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Preparing (FINANCIALLY) for the possibility of socialized medicine

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  • Avatar Dusn 
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    Well, it turned into a political thread (guess I shouldn’t have been surprised!). I understand this is an important sociopolitical issue, but I don’t want to jump into a flamewar as a new poster, so…

    Guess the advice is: keep costs low, save money, and treat it like a possible illness, job loss, or divorce? I’m wondering about stuff like: I’m probably going to have more money coming in now than I will in the future, does that mean I should be more conservative than I otherwise would (more bonds relative to stocks)? Or should I put more in stocks to build capital while I’m able? Does the fact that I’d be paying lower tax rates later make tax-loss harvesting less useful? Stuff like that.

    Click to expand…

    I think the advice is not to worry about it.  “Socialized medicine” is irrelevant. Don’t change your financial plan.

    #240168 Reply
    Avatar Panscan 
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    There have been numerous things about infant mortality. You always say this is the first time you’ve heard of this or that. Never heard of np wanting to be called doctor, even though it happens all over the country. It is a known thing that infant mortality is a different stat in America than Europe.

    I mean take a step back, do you really think in any way shape or form that our neonates get worse care here? It’s laughable. They do in fact give up on those hopeless cases, much earlier than we do.

    How exactly are the populations comparable. If you made each us state a country, we’d have the like 48 most obese countries in the world, literally at more double the rates of the average. Our chronic disease prevalence compared to other nations is sky high. So yes, they are not comparable.

    #240177 Reply
    Avatar Panscan 
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    American Healthcare is superior to any other country in the world. We have the best, the brightest and the most resources. The only metrics that don’t show this are skewed things that overvalue chronic disease in order to poopoo our current system and usher in socialism.

    People come to America for healthcare. Acute care is what measures the quality of a nation’s Healthcare. Chronic outcomes are extremely difficult to analyze as they are dependent on patient compliance and chronic disease. We have an entire class of unproductive, noncontributory, chronically ill, which is why we rank poorly in these metrics.

    #240178 Reply
    Liked by med_phys
    Avatar Panscan 
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    https://www.washingtontimes.com/news/2014/oct/3/editorial-the-statistics-of-life/

    We literally define it different than other nations do.

    #240179 Reply
    Liked by portlandia
    Vagabond MD Vagabond MD 
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    Here’s another data point from my life. Fast forward 20 years later from my previous post from 1976, I am now in private practice, where I am an associate and the radiology partners are probably eating $350ish (including retirement contributions and book/travel fund).

    A senior partner who had been in practice since around 1976, a mentor, calls me in for a conversation. “You know, experts are predicting blah, blah, blah. We expect our compensation to drop 25% over the next year or two and even more after that.”

    Compensation never dropped. Over the next 20 years, it about doubled.

    #240180 Reply
    Liked by q-school
    fatlittlepig fatlittlepig 
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    Individual liberty to live a healthy life? How in the world are you going to guarantee that, and over and over we see Healthcare access has little to do with that. People just don’t care about their health. Are you next going to tell me obesity is due to lack of access to care? Hint, it’s not. People just don’t care.

    Click to expand…

    Make better decisions and “don’t get sick” isn’t a health care delivery model.

    #240181 Reply
    Liked by AZPT
    Avatar SalmonWitch 
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    My $0.02 -First, global drug price arbitrage is one of the greatest forms of humanitarian aid that the US provides. The only reason that life-saving medication exists at prices below the cost of production in some locations is because the US and other advanced nations subsidize the manufacturers on the other end. It’s one thing to believe in global price setting but please do not overlook the fact that these policies will result in worse treatment options for the citizens of other nations.

    The idea that we will “pick 2 statins” that can stay in business while basically forcing the others out of business is patently absurd from both an economic standpoint and a healthcare standpoint. Especially, when the idea is that we can pick 2 and strong arm them to accept a price with small profit margins. The low profit margins of generics have already led to the consolidation of generic drug manufacturing process. Even minor disruptions in the supply chain can result in shortages or incredible price spikes. Why would we design a system that encourages these phenomena? Several leading hospitals realize that these negative shocks are potentially catastrophic and have actually formed a new company (Civica Rx) to improve the reliability of the generic pharmaceutical supply chain and improve availability.

    What will happen to the health of patients when these supply chains have problems? Rationing of vitally important medication is a net negative for all involved. Viable alternatives may be sub-optimal under ideal conditions but they are a necessary component of a robust, resilient pharmaceutical infrastructure. This “picking winners and losers” then using economies of scale to reduce cost sounds great in a textbook. In the real world, any distortion in the manufacturing or distribution process would be calamitous. I just had to get that off my chest.

