a lot of free clinics for other than emergency needs.

Most of these are very ad hoc, and the "free" care hospitals give are actually paid for by those who can afford to pay. This "catch as catch can" system is unbalanced, hitting smaller rural hospitals harder than major metro hospitals. Something a bit more structured seems reasonable to me.

At this point, after reading both sides for years now, I would support socialized medicine, IF it were done correctly and the level of service did not deteriorate (poor care, long waits, etc)

[Sparko]

Most of these are very ad hoc, and the "free" care hospitals give are actually paid for by those who can afford to pay. This "catch as catch can" system is unbalanced, hitting smaller rural hospitals harder than major metro hospitals. Something a bit more structured seems reasonable to me.

you are forgetting social security disability and medicaid which cover a lot of indigent people.

I said, IF. I have serious doubts that it would be run correctly. Look how bad Medicare is run now.

[Cow Poke]

I said, IF. I have serious doubts that it would be run correctly. Look how bad Medicare is run now.

I was on the hospital board before moving to where I am now, and SHEEEEEESH.... the Medicare game is crazy. They are constantly doing audits to see what they can "recoup" - if a doctor or nurse didn't code something exactly correctly.... and we're talking hundreds of thousands of dollars a month for a medium sized hospital (in recoupments) they can get charged back.

The Doctors and clinicians are constantly trying to figure out how to code treatments for the maximum payout, and audits often raise suspicion... It's a YUGE mess.

[Catholicity]

But how could it not deteriorate? With medical staff having to spend more and more of their time on paperwork - compliance and such - and the hopes of ever making enough money to offset their college debt.... who, in their right mind, would want to be a doctor?

Believe it or not.....I know someone who just finished as an NP. Someone my husband knows finished his residency, and Sister's Sister in Law is doing her residency in North Carolina. So...someone does. I know at this point in my life medical school is off the table but finishing nursing school is not.

[carpedm9587]

you are forgetting social security disability and medicaid which cover a lot of indigent people.

No - not forgetting - I was just responding to the examples you provided. And, unfortunately, every sign is that the next tax bill is going to necessitate scale-back in both medicaid and medicare, some of which are apparently slated to hit as early as October. I'm not sure why this isn't getting major press, but it doesn't seem to have been focused on by too many.

I said, IF. I have serious doubts that it would be run correctly. Look how bad Medicare is run now.

I keep hearing about "how bad." I won't described Medicare as "the most efficiently run system in the world," but I cannot say that my experiences with medicare/medicaid as I dealt with five different elderly (and eventually dying) relatives was any better/worse than my experiences with BC/BS. That being said, I am one data point and that was five experiences, so too small a data set to be a very compelling argument. I'd have to see some data that compares the two worlds to have an opinion one way or the other.

Since you have that opinion already, I presume you have access to such data? Can you point me in the right direction?

[Sparko]

No - not forgetting - I was just responding to the examples you provided. And, unfortunately, every sign is that the next tax bill is going to necessitate scale-back in both medicaid and medicare, some of which are apparently slated to hit as early as October. I'm not sure why this isn't getting major press, but it doesn't seem to have been focused on by too many.



I keep hearing about "how bad." I won't described Medicare as "the most efficiently run system in the world," but I cannot say that my experiences with medicare/medicaid as I dealt with five different elderly (and eventually dying) relatives was any better/worse than my experiences with BC/BS. That being said, I am one data point and that was five experiences, so too small a data set to be a very compelling argument. I'd have to see some data that compares the two worlds to have an opinion one way or the other.

Since you have that opinion already, I presume you have access to such data? Can you point me in the right direction?

well I have been researching it since I will be going on it in a few years time. It is a total mess to even figure out. Then it only covers hospital bills, and you have to get a separate thing for drugs and dental and whatnot. So even with the socialized medicine it is still going to cost me more out of pocket just for the premiums to keep the same level of coverage I have now. How is that good? Even on socialized medicine you still have to buy insurance? That's crazy. And according to Mossrose, it is the same in Canada. She couldn't afford a dentist because they are not covered under Canada's health plan. And because I have some specialized medicine I have to take, it will be expensive for me too.

Then there is the constant news about medicare funding being in trouble, and I have friends and family who are in the medical field. and I work at a law firm that deals in lawsuits that include medicare fraud and such. My experience is that it is very inefficient, with a lot of fraud, waste and poor coverage. And it seems pretty easy to scam medicare with false claims.

