Has Western capitalism become too efficient and ruthless?

Ichon

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Mar 2013
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British General Practitioners make about 15% less than GP in the U.S. after subtracting average cost of malpractice insurance and school debt.

Straight up U.S. GP make about 25% more and pay less in taxes on average but also around $15,000 annually for malpractice insurance (vs $45,000 for surgeons) also U.S. GP have average school debt over $200,000 vs British GP around $50,000 USD which means over 30 year career British GP actually have goods odds to make more money than U.S. GP while re-paying their student loans but once repaid in the latter half of their careers U.S. GP outpace British GP by about 40%

Due to the heavy stress and lower rate of acceptance and smaller # of schools for M.D. in the U.S. the per capita amount is 2.4 doctors per 1,000 while Britain is at 2.8 both among the lowest in the developed world which averages close to 3.8 per 1,000.


It seems there is a lot of confusion between single payer insurance and government run healthcare. The main reason single payer is popular is that it has a chance of reigning in costs due to transparency and a very large payer negotiating for rates. U.S. healthcare is vastly more profitable than healthcare in other nations while it is well documented that average outcomes are worse in almost every single statistical category.

The argument against is primarily based on 3 claims;

1. the premise it leads U.S. healthcare to fall in quality which on an overall metric is guaranteed to be wrong but in specific situations could be correct.
2. will lead to rationed care. That is hard to say because care is always rationed when the number of doctors and hospitals is already declining and the population is growing. both those factors contribute to rising healthcare costs of demographics play a role as does lifestyle where the U.S. population is on average less healthy than many other developed nations (not the LEAST healthy- important caveat as several other nations with even less healthy populations continue to have better health outcomes by most measurements).
3. actual costs will spiral even further as a portion of GDP because of a LACK of rationing if people aren't stopped by high premiums or out of pocket costs demand for services will escalate. initially is likely to increase but in the longer term critical care costs will decrease and critical care is by far the costliest form of healthcare so factoring in demographic trends costs per capita will decrease somewhere around the 10-20 year mark.

The argument for seems to be based on 2 broad claims;

1. healthcare is as much a part of living in modern society as access to air people breath because so much of sickness (not all) is a roll of the dice and by the logic that equal opportunities to pursue happiness are impossible when a certain % of the population is permanently stuck spending most of their lives simply trying to manage their own or very often a family members healthcare. this argument usually says families will be stronger and divorces fewer and society better off if healthcare costs are divided via taxes over the entire population- not mainly striking hardest on a few via random chance.

2. because the U.S. system is currently so awkwardly structured and impossible to overhaul fully the best way to constrain costs and provide better outcomes is a single-payer insurance plan at the national level where costs are spread out among the full population (in reality this will benefit baby boomers the most as they are the least healthy and the nearest to medicare anyway). having a single government point of contact to negotiate payments will in theory leads to lower costs as transparency becomes mandatory when there is mainly 1 buyer (private insurance will still exist- going by other places where single-payer plans are operating supplemental and gap insurance are large markets but overall size of the market and profits ARE diminished).

another claim I see more often among policymakers is that single-payer will more broadly allocate funding towards areas it is needed most for life/death patients rather than steered toward where the most money can be made which reduces outcomes as fewer specialists work in many fields because of the current insurance reimbursement policies and the lack of transparency around healthcare provider compensation. this may be true but will take decades to manifest as many specialities that are vastly understaffed will first have to be identified in the new structure and then new doctors trained up while current misallocated specialities slowly re-train/move into new areas of medicine. A personal example I know of 2 M.D.s colon-rectal surgeon and OB/GYN who recently left the field they had completed fellowships in and practised in for a few years because of work/life balance. Basically they traded about 200k per year in compensation for -20 hours a week of work (80+ to below 60) and where they felt the doctor patient relationship was better, neither work for hospitals, both now work in private practice with a group of other physicians of various specialities. They also have paid off about half their student debt of 400k (a bit above average for surgeons but not unheard of by anymeans) and are still making more than $150k per year or basically in the top 5% of wage earners.
 

deaf tuner

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Oct 2013
14,635
Europix
U.S. GP have average school debt over $200,000 vs British GP around $50,000 USD which means over 30 year career British GP actually have goods odds to make more money than U.S. GP while re-paying their student loans but once repaid in the latter half of their careers U.S. GP outpace British GP by about 40%


It's an aspect that is impacted by another sector: education, or more precisely, education subventioning.