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    Anyway, I see no reason why an individual’s financial preparations should deviate significantly based on the possibility of socialized medicine. As others have noted, it would be very surprising if any new system were fully in place within 5 years. Always pay yourself first (pay down high interest, save at least 15% of income, etc) and don’t make spending decisions that rely on income projections more than a few years into the future. The only possibly exception is housing. If you’re worried about future mortgage payments either (a) take a shorter mortgage and pay the loan before any reimbursement changes are implemented or (b) buy a cheaper house. You won’t regret the long-term outcome of either option regardless of what happens on the socialized medicine front.

    #240139 Reply
    Liked by AZPT
    fatlittlepig fatlittlepig 
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    I’ll be honest I had a hard time following what you wrote but that’s okay. Basically we don’t need redundant medications which are more costly than what we already have. We don’t need another Lipitor that’s no better than Lipitor and costs 5x Lipitor. Therefore we should exert pressure on the Rx companies to this effect. We shouldn’t accept treatments that cost 100K a year, it’s unacceptable.

    #240184 Reply
    Avatar SalmonWitch 
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    I’ll be honest I had a hard time following what you wrote but that’s okay. Basically we don’t need redundant medications which are more costly than what we already have. We don’t need another Lipitor that’s no better than Lipitor and costs 5x Lipitor. Therefore we should exert pressure on the Rx companies to this effect. We shouldn’t accept treatments that cost 100K a year, it’s unacceptable.

    Click to expand…

    I really don’t see how I could make it any easier but I guess I can try.

    Today, 10 different kids in your neighborhood sell hot tea. It turns out the kid with the best recipe has his recipe published online and he’s selling Earl Grey. He used to make $100/day in profit on this recipe. Now everyone in town is selling it and they are only making $5/day in profit. 8 of the kids decide that it’s not worth it to sit outside all day to make $5 so they focus on doing something else. Some of these kids start selling Green Tea for a $50/day profit. Some people in the community find they feel less groggy after they drink Green Tea. The community board decides that they will shut down any child who makes Green Tea. This is predominantly an Earl Grey town after all.

    So now only 2 kids sell Earl Grey for $5 and everyone else has new summer jobs. The 2 children produce enough for everyone in the town but just barely. Now 1 of the 2 kids gets hit by a car after school and can’t sell anything for the foreseeable future. Now only 1 kid sells the Earl Grey but he can’t make enough for everyone in the town (his mom isn’t going back to Costco for another 2 weeks). Now half the people in town don’t get their daily tea and those that do pay double the price.

    In this story, Earl Gray= generic drugs that are cheap. Green Tea = more expensive drugs that are still on patent. The car crash = disruption in the supply chain. The townsfolk are the patients. The community board is the authority that will arbitrarily decide what gets produced aka “pick 2 statins.”

    Limiting the number of suppliers in the ecosystem amplifies the negative shocks to that system. The consolidation of generic suppliers is an already observable phenomenon. This is partially why you read stories about generic shortages and increasing prices. You’re proposed remedy (forcibly removing alternatives from the marketplace) is going to increase the size of the shocks. Alternatives give a market the ability to absorb temporary shocks.

    After typing this I realize a more “real world” example is the devastation that runs through communities when they have a single major employer (GM plant for example) that suddenly leaves or closes shop.

    #240197 Reply
    Avatar SalmonWitch 
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    Competition has led to increased costs?  How exactly does that happen, FLP?  Please explain.  Competition has led to poorer outcomes?  Please explain.  You again reveal your ignorance about our healthcare system when saying that we are inferior to other monopolistic systems.  First, our populations are not comparable.  But let’s just say they are for this exercise.  I know you are simply repeating the tired talking points of our system being worse.  Because had you factored in and controlled for car deaths, homicide rates, suicide rates, obesity, etc. when you made the statement about health outcomes you wouldn’t have made it.  We are superior to other countries in cancer survival WITHOUT controlling for anything and then land #1 in life expectancy after those controls.  Also, when looking at birth statistics other countries don’t count infant mortality in the same way we do and they also give up on kids that we don’t give up on – we test the boundaries of what is possible to allow for their future kids to have the science and know-how to keep their future premature infants alive.  So spare me that we’re worse than other OECD countries.  We are better.

    Click to expand…

    I’m more watching this one that participating but a couple of questions.

    1. If you say our populations are not comparable (this is actually untrue but let’s assume it is for the sake of discussion) then how can you then go on to compare them in a way that supports the point you are making? If we cannot compare USA to say France for the purposes of most health stats then we can’t compare them on infant mortality either. I think you are trying to have this both ways. The argument that the USA is sui generis and therefore these systems that work very well (for less money) in our vacation destinations/staunchest allies is a common one that I find totally spurious, but if you’re going to voluntarily hoist yourself on that petard then I think you need to be consistent and just say that we are a completely unique case and eschew all comparison to other countries.

