7 ms·

Non-US anaesthesiologist here. I love my job and relish going to work each morning. I spend almost no time on non-clinical paperwork. I work reasonable hours,

• tarr11 12y ago
  In which country do you work as an anaesthesiologist?
  • toasted 12y ago
    NZ
    • jasonisalive 12y ago
      Keep in mind that, well-paid and satisfied specialists aside, there is another side to this picture - important to remember with state-run healthcare systems such as NZ, so often a poster child for socialist policy. For example this IT department head of a major district health board who embezzled ~$17 million dollars over a period of 6 years, with which to buy, among other things, luxury vehicles. http://www.odt.co.nz/news/tags/michael-swann-0 http://www.odt.co.nz/news/tags/michael-swann-0 http://www.odt.co.nz/news/dunedin/32268/fake-invoices-made-pair-17m-crown http://www.odt.co.nz/news/dunedin/32268/fake-invoices-made-p... Can you imagine this sort of thing happening in a free market for healthcare? I can't.
      • Bootvis 12y ago
        That's unfortunate but the bottom line for patients is that the NZ works excellently. Sure, it sucks that someone committed fraud and got rich in a dishonest manner but preventing that is not the goal. In the end, this fraud doesn't really affect the healthcare given.
        • jasonisalive 12y ago
          NZ works excellently. That is a pretty big claim... Have you ever actually lived in NZ and experienced the realities of paying for this system via taxes and claiming its services? Have you monitored the incessant demands for more services at better quality, the incessant complaints about being over-worked and underfunded, the endless criticisms and debates about inefficiency, long wait times, burdensome bureaucracy, poor outcomes, and unhappy doctors? Outright fraud and corruption is just the tip of the iceberg of problems that naturally develop when a society decides to sever the act of consumption from the actual purchase of a service.
          • Bootvis 12y ago
            You're not afraid of making some pretty big claims yourself. Wikipedia[1] supports my claim that while the situation might not be perfect it works quite well and that's the most important thing. Compared to other countries, the US in particular, the NZ healthcare system delivers good results. Which in my view makes it excellent. Then what about the negative aspects you mention. Well, in the Netherlands we have a similar system and to be honest I don't care about all the whining you mention. Sure, people complain and things probably can be better. There is always room for improvement. Unfortunately people will complain about healthcare if they stub their toe. Fuck 'em, you can't stop these people from complaining and policy should not accommodate their every whim. Can you support your claim that bad things happen and go unpunished > when a society decides to sever the act of consumption from the actual purchase of a service. I'm not feeling them, my family is not feeling them and my MD friends are happy with their jobs. And don't forget: the private sector is still an option so there is a choice. [1]: http://en.wikipedia.org/wiki/Health_care_in_New_Zealand http://en.wikipedia.org/wiki/Health_care_in_New_Zealand
• javert 12y ago
  The actual experience in the US has been that healthcare functioned best when it was closest to a free market, and the more we socialize it, the worse it gets. (We have been slowly socializing it for many decades through regulation.) You can argue that we haven't been socializing it "properly," but the way we are doing it is just the way government works in the US, and that's not going to change. In general, we don't have an efficient, honest, effective government, so it can't do anything right on a large scale. Though there are some exceptions, those are exceptions. Look at the Obamacare website scandal. That is the rule.
  • eli_gottlieb 12y ago
    >The actual experience in the US has been that healthcare functioned best when it was closest to a free market, When was this? >the way we are doing it is just the way government works in the US, and that's not going to change. That's some nice fatalism you've got there. >In general, we don't have an efficient, honest, effective government, so it can't do anything right on a large scale. Except for all the things you forget to mention, or even to think of as government programs, because they tick quietly away, working perfectly, in the background.
  • venomsnake 12y ago
    In US you have socialized the costs. Not the healthcare system. I think the only social type of medicine in US is the VA (they have the purse, their own hospitals and staff IIRC) and last time I read their costs of delivered product were much lower that the US average.
    • forkandwait 12y ago
      Socialized some of the costs. Some systems in the US, especially Kaiser, are basically a socialized system supported by premiums, and seem to work pretty well.
