Healthcare USA #1

Nah my point is these waiting periods aren’t a problem as long as you have access. In the USA #1 a huge percentage doesn’t have realistic access. That is the real problem.

I think you are making the same point right?

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Cool, thanks for clarifying :-) I’m feeling a little insecure about my communication at the moment.

I’m saying not having access is a huge/ real problem and supercedes any argument about wait times. I was just also saying I don’t think the extent of the issues with the free healthcare systems are very well understood (one of which is wait times) and they seem to be represented as more ideal than they are in practice.


I’m going to try to reply to this later (maybe tonight) - just got back from Stanford and gonna take a nap. It’s an interesting topic, and a lot of what people think about the topic (and this isn’t per L_M, in any negative sense) tends to be misunderstood. Source as a guy who was a doc involved with med school/residency application processes, and as a medical practice administrator (as a doc) who was also COS of a large hospital and on the hospital board. Now restricted to being a patient.



Considering how many Bernie supporters are on here, I almost feel like someone should contact his campaign and see if we can make this happen. It’s brilliant!

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Then show the average folks saying “Well you can’t just magically pay for all this stuff, Bernie’s lying” while they nod along to whatever garbage Trump’s rambling out of his mouth.

Feel free to TLDR - I find this stuff interesting, but I understand why a lot of people don’t.

  1. On the over/under payment of docs in the US, back in the day of Ikes in the old site, a scientific-wild-ass guess was that US docs were paid somewhere around 10-15% more than Western euro docs, with all sorts of variables bouncing around. We get paid more in raw income, but we have a lot of expenses and legal issues that the Euro guys don’t. This seems maybe reasonable to me, but YMMV. (FWIW, I feel I’m probably slightly overcompensated, but mostly because I’m in a private practice that allows us to do some VERY aggressive planning for our pension/retirement - for some people this would be a bug, not a feature, BTW)
  2. We don’t, for the most part, have a problem getting enough med students - I would guess that every med school in the country could easily absorb say 20 additional students and the primary expenses would be 5 more cadavers and more desks and chairs. (I kidding, sort of). Where we’re in trouble is residency slots. In 1997, the AMA to it’s everlasting shame crammed in during a budget act a measure to cap residency slots. To it’s credit 1) a bunch of docs left the AMA over that and a bunch of other stuff and 2) the AMA has for the last 3 years reversed field and supported additional slots. (How many and how soon I can’t figure out). This matters because Medicare funding pays for residency slots, and each one goes for about 140K. Amazingly, some hospitals actually have access to the money and don’t take it. OTOH, some health care systems will pay for slots out of their $$ (from what I can tell most of them are not-for-profit, which makes sense as they “have” to use the money somehow. But someone who has an MD degree but can’t get into a residency is essentially unemployable.
  3. As Lawnmower_Man noted, the payoff on training + debt is…concerning. I trained at Northwestern, and when I got out I owed about 140K (1991) - I had NO undergrad debt, and I did a four year residency during with I made around 24-28K (unusually, we could moonlight and made more than 2x that during years 3-4, which is now very unusual. My loans went into “pay interest” status for those 4 years, meaning I could defer them and interest rates were not too bad - it was doable. Now? NU quotes $62000 a year before you pay living expenses - and the majority of kids starting med school are carrying six-figures of debt due to undergrad. We hired a married couple who are 800K + in the hole coming out. And you’re going to go through 4 years of med school + 4 or more years of residency making nothing followed by about minimum wage, all while your loans accrue interest.
  4. Which makes people to either just do something else, or pick a specialty that will pay enough to get you in some sort of reasonable financial position. As noted above, primary care is dying - or more properly, the new model is going to be a number of NP/PA types riding herd over a single primary doc who hopefully can take care of the “sick” patients and let the worried well/low grade simple patients be handled by the “extender” practitioners. In theory, this can work.
  5. I’d spin it around and say that docs choose to locate in desirable areas - I think it’s more they don’t want to locate in UN-desirable areas. Especially in that the old model of male doc marries woman nurse who then stayed at home and raised the kids is LONG gone - now doc 1 marries doc 2, who are both young urban professional types - where would YOU want to live?
  6. Another problem is that a lot more docs are women than they used to be. This is because women are smarter than men - when I joined my group I was the 14th doc but 2 were leaving, and we had no women. We now have 66 docs, and we’re split 50/50. General surgeons, vascular surgeons - 60 hours a week, call every 5 days meaning up all night - fuck that. They’ll work 8 hours shifts and have an actual life. So we’re going to have to fix this so women (and men who don’t want to work like they did in the bad old days) - cause the old days for the most part ain’t coming back.
  7. Docs have been warning their kids to avoid medicine for decades - but the problem seems to be getting worse. Talking to most docs, it isn’t patient care that burns docs out and walks away from medicine (and I’ve had two EXCELLENT partners hang it up this year) We all use an EMR, and on the whole it’s a positive - no more shuffling thru papers to find that key value, no the old chart sitting up in the Residents room because it didn’t get forgotten to be sent back to medical records, real time ability to see images. But you end up being a data entry clerk, instead of a doctor. The nurses spend most of their shifts checking boxes on spreadsheets. One of the new ideas was to give a doc to a scribe, who would stand in the room and basically act as a stenographer and create a real-time medical record for each patient visit. Then the doc could just concentrate on examining and interviewing the patient. I didn’t use a scribe (for personal reasons), but there are plus and minus aspects - and predictably one of the mega providers happily informed that because they found that the scribes increased their productivity by x, the doctors could now see x more patients. The treadmill just spinning faster, so people jump off.
  8. Going all the way back to #1 in terms of docs being paid too much - It’s encouraging that health care cost for the last couple of years has flattened out to a degree - but from another point of view the last chart from 2019 docs collect about 20% of health care $ - and we’re going up about for the overall medical debt 4% a year (back of the envelope guess) would suggest that if you decided to pay me and my ilk a grand total of 0$ going forward - in around 6 years we’d be right back where we are now. Which seems sub-optimal.