In EU (UK excepted), medicine studies are much less expensive: tuition fees, depending on country, range from 0 $ to aprox 1,500 $ per annum. The indirect costs (lodging, food, etc) are at aprox. 10-15,000 $ per annum (sensibly lower in eastern EU). That leads to a low (if any) school debt and also (in theory at least) a larger accessibility of medical studies.

I don't have stats, but logically, I suppose it's influencing health care costs, as the loan reimbursement is there. After all, it's the patient/its insurances paying that loan in the end.





source: How Much Do Doctors in Other Countries Make?
 
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sparky

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Jan 2017
5,353
Sydney
The Australian system rest on a basic universal healthcare ,pretty cheap
and a private insurance system for "better" coverage
it's no secret that the young and healthy subsidize the old , and that men subsidize women health
many young male people thought , rightly , that a private cover is a waste of money for them
the government introduced a law where they pay more in tax if they do not have a supplementary cover
one of the private insurance company is in fact state owner and has to return a profit
Medibank keep the bastards honest
i'm not saying it's perfect but it is affordable and of decent quality

how good are health statistics in the USA ?
 
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Iraq Bruin

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Oct 2010
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It's an aspect that is impacted by another sector: education, or more precisely, education subventioning.
It is impacted by Education in more than way, loans are just part of the story.
In EU (UK excepted), medicine studies are much less expensive: tuition fees, depending on country, range from 0 $ to aprox 1,500 $ per annum. The indirect costs (lodging, food, etc) are at aprox. 10-15,000 $ per annum (sensibly lower in eastern EU). That leads to a low (if any) school debt and also (in theory at least) a larger accessibility of medical studies.

I don't have stats, but logically, I suppose it's influencing health care costs, as the loan reimbursement is there. After all, it's the patient/its insurances paying that loan in the end.





source: How Much Do Doctors in Other Countries Make?
I am not a statistician but I studied enough to ask various probing questions:
are the comparisons taking into account the different size of populations, by that I mean the number of people in the country, the sheer number of Medical doctors, specialists, ..etc.
Is the relationship linear, percentage based, or flat-line? Should the increased population numbers mean better or worse medical data numbers ? (do we take into account that the larger the sample size, the closer we are to the real averages)
Is it feasible to compare countries to countries ? or countries to similar demographic-makeup/size US-State(s)?
 
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deaf tuner

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Oct 2013
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It is impacted by Education in more than way, loans are just part of the story. ...
Off course.

But as I remained on the costs line and possible implications, I mentioned it because I think that it's an aspect that might have a significant impact.

The first is purely financial: once in active life (=practicing), the medics have to include the reimbursement into their salaries. That's augmenting the price of the medical acts. American statistics say that 80% of doctors have an average of 120,000 $ loan to reimburse. It's actually a big sum at national level, as it's a permanent unpaid debt (the debt of the older doctors that had finished paying the loan this year is replaced by the debt of the new doctors starting this year).

It's something that's almost inexistent in most European countries. Meaning, European healthcare has an expense in less. (Of course, at state level, it remains to make a balance, to see how much more costs the education system).

The other aspect is the recruiting base: cheaper the medical studies, larger the recruiting base. Meaning the society has probabilistically access to more dedicated and able doctors (of course, that is to be pondered with the quality of the schooling).

The last aspect, and that can't be quantified, is doctor's quality of life, the stress: if one is finishing studies without a big loan, it can take that loan for buying a house, a practice, for example. As I said, it isn't quantifiable, but I suppose we can reasonably assume that a beginner doctor at ease financially is more likely to do better his job.

