4 ms·

>> "The reason the EU model works is that doctors (and other medical professionals) get paid less. A quick google search suggests a US ER doctor or radiologist

>> "The reason the EU model works is that doctors (and other medical professionals) get paid less. A quick google search suggests a US ER doctor or radiologist gets paid more than 3x what a British one does, a family practitioner 2x." I'm not sure if you were posing this as a problem or not but as long as doctors want to work for the NHS it isn't one.

arethuza 10y ago
Going by the standards required to get into medical school in the UK from high school I don't think there is any lack of applicants! Might also be worth comparing the cost of qualifying as a medic in the UK and the US!
yummyfajitas 10y ago
I'm not posing it as a problem. I'm simply pointing out the real reason things work in the UK is that people pay less for the same thing. Tangentially, if anyone proposes UK-style solutions to health care problems in the US without proposing 50-66% wage cuts for doctors/nurses, they are lying to you.
- andreasklinger 10y ago
  as said above - almost all jobs are Nx paid in the US. Doesnt necessary mean you have more money NET in the end
- arethuza 10y ago
  Well, the NHS is socialism so as far as I can see an approach like that wouldn't be ideologically acceptable in the US. NB Regarding the "socialism" part, from NHS founder Aneurin Bevan: "A free health service is pure Socialism and as such it is opposed to the hedonism of capitalist society." I always think it is worth noting that the title of Bevan's book on the NHS was "In Place of Fear" - which I think sums it up nicely. https://en.wikipedia.org/wiki/Aneurin_Bevan https://en.wikipedia.org/wiki/Aneurin_Bevan
  - yummyfajitas 10y ago
    I have no problem, in theory, with socialized medicine that we drastically underfund. It's probably a great way to waste fewer resources on medicine. In practice that's just not politically feasible in the US. An illustrative example: a few years ago, a major study found that mammograms before age 50 are financially wasteful and medically harmful. Congress passed a law requiring insurance companies to pay for them anyway. https://www.bloomberg.com/view/articles/2012-07-31/in-mammogram-debate-politics-trounces-science https://www.bloomberg.com/view/articles/2012-07-31/in-mammog... http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening http://www.uspreventiveservicestaskforce.org/Page/Document/U...
    - maxerickson 10y ago
      Medicare, Medicaid and the must stabilize mandate for ERs are underfunded. It's one of the reasons that out of pocket costs are so high.
      - chimeracoder 10y ago
        > Medicare, Medicaid and the must stabilize mandate for ERs are underfunded. It's one of the reasons that out of pocket costs are so high. Exactly. This is the hidden secret about US healthcare that very few people are aware of. Even providers usually don't see this anymore, because they're so removed from the billing process (especially now that most providers are salaried and not running their own practices). Medicare and Medicaid are the reasons that sticker prices for treatment in the US are absurdly high. Incidentally - and most people don't know this - if you're uninsured and self-paying, you almost never have to pay the sticker price. Hospitals really don't care, and if you just tell them that you're self-paying and can only afford (say) 10% of what they billed you for, they'll almost always immediately agree to a 90% discount. The only reason they're showing you that bill is that they need to present high bills to private insurers (to make up for the loss on Medicare/Medicaid reimbursements) and they're not legally allowed to present differently-priced initial bills to patients based on their insurance status.
      - yummyfajitas 10y ago
- throwaway-hn123 10y ago
  Except that the per-capita spend on health in the US is approximately three times what it is in the UK, which seems to corresponds quite nicely to what you're saying is the difference in salaries. So, actually, yeah, you probably could move to a UK style solution, with the same per-capita spend as in the US while still preserving the seemingly very high wages for doctors and nurses.
jessriedel 10y ago
It's always possible to get someone to be a doctor. Since there are many other jobs paying competitive salaries for smart folks, paying doctors less necessarily means they will be lower quality all other things equal.
nikcheerla 10y ago
They don't. Doctors in the NHS work longer hours than their U.S counterparts, and those who go through the system tend to move to either private practice, Australia, or the U.S after their residencies. For now, the system is still working, but it's clear that medicine is a much less lucrative/desirable job in the U.K than, for example the U.S. (And maybe that's a good thing – I don't know).
- Angostura 10y ago
  > k longer hours than their U.S counterparts, and those who go through the system tend to move to either private practice, Australia, or the U.S The figures suggest you are wrong. The substantial majority stay in the NHS
DanBC 10y ago
> but as long as doctors want to work for the NHS Current under-funding of the NHS means there's a shortage of consultants (especially in A&E and mental health) and a shortage of nurses. Some A&E units are being downgraded and closed at night because of these shortages of staff.
- k-mcgrady 10y ago
  It's possible the problem is that we don't have enough qualified staff. Any source showing is that's the issue or it's that a huge number of people are going abroad?
  - DanBC 10y ago
    I'm not claiming staff are going abroad. Some, although I don't know how many, definitely are, though, especially after the junior doctors contract change.
    - k-mcgrady 10y ago
      I agree. I have several friends who have went abroad because they get paid more, work is less stressful and the weather is nice. I'd like to see a proper breakdown. From what I can see the problem is more of an increase in total jobs that was not met by the number of people qualifying which could just be poor planning.