Having said that - best job I ever had. You work with smart people, taught some smart students, dealt with disasters, actually saved a few lives. But I can see that some people would rationally think “no thanks”



Great stuff. I hope Stanford has something for you.

Thanks. Surgery went great. We’re talking years, not weeks/months, which I could have been looking at pre-surgery. Starting a clinical trial Feb 24th - or more properly, hoping to get the green light if my labs stay good (fingers crossed) - I get treated either way, but they (and me) want to be aggressive as possible. So, until then I wait for my brain to heal and leave intermittently incoherent posts.



Health Affairs is where I’d look for this. The papers I can vaguely recall from (poor) memory estimate the difference to be substantially higher, especially in lucrative specialties. For example, this one

which I don’t think is the best paper written on this topic, but the names and/or locations of the others elude me right now.

Oh yeah if you’re a plastic surgeon who does nothing but esthetics or a spine guy who is willing to go aggressively for back surgery early on (the data is convincing that it should be absolutely the last resort and it pays like crazy) you can crack 7 figures comfortably, in the right neighborhood (economically)

US docs, especially some poor bastard trying to run a private practice can literally go broke despite making 2-300K if you have to pay for staff, mandatory EMR, etc, etc.

I would take pretty much ANY $ figures on US docs with several grains of salt, because it’s so easy for the numbers to dance to the accountants tune.


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Won’t most people’s taxes go up though? People making 40-50K will see a rise in taxes BUT they won’t have to pay anything for health insurance. So they will pay less overall.

The problem is people just hear taxes.

That’s how the propaganda machine works.

I don’t know what the cutoff is for raising taxes. I’m just guessing.

But poor people are going to be contributing too. I think it’s naive to think only the rich are going to pay.

Majority of people don’t have a calling and are focused on paying bills just to survive.

Or if they had a calling the reality of the system we live in is “do work that is deemed valuable economically and the work you love that doesn’t have economic value can wait/or just stop doing it”

I’m not up on the most recent numbers but something like 60% pay functionally zero federal income tax. They pay social security and Medicare, which is a phenomenal deal. Approximately none of these people have any awareness of this.

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You are misunderstanding.

Most people have to work stressful jobs that pay next to nothing because they have to work those jobs to literally survive.

No amount of frugality can fix that.

Also when you are stressed about paying bills it takes up bandwidth from your brain function that could otherwise be used for other purposes.

Im a minimalist so my co workers think I’m a little crazy. I’m all for not giving into social pressures (I also wear the same three shirts rotating to work, I haven’t worked up the courage to wear the same thing everyday yet).

I’m also aware that my privilege (white, 6’ tall, above average IQ) has allowed me to cultivate this lifestyle despite growing up poor.

Telling someone who grew up poor, never was lucky enough to find a path out, and wasn’t born with brains to not give into social pressure is ignorant.


I wanna run though the halls of my high school
I wanna scream at the top my my lungs
I just found out there’s no thing as the real world
Just a lie you got to rise above

Just be John Mayer, easy peasy


This will differ state to state but the federal law is that you can garnish up to 25% of someone’s wages, but you can’t take them below the equivalent of 30 hours/week at minimum wage. Someone working full time for minimum wage can be garnished at the maximum rate allowable by law.

That is not a very robust protection, in my opinion.

Edit: this is also federal minimum wage, which is like 7 bucks/hour. So you’re guaranteed about 210 bucks/week minus taxes, even if your state has a $15/hr minimum wage.

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I’m not saying we should tell people “life sucks, you didn’t hit the genetic lottery, don’t try”

I’m saying we should fix the system to where everyone has a shot.

I’m just trying to point out why the system makes it tough for people to “follow their dreams”.

You can only do that if you either come from a wealthy family or hit the genetic lottery.

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People strongly undervalue this when talking about universal healthcare.

Having to worry about being able to afford medical care if needed is a psychological burden. It becomes an enormous one when you’re trying to pay for life-saving treatment that you really can’t afford. I am content knowing that my taxes go towards a government medical system that won’t be sending bills to debt collectors so they could ruin my life later on.

Assuming that there is a later on.


You have no idea.

One month ago I walked into work on a standard shift. 2 days later I’m wheeled into the OR with a chance of less than 6 mos survival. Happily, I’ve been upgraded to “about 2 years and maybe you’ll live long enough to die of something else” - which when you’re 64 is actually a hopeful expectation. My wife is of course freaking out (she’s not medical in any way) and I get anxious periods about the future.

But (after my deductible, which is doable out of pocket) I’ve chewed thru easily 250K in treatment with zero co-pay/further deductibles. Same at Stanford. They hand them your little red card with a few numbers on it, and magically all the problems go away. If not, it becomes a shitstorm of misery. I honestly don’t know how I’d function with that sort of crap stacked on top of the acute medical stuff we’re dealing with, and no one should be having to deal with this stuff during a time when your life is falling apart.



And the worst thing you can have when battling an illness or trying to recover from something? Stress. USA! USA! USA!