    2. This would be the first time that I’ve heard about vaguely defined allies “giv[ing] up on” neonates that we don’t. Do you have data for this? It seems that some of our NICU practices mirror some problematic practices at the end of life, namely massive expenditure for very marginal gains. That isn’t sustainable no matter who wins the policy argument. Everything I’ve read about infant mortality in the USA is an indictment of our system not a defense of it. Are you saying our stats are higher b/c we give more NICU babies a shot?

    3. Everyone thinks their country is better. What we resist as a nation is looking at best practices. Any interesting exercise here is to apply the philosophical principles of John Rawls and work behind the veil of ignorance.

    “Imagine that you have set for yourself the task of developing a totally new social contract for today’s society. How could you do so fairly? Although you could never actually eliminate all of your personal biases and prejudices, you would need to take steps at least to minimize them. Rawls suggests that you imagine yourself in an original position behind a veil of ignorance. Behind this veil, you know nothing of yourself and your natural abilities, or your position in society. You know nothing of your sex, race, nationality, or individual tastes. Behind such a veil of ignorance all individuals are simply specified as rational, free, and morally equal beings. You do know that in the “real world”, however, there will be a wide variety in the natural distribution of natural assets and abilities, and that there will be differences of sex, race, and culture that will distinguish groups of people from each other.”

    The interesting thing about Rawls is that you don’t get to be ENTDoc — an intelligent, well-spoken, well-read, and (I hope) relatively healthy professional. You are just “folks” as one of my college ethics profs put it. Any honest treatment of this exercise would not lead a rational actor to chose to be born in America. You would chose a Scandanavian nation, Japan, Switzerland, or perhaps Germany. Are we better?

    Click to expand…

    Really trying to take this discussion back to Intro to Political Theory? Anyway, I disagree with your conclusion that the rational choice would be to “choose a Scandanavian nation, Japan, Switzerland or Germany.”

    The only rational choice is to take a probabilistic approach to the situation based on your values. The problem with the veil of ignorance as a concept is that it over-emphasizes the risk of being the worst position in society. This also leads to your subjective interpretation of “worst” being over-emphasized. If you think being a toddler with cancer is the worst, you would choose America. If you think being homeless is the worst you would choose to be in Japan or Denmark.

    Overall, I think if you are looking at it holistically this situation dictates that one would marginally favor a life in Scandanavia/Switzerland over the US. I would then say the US is marginally better than Germany and significantly better than Japan. The fact that you think it is a cut and dry answer and not a difference at the margins points more to your own biases than the objective superiority of any singular nation.

    FWIW, I typed this up then was curious and Googled “average Germany salary in USD” and the OECD apparently has a “Better Life Index” that essentially agrees with the analysis above when giving each of their inputs equal relative importance.

    Regarding bullet #2, I think you either (a) haven’t looked or (b) are willfully ignoring this data. It is well-established that the way we classify infant mortality is systematically different from every other nation.

    #240202 Reply
    childay childay 
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    It is well-established that the way we classify infant mortality is systematically different from every other nation.

    Click to expand…

    And of course way better!

    #240204 Reply
    Avatar Dusn 
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    WashingtonPost, “Democrats back off once-fervent embrace of Medicare-for-all:”

    https://www.washingtonpost.com/politics/democrats-back-off-once-fervent-embrace-of-medicare-for-all/2019/08/19/13c76ffe-c28b-11e9-b5e4-54aa56d5b7ce_story.html

    And we haven’t even gotten to the general election season yet… let alone getting the bill through congress, and then the political pressure from lobbying groups, and then the general public freak out about losing their insurance plan…

    Honestly, if I were a politician I wouldn’t want to have any responsibility for the healthcare system.

    #240210 Reply
    Lordosis Lordosis 
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    IF this happens it will just be a new set of rules for every one to learn to play the new game.  It might be harder for some specialties and easier for others.  Some people are good at learning the rules and maximizing where they can and others just stumble through and complain.

     

    As for multiple drugs in the same class it does seem silly to have so many equivalent meds.  However many times I have a patient “intolerant” to X and Y but Z is fine.  Even when X,Y, and Z are omeprazole, pantoprazole, and esomeprazole.  Even more so with statins and SSRIs.  I do not pretend to understand it but if that is what it takes to get someone to take the proper treatment then so be it.

     

    The issue not mentioned yet is that our society has become used to they way medicine is.  It will take a lot of training to change that.  People come in to the office for the most ridiculous things.  I cannot imagine how much ridiculousness an ER doc deals with over a career.  This is what people do when things are “Free”

    “Never let your sense of morals prevent you from doing what is right.”

    #240214 Reply
    Liked by wonka31
    Avatar snowcanyon 
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    I’d be psyched because then I could retire without worrying about health insurance.

