Tommy Douglas: Not Dead Enough

You want to know why they have a shortage? H1B visas and the hideously broken, arrogant and abusive immigration system they have.

That's it. Doctors from all over the world are hammering at the gate to get in, and they CAN'T, because of the immigration system.

So if Obama can fix that he will have proved he's not completely and totally useless. I'm not holding my breath.

Lowing the obscene cost of medical school wouldn't kill them either. I'd suggest repealing a few million pages of regulations as a start on lowering education costs, but this is the DemocRats we're talking about here. They aren't going to even think about that.

It's not about you, or me, it's "We," now -- it's all about top-down decisions of what "We" need to do.

"If 'We' expand coverage," (says a "health policy analyst")"'We' need to make sure 'We' have physicians...Let's say 'We' insure everyone. What next? 'We' won't be able to take care of all those people overnight."

"'We' have to increase spending..."

Top-down collectivism.....Wheeee....

"Increasing the supply of doctors, for example, would increase access to care, but could make it more difficult to rein in costs."

COULD make it difficult??? Don't sugar-coat,honey.It WILL,by many hundreds of BILLIONS of dollars. You Yanks think you have a deficit now? Wait until "universal" health care hits!!! The Owes 3 trillion dollar "stimulis(read pork) package" will look like the good old days!
Take it from somebody with experience.

its like watching the US self destruct in fast motion. a 100 days and 100 mistakes.

I'm not sure about other provinces, but here in Ontario OHIP basically tells doctors how much they can earn each year. Unless of course you're a dentist which is private health care. But don't tell the NDP. They think that there is no such animal in all of Canada.

remember the dippers think ever doctor should be as serving to the revolution as Dr. Zivago.

and every autoworker should be paid at least $70/hr.

Doctors who take Medicare patients in the US already lose money on every one they treat - it's why so many refuse to treat them at all.

By the way.

They don't actually -have- a doctor shortage in the USA. What they have is "under served areas". This is places outside the large cities where the population thins out, and there's not enough patients to support the number of docs you need to cover 24 hour call. Normally that shortfall would be offset by raising prices (DUH!!!) but patients don't pay for their own stuff. Big corporations and government set the prices. So docs don't go out there, because there's no money. Duh.

Also there's an interesting phenomenon in small towns where the local hospital is run by the old guys, and they make new kids join their group practice if they want hospital privileges. The group practices have "costs" (retirement fund for the old guys is what it is) which have to be covered by the new kids, meaning half the insurance and medicare pay-outs go to the practice and what's left goes to the doc.

In a big enough town you can just crank through more patients and make it up that way, but small towns don't have that number, so kids don't make enough money to pay the interest on the $400,000 student loan monkey on their back. Also, small towns only have one group. No competition for new hires, they can do whatever the hell they want. And they do, they absolutely do.

So new docs don't go to small towns. So call doesn't get covered, and it looks like a "shortage", but it isn't one. Its an unholy aggregate of socialist stupidity, central planning and small town monopolies.

Throwing more money at it will do absolutely nothing. So of course that's what the Democrats are going to do. You just watch.

Well, money is one thing, but a Hero of the Revolution ribbon is quite another. Only knuckledraggers are unable to discern the nuanced difference between the two.

Don't forget the need for tort reform. Regular lawsuits and exorbitant liability insurance premiums are a huge wet blanket over aspiring physicians, not to mention massively adding to the costs throughout the medical system in the US.

Well there is a solution to this problem that is quite natural under socialism. You simply decide who are going to become doctors, decide on their specialties, if any, and where they are going to practice. One idea is to simply make it hereditary and put restrictions on internal mobility.

I guess the lefties all studied social engineering (Soc-Eng) at the same Kindergarten.

The reason healthcare is so expensive is that the US is "sue happy". You get MD's knowing the diagnosis but having to do multiple expensive tests to cover their ass. The liability insurance is also a major expense for these MD's and they will not recoup getting paid Medicare wages! Just like Canadian doctors were fleeing here to go work in the States for the higher wages, you will see many retire rather than get paid peanuts and have to go into assembly line care to even pay the overhead. Nothing like watching bureaucrats who know nothing try to pretend they know it all. The US is in self destruct under the Big Zero and yet watch the fawning as the media hails and bows at the first 100 days. Crap, can we survive to 2010 at this rate?

One more thing. Kate is correct about the Medicare reimbursement, but it is -worse- than that. One word, lawsuits!

There are states in which it is effectively impossible to get medical malpractice insurance if you are an obstetrician/gynecologist, or if you are a GP who delivers babies. You can be sued at any time for a baby you delivered up until said baby reaches the age of 18.

This 18 year window of lawyerly opportunity is called the "tail", and in some states due to this tail your risk of being sued during your career surpasses 100%. Not only will you be sued, you will be sued -repeatedly-. That assumes you are a very paragon of virtue and medical perfection. Normal mortals get sued semi-annually.