...

I am not a statistician but I studied enough to ask various probing questions:

are the comparisons taking into account the different size of populations, by that I mean the number of people in the country, the sheer number of Medical doctors, specialists, ..etc.

Is the relationship linear, percentage based, or flat-line? Should the increased population numbers mean better or worse medical data numbers ? (do we take into account that the larger the sample size, the closer we are to the real averages) ...
Good questions.

In the few figures I used and posted, it's generally national level statistics, so the sample size isn't an issue: it's the totality of docs, of beds, expenses, aso, the population is total population, salaries, compensations are average at national level.


...
Is it feasible to compare countries to countries ? or countries to similar demographic-makeup/size US-State(s)?
Even better question.

Actually, it would be quit simple to compare equivalents, and I think it could be useful: US and EU are very close, in terms population, economic development and level, it's also convenient as EU members are using the same principle (=universal health care) that is different of the US system, plus, good, reliable and accessible statistics exist and on US and on EU.

It's just that lately I am a bit reluctant to even remind the sylabe "EU". Simple mentioning it is sometimes triggering some strong reactions, and sometimes it's backslashing. Me.
 
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Iraq Bruin

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Oct 2010
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I asked the latter question because not all states are the same so I doubt one law or system will fix all. I brought the education for a reason, my county and neighboring county have good ones, I wouldn’t send my child to most school systems in California.

Also, remember that a lot of these loans are tax payer money that they should payback ( if not directly, then eventually as high tax rate on their income)
 

Ichon

Ad Honorem
Mar 2013
3,726
Also, remember that a lot of these loans are tax payer money that they should payback ( if not directly, then eventually as high tax rate on their income)
Quality of education is a different topic but I am curious why it seems you disagreed earlier with the premise that some people among them presidential candidates have put forward that businesses require government regulation, infrastructure, enforcement, and standard-setting so successful businesses and the people who reap the most reward from success pay a higher portion of taxes- if communities are a group effort that rewards individual hard work- how is that different than communities loaning money to medical students who then are very highly reimbursed for their part in taking care of the community and the hard work required to reach and maintain that position with higher taxes proportionally on their income?

To me, it is the same idea but somehow I see people not minding that physicians or others who took out government loans getting taxed at a high rate but 'businesses' conversely that theoretically might do far less for the community (in fact could sell harmful or just trivial products) are more privileged than medical professionals?

Is it simply the link between a business being able to operate due to the government (taxpayer money at work) and direct loans to a person (doctors are really business professionals) is a bit less direct? Actually, a huge number of businesses depend on government support even more directly than medical students taking out taxpayer-backed loans. Subsidies, price floors, tax breaks for business investment, laws the protect from competitors stealing intellectual property, all sorts of things without which most businesses would not operate nearly as efficiently or in some cases at all.
 

sparky

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Jan 2017
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Sydney
@ iraq bruin
what make you think the US has a competent health care system ,
by any metric it is a dysfunctional vampiric construct made to extract money for the medical industry

if company profits are the only good to be considered , anyone who loose his life to protect such an aberration is delusional
their life is worth much more than a tenth of a point on the Dow Jones index
 

deaf tuner

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Oct 2013
14,635
Europix
Also, remember that a lot of these loans are tax payer money that they should payback ( if not directly, then eventually as high tax rate on their income)
I didn't knew that. I thought the loans are loans, You know, like going to the bank ...

I asked the latter question because not all states are the same so I doubt one law or system will fix all. I brought the education for a reason, my county and neighboring county have good ones, I wouldn’t send my child to most school systems in California
No law or system would love everything. For me it's rather about which variant, which principle works better, achieve more.
 

deaf tuner

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Oct 2013
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To me, it is the same idea
My opinion too.

It's the reason (in this comparison of healthcare systems too, for example) why I look for stats that take the overall costs/expenses, regardless who and how they're paid (out of the pocket, private insurance, governmental taxes). I believe it's a better indicator as it isn't blurred by ideological/social positions or convictions that all of us have.