    #240218 Reply
    Liked by fatlittlepig
    MPMD MPMD 
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    Competition has led to increased costs?  How exactly does that happen, FLP?  Please explain.  Competition has led to poorer outcomes?  Please explain.  You again reveal your ignorance about our healthcare system when saying that we are inferior to other monopolistic systems.  First, our populations are not comparable.  But let’s just say they are for this exercise.  I know you are simply repeating the tired talking points of our system being worse.  Because had you factored in and controlled for car deaths, homicide rates, suicide rates, obesity, etc. when you made the statement about health outcomes you wouldn’t have made it.  We are superior to other countries in cancer survival WITHOUT controlling for anything and then land #1 in life expectancy after those controls.  Also, when looking at birth statistics other countries don’t count infant mortality in the same way we do and they also give up on kids that we don’t give up on – we test the boundaries of what is possible to allow for their future kids to have the science and know-how to keep their future premature infants alive.  So spare me that we’re worse than other OECD countries.  We are better.

    Click to expand…

    I’m more watching this one that participating but a couple of questions.

    1. If you say our populations are not comparable (this is actually untrue but let’s assume it is for the sake of discussion) then how can you then go on to compare them in a way that supports the point you are making? If we cannot compare USA to say France for the purposes of most health stats then we can’t compare them on infant mortality either. I think you are trying to have this both ways. The argument that the USA is sui generis and therefore these systems that work very well (for less money) in our vacation destinations/staunchest allies is a common one that I find totally spurious, but if you’re going to voluntarily hoist yourself on that petard then I think you need to be consistent and just say that we are a completely unique case and eschew all comparison to other countries.

    2. This would be the first time that I’ve heard about vaguely defined allies “giv[ing] up on” neonates that we don’t. Do you have data for this? It seems that some of our NICU practices mirror some problematic practices at the end of life, namely massive expenditure for very marginal gains. That isn’t sustainable no matter who wins the policy argument. Everything I’ve read about infant mortality in the USA is an indictment of our system not a defense of it. Are you saying our stats are higher b/c we give more NICU babies a shot?

    3. Everyone thinks their country is better. What we resist as a nation is looking at best practices. Any interesting exercise here is to apply the philosophical principles of John Rawls and work behind the veil of ignorance.

    “Imagine that you have set for yourself the task of developing a totally new social contract for today’s society. How could you do so fairly? Although you could never actually eliminate all of your personal biases and prejudices, you would need to take steps at least to minimize them. Rawls suggests that you imagine yourself in an original position behind a veil of ignorance. Behind this veil, you know nothing of yourself and your natural abilities, or your position in society. You know nothing of your sex, race, nationality, or individual tastes. Behind such a veil of ignorance all individuals are simply specified as rational, free, and morally equal beings. You do know that in the “real world”, however, there will be a wide variety in the natural distribution of natural assets and abilities, and that there will be differences of sex, race, and culture that will distinguish groups of people from each other.”

    The interesting thing about Rawls is that you don’t get to be ENTDoc — an intelligent, well-spoken, well-read, and (I hope) relatively healthy professional. You are just “folks” as one of my college ethics profs put it. Any honest treatment of this exercise would not lead a rational actor to chose to be born in America. You would chose a Scandanavian nation, Japan, Switzerland, or perhaps Germany. Are we better?

    Click to expand…

    Really trying to take this discussion back to Intro to Political Theory? Anyway, I disagree with your conclusion that the rational choice would be to “choose a Scandanavian nation, Japan, Switzerland or Germany.”

    The only rational choice is to take a probabilistic approach to the situation based on your values. The problem with the veil of ignorance as a concept is that it over-emphasizes the risk of being the worst position in society. This also leads to your subjective interpretation of “worst” being over-emphasized. If you think being a toddler with cancer is the worst, you would choose America. If you think being homeless is the worst you would choose to be in Japan or Denmark.

    Overall, I think if you are looking at it holistically this situation dictates that one would marginally favor a life in Scandanavia/Switzerland over the US. I would then say the US is marginally better than Germany and significantly better than Japan. The fact that you think it is a cut and dry answer and not a difference at the margins points more to your own biases than the objective superiority of any singular nation.

    FWIW, I typed this up then was curious and Googled “average Germany salary in USD” and the OECD apparently has a “Better Life Index” that essentially agrees with the analysis above when giving each of their inputs equal relative importance.

    Regarding bullet #2, I think you either (a) haven’t looked or (b) are willfully ignoring this data. It is well-established that the way we classify infant mortality is systematically different from every other nation.

    Click to expand…

    How could a veil of ignorance analysis over-emphasize the risk of being in the worst position? How could it over-emphasize anything? The point is that you don’t know, nothing is over-emphasized.

    Believe me I am not willfully ignoring data. This would literally be the first time I have heard that the usa classifies infant mortality differently. Actually trying to learn if this is true.

    #240220 Reply

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