"Tail insurance" is required to cover you for what you've already done. Nobody can afford the insurance premiums on an 18 year long tail with thousands of baby time bombs in it waiting to go off. Normal tails are seven years, which is quite bad enough.

So, duh, people don't practice in those states. Creating a "shortage".

So high insurance and lawsuits cause doctor shortages in the US but what causes that same phenomina north of the 49th?

Immigrating doctors coming to North America aren't the answer either. I honestly don't know of any country that has too many doctors that they can afford to export them. Then there is the whole thing of competence. A medical degree from the U of Timbuktu might not be of too much use here.

And then there is that slippery socialist slope of making doctors practice in communities where they are needed as opposed to where they want to practice or where they might be able to make some money to pay back student loans.

IMO, the problem is not the number of doctors available for primary care. It's peoples' expectations. Both here and in the US.

Just because someone may 'feel' ill, why see a doctor? Why not instead see a nurse, a nurse practioner, or simply a medic like we have in the navy? A large percentage of visits are for minor things like colds and scrapes. If it is serious enough or the medic believes there may be more at issue, escalate the case to the care of a doctor. Triage in other words with nurses and medics manning the ramparts instead of doctors.

Billions of people on this earth walk for miles just to see a nurse or medical practioner who in many cases is overworked, under staffed and usually w/o adequate medicines. Yet the care offered, as limited as it sometimes is, can yield immeasurable results. Here in North America, we cry foul if we wait a couple of hours.

I think it's been posted on SDA before how people in the west just understand that living in rural areas necessarily means being a couple of hours from high tech medical help. That's a lifestyle choice and by all accounts, westerners have thrived through sheer will, courage and interdependence. Much of which is foreign to the denizens of large urban centres.

Economics is all about rationing limited resources with unlimited desires. Until we rework the rules of the health care system, I see us as just another train heading into the station w/o brakes.

It is is simply amazing how the real issues are just completely overlooked. Sadly nobody with the slightest power to shape public opinion wants to kill the proverbial goose - they each just want more of those golden eggs. - the Doctors, the Insurance Companies, the Drug Companies, the Government folks, the Lawyers, the MSM - a pox on them all.

The simple truth is, make health care inexpensive by eliminating the several monopolies involved. Deregulate medicine and let markets do what markets do best. One small example, on the 'practitioner' side - after eliminating the CMA and the AMA as Unions - solely in charge of the definition, education and licensing of physicians, make the first of many possible cuts - separate diagnosis and treatment. Medicine is just as amenable to division of labor as any other trade.

The total inability of folks to discuss medical care in a meaningful manner is just another indication that so - called "Liberal Democracy" is evolutionary, not even remotely the "end of history". And we are entering the dinosaur stage. Religion - toast, the Media - toast, The 'Professions' - toast. Adapt or perish, folks.

Obama et al think they smarter than anyone and can just "fix" things by fiat.

They have never learned the 2 rules of the game.

Life is a series of lessons.
Lessons will be repeated until learned.

Actually, although a "sue-happy" culture is partly to blame for the high costs of health care in the US, there are plenty of other reasons as well:

1. The FDA.
2. Insane regulatory system.
3. Government controlled hospitals.
4. Government controlled HMO's.

The U.S. health care system follows the fascist model where gov't controls (not own) the means of production and has created a cartel. As with any cartel, the consumer gets gouged.

Smart people learn from their mistakes.
Wise people learn from the mistakes of others.

Obongo is dreaming the Canadian dream.

I predict more and more doctors in the USA will become abortion doctors because dead babies don't sue.

"They have never learned the 2 rules of the game.

Life is a series of lessons.
Lessons will be repeated until learned."

Then, of course, there is this rule as described by Raif Mair that says
"we make a BIG mistake in thinking that people in charge actually know what they are doing"

Horny Toad

Could a quasi "Directive 10-289" be in the wings in the USA as they already have for doctors here in Canada?

Kate posted a comment "Doctors who take Medicare patients in the US already lose money on every one they treat." Here's a quick link to which she is referring: http://hotair.com/archives/2009/04/18/when-doctors-go-galt/

When a new grad enters practice they do not have the resources in small towns they have in the major cities. You can't get MRI's etc. when you want them. The new docs do not have the comfort level they are used to. The litigation and practice purchase are valid points. Big city lawyers will persecute a MD they didn't do this or that but those services aren't readily available. Add to that being on call 1 in 2, or 1 and 3 and being stuck in Spitoon Anywhere and it is a tough sell. Alberta has the right idea with STARS, real help is a phone call away.

