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Because capitalism. More concretely, because of for-profit healthcare. Even more specifically, individual health insurance is a terrible idea, as is tying insur
by jmyeet 2y ago
Because capitalism. More concretely, because of for-profit healthcare. Even more specifically, individual health insurance is a terrible idea, as is tying insurance to employment.
Brief list of problems:
1. It's too expensive to become a doctor. Unless you come from a relatively affluent background, a freshly-minted doctor will graduate with $300k+ in student loan debt. After 3-10 years of working minimum wage (ie residency) that debt will be $500k+. Salaries need to be high to cover that. Everyone pays for that input cost, a lesson we're also failing to learn from increased housing costs too.
If anyone complains about physician salaries and points to other countries, particularly in the EU, ask them about the debt required to become a doctor in the US vs whatever country they bring up;
2. For-profit healthcare incentivizes taking money and then not paying for medical care to increase profits. The industry calls any payout they have to make a "medical loss";
3. The ban on importing medicines and Medicare negotiating drug prices needs to go. All it does is make drugs WAY more expensive in the US than any developed nation, often by orders of magnitude;
4. Even so-called not-for-profit foundations that own hosptials and medical providers are little better because, for example, the executives can be incentivized to icnrease assets under administration, just like a mutual fund. And any such money put into assets isn't being spent on healthcare. This needs to stop.
5. More artifical barriers. As just one example, physicians are legally forbidden from owning hospitals. This provision was snuck into the ACA;
6. Standardize electronic health records. EPYC is a scam and more rent-seeking;
7. Federal research dollars should come with equity in any drugs commercialized from that research. Drug companies don't do research, much as they claim to. They spend their money on marketing, lobbying and patent extension;
8. Patent reform. Drug companies make pointless changes to molecules and stop making the version that goes out-of-patent. No one else can produce it because parts of the manufacturing process are hidden (eg trade secrets) and, even if you can, you can't verify what you've produced is compliant with the approved version;
9. The state should produce generics. Insulin, epi pens, that sort of thing. Price gouging on these should be a crime. Some states are or will be producing insulin.
- breadwinner 2y ago> It's too expensive to become a doctor. This can be solved easily by not requiring a bachelor's degree before getting into medical school. It is wasteful, especially when the bachelor's degree can be in any field such as music or computer science.
- jmyeet 2y agoSo that's only partly true. If you're going to go to medical school, you technically have to do a pre-med program with required courses like Organic Chemistry. Now some of these are relevant to medical school but some (like OChem) are viewed as a weed-out [1]. Could you just do a straight medicine degree out of high school? Yes. How much shorter would it be? You can look at other countries for this. The US system is getting worse too because there's an increasing demand for gap years to make your applications competitive. That means a gap between undergrad and medical school where you're padding your resume. That might be doing a Masters or it might be practical experience. That's potentially more debt and more interest on your debt. The residency application process is a nightmare. For competitive specialties you might need another gap year after medical school to do "research", That position can be low-paid too so, again, more debt. And you'll be even older by the time you're a doctor. If you fail to match the first time you try, you're in a bad place. You're going to be less desirable as a candidate the next year if you try and match again. [1]: https://forums.medicalschoolhq.net/t/why-organic-chemistry-is-the-weed-out-course-for-medical-school/15121 https://forums.medicalschoolhq.net/t/why-organic-chemistry-i...
- breadwinner 2y agoIn the UK it takes only 7 years to become a doctor. Students can enter medical school directly after high school. You do undergraduate medical degree (MBBS), followed by 2 years of Foundation program (paid clinical internship).
- nradov 2y agoA few schools are now offering combined Baccalaureate-MD programs which cut up to two years from that education. That's a relatively simple change which can significantly reduce the cost of becoming a doctor so we should encourage more schools to do the same. https://students-residents.aamc.org/medical-school-admission-requirements/medical-schools-offering-combined-baccalaureate-md-programs-state-and-program-length-2023-2024 https://students-residents.aamc.org/medical-school-admission...
- 2y ago