[carpedm9587]

well I have been researching it since I will be going on it in a few years time. It is a total mess to even figure out. Then it only covers hospital bills, and you have to get a separate thing for drugs and dental and whatnot. So even with the socialized medicine it is still going to cost me more out of pocket just for the premiums to keep the same level of coverage I have now. How is that good? Even on socialized medicine you still have to buy insurance? That's crazy.

And according to Mossrose, it is the same in Canada. She couldn't afford a dentist because they are not covered under Canada's health plan. And because I have some specialized medicine I have to take, it will be expensive for me too.

No - not crazy. It depends on what the socialized medicine covers. A program that covers "absolutely everything," would have a higher cost than a program that covers non-elective procedures only, which would be more expensive that a program that protects against "catastrophic events" only. A program that includes pharmacy coverage will be more expensive than one that does not. So the question becomes, how much do any/all of us want to see our taxes increased for the coverage. There can still be an independent insurance industry for anything NOT covered by the socialized system. Personally, I would love to see a system that covers ALL non-elective medical costs, but even that will require a clear definition of what is and is not elective.

Then you get into all of the moral issues. Will a socialized system cover abortions? There will be a strong push-back from many religious groups if it is included. Will it cover contraception? There will be push-back from a smaller group.

Any socialized program will be a set of compromises, leaving room for private insurance for the uncovered elements.

Then there is the constant news about medicare funding being in trouble, and I have friends and family who are in the medical field. and I work at a law firm that deals in lawsuits that include medicare fraud and such. My experience is that it is very inefficient, with a lot of fraud, waste and poor coverage. And it seems pretty easy to scam medicare with false claims.

Here I am in agreement. Any program that is administered at a federal level is almost sure to be inefficient and rife with opportunities for fraud. History suggests to us that the more local you get, the more fraud tends to reduce. It would be nice to see a program with federal guidelines and parameters that is then funded to be administered locally, perhaps by city or country/parish governments.

[Terraceth]

But how could it not deteriorate? With medical staff having to spend more and more of their time on paperwork - compliance and such - and the hopes of ever making enough money to offset their college debt.... who, in their right mind, would want to be a doctor?

How would doctors not have hope of offsetting college debts? The low-end starting pay for a full-fledged doctor is around $200,000. With that kind of income, it seems like it'd be pretty darn easy to pay off your student debt.

The bigger problem is the time requirement; you have to get a Bachelor's Degree, go through medical school, and then the residency which is at least 3 years, possibly a lot more depending on the specialty (I think it's something like 7 for neurosurgeons). The residency isn't so bad because you at least get paid for it (not bad pay either, it's around $55,000/year), but there's still around 8 years leading up to that.

I was on the hospital board before moving to where I am now, and SHEEEEEESH.... the Medicare game is crazy. They are constantly doing audits to see what they can "recoup" - if a doctor or nurse didn't code something exactly correctly.... and we're talking hundreds of thousands of dollars a month for a medium sized hospital (in recoupments) they can get charged back.

Why should the accuracy of the doctor or nurse's coding affect things? Doesn't that all get handled by the medical coders? I know that providers will often put in some diagnosis/procedure codes before it gets sent to the coders, but then the coders modify it as necessary.

To be fair, coders can totally flub stuff up also. But they'll be far more accurate than a provider.

Believe it or not.....I know someone who just finished as an NP. Someone my husband knows finished his residency, and Sister's Sister in Law is doing her residency in North Carolina. So...someone does. I know at this point in my life medical school is off the table but finishing nursing school is not.

Well, someone getting an NP isn't them becoming a doctor. The pay isn't as high as that of an MD (it's still pretty good though), but you don't have to go through as much schooling and it's generally a less stressful job because your responsibilities are lower.

[Cow Poke]

How would doctors not have hope of offsetting college debts? The low-end starting pay for a full-fledged doctor is around $200,000 (average pay during residency is around $55,00). With that kind of income, it seems like it'd be pretty darn easy to pay off your student debt.

Do you have any idea at all what they pay in insurance - particularly malpractice insurance. Tort reform might help address that, but unless they're working "for" somebody, they have incredible expenses.

Why should the accuracy of the doctor or nurse's coding affect things? Doesn't that all get handled by the medical coders?