Immigration is only a partial answer because educational standards differ around the world and many immigrant doctors have as professional as cultural difficulties to adapt to the North American system. In Manitoba there was a wave of East-European and South-African physicians that made the transition rather smoothly, but that's not always the case with people coming from other geographic locations.
One solution worth to try for the shortage of primary-health care providers (in Canada) would be to introduce payments per capita with some financial participation by the patient. That would create competition among the doctors, allow for prophylactic medicine which under fee-for-service scheme is not existent, allocate time for more complex cases and basic psychotherapy. Competitive pressures would force some doctors to move to under-serviced areas. Paying a nominal fee directly to a doctor by a patient on periodic bases would inject a greater responsibility into the relation by all parties. Physicians would be able to practice medicine in full, not just cure symptoms or re-direct traffic to specialists in 15 minute slots.

Kate says "Nobody *needs* to be a doctor."

Quite true. There are other professions.

I hear that community organizing can be pretty lucrative ....

Kate says "Nobody *needs* to be a doctor."

Quite true. There are other professions.

I hear that community organizing can be pretty lucrative ....

I agree with Woodporter and Nicole; a few years back, I had a car accident in California. My injuries were a broken foot, and a lacerated tongue (from the airbag punching me in the face). The doctors ordered a CAT scan, which showed nothing, an MRI, which showed nothing, and then an MRI with a radioactive contrast, which showed - nothing. Each one of those tests cost over $5,000 US, and was indicated because.. well, I never got an answer to that. My respiration, pulse, blood pressure, etc. were all normal. I had no external bruising (other than my tongue), felt no pain other than my foot and tongue, and exhibited no diminishment of my mental faculties. I figured out later it was simply a case of "CYA" in case they'd missed something. It was a complete waste of time and money purely to keep potential lawsuits and vulture lawyers at bay, and is surely one reason US health care costs are so bloated.

KevinB, nice story.
In canuckistan, my experience was this;
Daughter gets hit by a car. Slight knee injury.
MRI six months later!

should be able to train a good gp in four years and a good cutter in six or less.

justthinkin. imagine when 40 plus percent of their gdp is being used by medicare. hahahahahahaha.

KevinB/Pudding

Sorry about your daughter P.

A few years ago my wife came home from a Michael Moore movie bloviating about how terrible health-care was in the US and how Canadian health-care is so much better. Even though this topic was never of interest to her before, and that I'm a political junkie living in Canada(so I've had this discussion before), she proceeded to tell me how I'm wrong despite my solid argument.

Three years, a broken ankle and a plate that should have been removed two years ago later, the words "I told you so" have never had so much meaning. Sure it's a minor thing waking up to an aching ankle every morning, realizing it will never come out. But I can't help but think that it's worth it; you know, being able to say " I told you so" vs. my discomfort having to hear about how her ankle aches.

BTW it's a twofor. I also told her not to wear heals in the winter;)

socialism has an answer for talent shoratges and lack of incentive. You invoke the power of afirmative action and negate AMA standards and mediacal exams for select miniorities going into medical studies.

Then you enforce the case rate at hospitals with a state political officer who sends slakers to the gulag and fudges through-put figures.

It's all been done, ask an old Cuban, if you can locate one.

KevinB, you got 3 scans because the first two looked funny and because you'd had a head trauma. MRI with contrast rules out brain injury, but they don't like using it because its expensive and somewhat more risky than non-contrast.

You may recall the actress Natasha Richardson who fell on the ski hill at Mont Tremblant and was DEAD as a door nail two days later? Brain injury with bleeding inside the skull. Non-technical terms, the swelling shoved her brain out the little hole at the bottom of her skull and killed her. She felt fine too, until she passed out and never woke up.

People are very quick to claim CYA and rip-off and etc. with these things, but that is almost never the case. The real rip-off CYA crap is embedded deep in the system and individual practitioners just deal with it as if it were gravity. They don't skate too close to the edge, they stay in the nice safe part.

http://www.city-journal.org/html/17_3_canadian_healthcare.html

Ahem. Tip.

No need to thank me.

"The doctors ordered a CAT scan, which showed nothing, an MRI, which showed nothing, and then an MRI with a radioactive contrast, which showed - nothing. Each one of those tests cost over $5,000 US, and was indicated because.. well, I never got an answer to that."

Because you never asked, or asked but didn't understand the explanation...

Or you're lying/made the whole thing up. Which, given this is SDA...is the most likely explanation.

Phantom/dr in the house:

Thanks, since I have two advanced degrees, I'm pretty confident about asking questions. I will agree because of the severely bruised tongue that I didn't win any awards for eloquence, but you can be sure I asked "Why?" repeatedly, and was told just as repeatedly "It's just a precaution". I asked if they'd seen anything wrong, and "Oh, no" I was told.

And for you to imply I'm lying, "dickhead in the house"? You're welcome to come over and view the voluminous file I have regarding my fight with my insurance company to pay the $30,000 US medical bill I received. I have many words to describe you, but in deference to Kate, I'll forebear.