arethuza 10y ago

Going by the standards required to get into medical school in the UK from high school I don't think there is any lack of applicants! Might also be worth comparing the cost of qualifying as a medic in the UK and the US!

yummyfajitas 10y ago

I'm not posing it as a problem. I'm simply pointing out the real reason things work in the UK is that people pay less for the same thing. Tangentially, if anyone proposes UK-style solutions to health care problems in the US without proposing 50-66% wage cuts for doctors/nurses, they are lying to you.

andreasklinger 10y ago
as said above - almost all jobs are Nx paid in the US. Doesnt necessary mean you have more money NET in the end
arethuza 10y ago
Well, the NHS is socialism so as far as I can see an approach like that wouldn't be ideologically acceptable in the US. NB Regarding the "socialism" part, from NHS founder Aneurin Bevan: "A free health service is pure Socialism and as such it is opposed to the hedonism of capitalist society." I always think it is worth noting that the title of Bevan's book on the NHS was "In Place of Fear" - which I think sums it up nicely. https://en.wikipedia.org/wiki/Aneurin_Bevan https://en.wikipedia.org/wiki/Aneurin_Bevan
- yummyfajitas 10y ago
  I have no problem, in theory, with socialized medicine that we drastically underfund. It's probably a great way to waste fewer resources on medicine. In practice that's just not politically feasible in the US. An illustrative example: a few years ago, a major study found that mammograms before age 50 are financially wasteful and medically harmful. Congress passed a law requiring insurance companies to pay for them anyway. https://www.bloomberg.com/view/articles/2012-07-31/in-mammogram-debate-politics-trounces-science https://www.bloomberg.com/view/articles/2012-07-31/in-mammog... http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening http://www.uspreventiveservicestaskforce.org/Page/Document/U...
  - maxerickson 10y ago
    Medicare, Medicaid and the must stabilize mandate for ERs are underfunded. It's one of the reasons that out of pocket costs are so high.
    - chimeracoder 10y ago
      > Medicare, Medicaid and the must stabilize mandate for ERs are underfunded. It's one of the reasons that out of pocket costs are so high. Exactly. This is the hidden secret about US healthcare that very few people are aware of. Even providers usually don't see this anymore, because they're so removed from the billing process (especially now that most providers are salaried and not running their own practices). Medicare and Medicaid are the reasons that sticker prices for treatment in the US are absurdly high. Incidentally - and most people don't know this - if you're uninsured and self-paying, you almost never have to pay the sticker price. Hospitals really don't care, and if you just tell them that you're self-paying and can only afford (say) 10% of what they billed you for, they'll almost always immediately agree to a 90% discount. The only reason they're showing you that bill is that they need to present high bills to private insurers (to make up for the loss on Medicare/Medicaid reimbursements) and they're not legally allowed to present differently-priced initial bills to patients based on their insurance status.
    - yummyfajitas 10y ago
throwaway-hn123 10y ago
Except that the per-capita spend on health in the US is approximately three times what it is in the UK, which seems to corresponds quite nicely to what you're saying is the difference in salaries. So, actually, yeah, you probably could move to a UK style solution, with the same per-capita spend as in the US while still preserving the seemingly very high wages for doctors and nurses.

jessriedel 10y ago

It's always possible to get someone to be a doctor. Since there are many other jobs paying competitive salaries for smart folks, paying doctors less necessarily means they will be lower quality all other things equal.

nikcheerla 10y ago

They don't. Doctors in the NHS work longer hours than their U.S counterparts, and those who go through the system tend to move to either private practice, Australia, or the U.S after their residencies. For now, the system is still working, but it's clear that medicine is a much less lucrative/desirable job in the U.K than, for example the U.S. (And maybe that's a good thing – I don't know).

Angostura 10y ago
> k longer hours than their U.S counterparts, and those who go through the system tend to move to either private practice, Australia, or the U.S The figures suggest you are wrong. The substantial majority stay in the NHS

DanBC 10y ago

> but as long as doctors want to work for the NHS Current under-funding of the NHS means there's a shortage of consultants (especially in A&E and mental health) and a shortage of nurses. Some A&E units are being downgraded and closed at night because of these shortages of staff.

k-mcgrady 10y ago
It's possible the problem is that we don't have enough qualified staff. Any source showing is that's the issue or it's that a huge number of people are going abroad?
- DanBC 10y ago
  I'm not claiming staff are going abroad. Some, although I don't know how many, definitely are, though, especially after the junior doctors contract change.
  - k-mcgrady 10y ago
    I agree. I have several friends who have went abroad because they get paid more, work is less stressful and the weather is nice. I'd like to see a proper breakdown. From what I can see the problem is more of an increase in total jobs that was not met by the number of people qualifying which could just be poor planning.