      • deleted 12y ago
        [deleted]
    • 12y ago
• ArkyBeagle 12y ago
  I think it's all about 1945-1950. That's when Truman (accidentally?) ensconced employer-based healthcare into law in the US and the NHS began in Britain. Of course France's solution is quite compelling, as is Germany's, Canada's, Japan's... The "socialism" thing is just spall from decades of identity politics. Pick apart the propaganda aspects of John Wayne's movies, especially "The Alamo". I'm not snarkin' on Wayne, I love his stuff, partly because it's propaganda. Our cognitive dissonance is best cognitive dissonance :) I also have to wonder - if the US actually embraces a public health service would that take the pressure off the public health services of the world to keep cost down? As economics, it's actually pretty difficult to analyze this issue. The assumptions are formidable.
• alexqgb 12y ago
  It's not true to say that the US, in general, ignores these systems when in fact, a significant portion of the US population pays very close attention to them and would like nothing more than to seem them implemented here. There is, however, a significant minority of really horrible, angry, violent, and generally racist people who feel deeply and ideologically threatened by the social contract on which these systems rest. And because of some unfortunate quirks in the American electoral system, they wield a level of political power that vastly exceeds their numbers. In a properly representational system, they'd be just as aggressive, ignorant, and self-defeating as they are right now. However, the body politic would be largely insulated from their rage, allowing us to safely get on with the design and development of a decent, cost-effective system. In other words, we're being plagued by a really nasty infestation of trolls, and it's making progress in general pretty damn difficult. The good news is that this, too, shall pass. In demographic terms, this problematic political outlook is the rooted in the reactionary portion of the generation that came of age during the Civil Rights era. Their bigotry translated into a life-long political identity that has done everything it can to resist, if not reverse the "loss" they suffered in the wake of Jim Crow ending. The Drug War is probably the best example of their continued effort to put a boot on the necks of black people. It's worth noting that the militarization of US police forces, combined with an exploding private prison industry, took root in the former Confederate states before spreading outwards to damage the rest of the nation. And of course, opposition to any kind of drug legalization remains strongest in places with the deepest histories of institutionalized racism. The same perspective that says the state should be used as a weapon to harm black people also says the state should not be used to protect or help them in any way. Thus, the vitriolic opposition to any kind of welfare program than benefits black people. Keeping them out of the health care system was part and parcel of this larger push for institutionalized white supremacy. But again, all this is a generational reaction to the 1960s, a particularly divisive and transformative time in American politics. When the generation that dedicated itself to obstructing the movement for greater equality finally passes from the stage, there won't be another one with either the size or the depth of hatred to maintain the current levels of opposition. So even in an electoral system as warped as ours, the certifiably batshit-insane won't be able to maintain their dominance. That's bad news for everyone with a stake in Fox News, great news for everyone else on planet Earth. At that stage, with the right wing of the baby boom dead and buried, America will be able get on with the long-delayed work of creating a more-perfect union. Given how much pent-up demand there is for policies that reflect intelligence, fairness, humanity, and decency, I suspect demand for change - and the consensus to support it - will appear quite swiftly. So it's nice to know that there are already well-developed models we can refer to when the time comes.
• deleted 12y ago
  [deleted]
  • ArkyBeagle 12y ago
    Probably because of an old concept called "modesty". I know, right?
    • deleted 12y ago
      [deleted]
      • ArkyBeagle 12y ago
        That's a big part of modesty :)
    • watwut 12y ago
      He was not modest. He wrote the comment to say how much better his county medical system is. Except that he did not specified the country, so there is no way to verify his claim. Many non US healthcare systems have bureaucracy or long hours too or both too.
• e40 12y ago
  There are many great examples of socialised health systems in the world, I'm not sure why the US ignores them? Because debate in this country has been taken over by assholes and idiots. They lie at every turn to justify their position and they don't care about facts or figures, unless they agree with their ideology. In my dreams I fantasize about what happened in Portugal regarding decriminalization of drugs. In the current US climate, that could never happen. It bums me out, too.