The "medical coders" (if they exist in a small office) have to know what procedure the doctor did, so they can code it, and it's quite a complex array.

I know that providers will often put in some diagnosis/procedure codes before it gets sent to the coders, but then the coders modify it as necessary.

To be fair, coders can totally flub stuff up also. But they'll be far more accurate than a provider.

I think my point was that, sometimes, the doctor (or clinic manager) didn't want the procedures to be coded "correctly" - they wanted them to be coded for maximum payoff.

[Starlight]

With medical staff having to spend more and more of their time on paperwork - compliance and such

In the US studies have consistently shown that Medicare has much lower bureaucratic expenditures than private insurance companies - a much higher percentage of the money put into it goes into healthcare. So why would you expect government-run healthcare would have more paperwork rather than less?

I recall reading an article about two hospitals across the river from each other, one in Canada one in the US. The US one had an entire floor of staff dedicated to billing, because the administration involved in calculating costs for all the procedures, interacting with insurance companies, sending bills to all the patients and chasing up unpaid bills etc, is huge. In the Canadian hospital, the billing department was two part time workers sharing one desk, because they only bothered to bill a patient in the rare instance they were non-Canadian.

In the articles I've read here in NZ about billing, I learned that because we don't bill NZ patients, our hospitals here don't bother to keep track of what each individual patient receives in terms of services - e.g. because they don't need to give an itemized bill at the end that says "2x Bandage, $400", "1x Splint, $800" etc, no doctors or nurses need to create that paperwork in the first place, they can treat the patient with the supplies the hospital has without worrying about recording every last item for later billing. Instead all they write on the record is medically relevant things. This actually creates minor problems for the billing of foreign patients, because of the lack of paperwork created - the part-time worker at the billing desk can only see that the patient came in with a particular medical condition and had a particular type of operation and can read some doctors notes about the medical details and test results. The billing people thus have little idea what equipment was actually used or what number of doctor/nurse/surgeon-hours was spent on the patient, and they just make up a number (which the articles tend to point out vary wildly from hospital to hospital and are almost always too low by an order of magnitude).

who, in their right mind, would want to be a doctor?

Well doctor is one of the highest-paid professions here, perhaps the highest. A sister of mine and two of my friends are doctors here.

Well apparently these other countries have doctors. Although I read that there is a doctor shortage in New Zealand.

Despite that they are paying some doctors NZ$400,0000 a year!

A problem that has always existed is that highly-qualified professionals who have degrees obtained in cities don't particularly want to move into the countryside and live far away from anything interesting. As a result, really high pay rates have to be offered to attract them. My grandfather, after he got his teaching qualification, did actually decide to take up the offer to be paid really well to go teach in a rural town for several years. ~60 years later, the government is still having to offer large paychecks to attract doctors to rural areas. If anything it's becoming more of a problem because the country is increasingly urbanizing, and so rural populations are dropping not increasing.

Anyway, it's not a lack of total doctor numbers, it's a lack of people wanting to live in rural areas.

OK, so who's paying them? The government?

In public hospitals here, doctors are 100% government paid.

For GPs / family doctors / local physicians / whatever you want to call them, the funding is partially government and partially paid by the person per visit ($0 US to $40 US depending on their demographics and what the doctor feels like charging for an appointment). These are usually referred to as "private" clinics, though they are massively government-subsidized in practice.

[JimL]

Isn't so free after all....

For one thing, no one pushing for Singlepayor ever defined it as "FREE HEALTH CARE FOR ALL." Medicare is not free, it's just much less expensive. Common sense should inform you that cutting out the middleman, i.e. cutting out the insurance companies whose only goal is, not healthcare, but more profits, will make insurance cheaper and better. Now, besides all that, what ever happened to the Trump led republican repeal and replace plan wherein Trump and republicans were going to replace ObamaCare with better cheaper insurance for all. It was going to be so easy to do. Remember?

[JimL]

And throwing all that money at it won't make it work.

You conservatives are such pessimists. Your fellow Canadians disagree with you and favor by 86% (if I remeber correctly) their government healthcare.

[Terraceth]

The "medical coders" (if they exist in a small office) have to know what procedure the doctor did, so they can code it, and it's quite a complex array.

I was under the impression that the smaller offices that don't want to hire a coder themselves generally just contracted with some medical coding company that handles that for them.

It's true that the coder has to know what the procedure was in order to code it, but, well, that's what the documentation is for.