• dobbsbob 12y ago
  Problem with social health care is of course each successive government tries to purposely run it into the ground in my country so they can point to it's failures and claim we must adopt a US style private insurance method. Another problem is creeping fees. Most clinics, hospitals ect all nickle and dime you for fees here which add up even though they aren't supposed to. Some regional health authorities here charge a flat monthly tax, which if you can't pay or are in arrears you're screwed and have to pay cash to these clinics. Because there is a standardized rate you're going to pay $135 just to talk to a doctor for 5 minutes because there's no low income clinics, all rates are the same. Source: my young, foolish self who had to pay this out numerous times to clinics for being behind on taxes. It's good that this works where you live but you need to be hyper vigilant on who is elected to govern your health authority, which is a huge downside of any kind of socialization of medicine. Governments are fleeting, the next one could purposely sabotage it to satisfy insurance lobbyists or be so incompetent they accidentally let it all go to hell.
• jval 12y ago
  The problem is that the United States isn't a 'country' in the way the UK, or Denmark, or Australia is. The entire population of Denmark is 5.59 million, the size of a single second or third tier city in the US. Australia is 22 million, the size of the NYC metro area. You can socialise and centralise healthcare in countries on such a small scale, but it becomes exponentially more difficult to do in a country like the US (pop: 313 M). The United States is an enormous country comprised of 50 separate state governments, where the powers of the federal government are extremely limited (both by the constitution itself, and by the fact that it is practically impossible to do anything at that kind of scale). As a result, it is extremely hard to pass any sort of massive reforms. Can you imagine how difficult it would be to pass one single, uniform system of health care for all Europeans? Talking about solutions that work well in smaller countries is all well and good, but the reality is you need different solutions if you want them to work at scale. It's the same reason why most of Facebook's backend is now written in C++ instead of PHP. It is much more painstaking to work with and harder to pick up but when you're building a huge system of interconnected parts you want something that isn't going to fall over and die suddenly. The supposed chaos and gridlock of the US political system is a feature, not a bug. It's the reason why if you look at a list of the world's oldest nations the United States is right at the top, and is one of the largest. EDIT: Sorry - not saying the US's healthcare system is the best it can be and didn't make that clear enough. Just saying that comparing it to other countries won't help as the US has a unique political reality.
  • hvidgaard 12y ago
    I can understand the political barriers to socialized healthcare in the US, for starters it would require a federal tax. However, I am not buying the scale argument. What exactly makes it hard to scale? The only argument I've heard is that managing all doctors and hospitals, but that is trying to control everything, something that never works when you try to scale out, and isn't necessary either. If anything the scale enables you to build large and very specialized hospitals that only deal with one particular aspect, e.g. cancer, and do some serious research as well.
    • jval 12y ago
• kghose 12y ago
  Radiology, Ophthalmology, Anesthesiology, and Dermatology ROAD to success.
• Symmetry 12y ago
  The issue is more complicated than just socialized vs. non-socialized. There are many countries with privately run healthcare system that are perfectly good, such as France or Switzerland. And there are countries that combine both public and private provision of healthcare and have it work perfectly well, such as Sweden or Singapore[1]. The US actually does run some hospitals directly, the VA, and I doubt this made the news outside of the US but there was a huge scandal a while ago concerning them. The current US health situation is the end result of a long process of complicated schemes to provide more healthcare to Americans without any clearly visible costs in ways complicated enough that there are no obvious deficiencies. For instance Nixon's scheme[2] to lower costs by preventing competitions between hospitals[3] is still on the books all these years later. Given all the government interventions in the healthcare market combined with an unwillingness to bite the bullet pay for or subsidize most people's insurance directly has left the US with a healthcare system that is neither government run nor free market, but something far inferior to both. [1] Singapore has a really weird combination of forced savings, mostly private payment, and mostly public provision which is really weird compared to everyone else but somehow gives them really good health outcomes really cheaply. I don't think the US could make that system work, though. [2] Is there something Nixon didn't screw up? Well, besides repairing our relationship with China. [3] Back in the day everybody knew that the USSR had a far more efficient economy than the US did (the Soviet statistics said so!), and one way people explained this was that the Soviets weren't wasting resources on competition but instead just figured out the best way to do something and put all their effort behind that.
  • refurb 12y ago
    This is the best explanation of the healthcare problems the US has that I've seen in a while. It's not a "public vs. private" thing in the US that is the problem. It's a byzantine system of patchwork laws that have tried to make the system better, but only made it worse. It's so complicated now that it'll take a hell of a lot of work to fix it.