Chris's experience is representative of what one can expect from the Indian health care system. If you are a working, middle class person, the free market health care works extremely well.
Here's another example: https://www.washingtonpost.com/business/economy/new-machine-...
"Anesthesiologists tried to stop Sedasys.
They lobbied against it for years, arguing no machine could possibly replicate their skills or handle an emergency if something went wrong. Putting someone to sleep is an art, they said. Too little sedation, and the patient feels pain. Too much, and the patient dies. Anesthesiology requires four years of training after medical school, meaning careers might not launch until the doctors are in their 30s. It’s one reason the profession’s median salary is $277,000 a year, according to research firm Payscale."
What about the increase in physicians assistants and nurse practitioners, who seem to be taking over in the scene of less serious, more routine healthcare?
On the other hand, wages in IT suffer from an overabundance of indentured H1-B labourers, held on the very short leash of the US immigration system. This should demonstrate the importance of union representation, even at the high end of the qualification scale.
[1]https://en.wikipedia.org/wiki/Resource-based_relative_value_...
As far as overbuilding hospitals goes, you'd think that physicians and administrators will try to fill those beds at any cost, cost that is billed to patients and the taxpayer. Hospital overcapacity is not like airline overcapacity.
The AMA is a common scapegoat, except that the AMA has literally nothing to do with the number of of doctors supply-side.
You're probably thinking of the AAMC, which has nothing to do with the AMA, and is responsible for the number of medical students who graduate each year from the US. Except the AAMC has very deliberately and openly increased the number of medical student slots each year for over a decade, specifically with this goal in mind.
But even this is a moot point, because the number of people gradating with MDs is not the bottleneck - the problem is that doctors can't practice medicine until they complete a residency program. We graduate more medical students every year than we have residency slots available, so increasing the number of graduates even further will have no effect.
Increasing the number of residency slots is up to Medicare, because Medicare funds residency programs nationwide.
In 2015 there were 41,000+ applicants for ~30,000 residency positions[0]. I don't have the 2015 numbers for medical schools, but in 2014, there were 18,000 graduates in the US[1].
Increasing the number of medical school graduates in the US would mean that a larger percentage of residency slots are taken by people who went to school in the US but not the total number of residents. Ironically, this would actually be a bad thing cost-wise, since foreign medical schools are usually cheaper and students carry a lower debt load[2].
> Does this mean there is an ever-growing population of "post-doc" physicians, stuck in labs or other non-patient-facing situations?
Yes. You are likely to see them take jobs in industry - e.g. at a pharmaceutical or insurance company, but on the business side, since they're not licensed to practice. (Nor are they even qualified - medical school teaches essential knowledge for doctors, but they receive basically no training on actual clinical practice. All of that happens during residency).
It's worth noting that not all doctors want to practice medicine - for example, people in an MD/PhD program often go into research, and that's a good thing. But if we're talking about increasing the supply of practicing physicians, increasing the number of medical school applicants in the US makes literally zero difference.
[0] http://www.nrmp.org/press-release-2015-residency-match-large...
[1] https://www.aamc.org/download/321532/data/factstable27-2.pdf
[2] These aren't necessarily "foreign" students either; it's quite common for people in the US to go to medical school in the Caribbean and then come back for their residency.
What if the Gates Foundation decided it wanted to fund 1 residency position? Is there some structural roadblock in the way of its money?
But besides that, the Gates Foundation has decided that the most effective way to spend its money, dollar-for-dollar, is on efforts like polio eradication and malaria research. You'd have to convince them that this would be the most worthwhile use of their money - and quite frankly, if I were in their shoes, I wouldn't. Even if lowering the costs of healthcare in the US were their explicit goal (it's not), it would be a rather inefficient way to go about it. And eradicating infectious diseases that largely affect the poor is a much bigger win for humanity than an ongoing subsidy[0] for medical care in the developed world.
[0] This would require perpetual funding for it to be effective; as soon as they decided to stop funding residency programs, we'd go back to the status quo.
No, it isn't. Congress limited the number of residency slots Medicare could underwrite, but medical residency is not controlled by Medicare. Additionally, Medicare only pays for about 25% to the total costs incurred by residency programs.
In fact, the law that created Medicare specifically stated it was to subsidize residencies “until the community undertakes to bear such education costs in some other way.” Understandably, no one has stepped up to replace the federal government gravy train. Since the AAMC is predominantly responsible for Graduate Medical Education (the formal name of residency) it is absolutely the appropriate scapegoat for the residency bottleneck (since their only answer is to make the FGGT bigger), as is the AMA for pushing increasingly long residency requirements for medical licensure.
It seems like you don't want Medicare to be responsible for the funding of residency programs, and you'll get no disagreement from me on that point. In an ideal world, this would not come Medicare, because Medicare is the least efficient funding source for - well, pretty much anything.
But the fact remains that residency programs are not a profit center for hospitals, and hospitals cannot absorb an extra $9.8 billion/year just to train residents. And there's no other funding source for these programs at most hospitals that doesn't ultimately make its way back to the patient in some form.
It's also worth mentioning that the Balanced Budget Act capped Medicare's funding for residency programs specifically to reduce the number of residency slots available and avoid an "oversupply" of doctors. It's not that the AAMC is looking for free money so that they can keep the number of physicians artificially low, as you're implying; the external funding is what drove the increase in the number of physicians in the first place.
If you want residency programs to be funded by someone other than Medicare, that's fine, but just realize that the free-market would reach equilibrium at even fewer residency slots than we have today.
Contrast that to a completely mediocre web dev who can pull 100k+ at 21 putting in 40-50 hours a week and do you really still think physicians are overpaid? Keep in mind the majority end up in family or internal medicine working 60+ hours a week for ~$175k/yr. Going to medical school is a massive financial risk with an incredibly uncertain future.
If you want a human punching bag then turn your gaze towards hospital administrators, pharmaceutical executives, and exploitative vendors. The actual hospital employees are just as much victims of the healthcare shit show as members of the public are.
Yeah, lady, that includes not giving you all our money without asking how much you'll be taking.
It's a broken system and there's no excuse for it, but at least in the US it is not because they're being intentionally obtuse.
Now some of that is that if a complication occurs, there will be additional cost, but I was just asking for a baseline, and all they could give me were guesses.
Depending on the arrangement with the insurer, and what the recovery period was like for that type of operation, nobody in the office probably had any idea (and I bet their guesses were pretty far apart, too). Some medication used in recovery is very expensive and can add five-figure variances if someone doesn't respond well to the procedure or is in an abnormal amount of pain. And as you mentioned any complications can double the cost in an instant.
From the insurer side, they will decide after they receive the care provider's bill what they're covering and for how much. They may decide she only need five hydrocodone, not eight, so there's (3 * $n) out of your pocket (I am not googling the cost of hydrocodone at work :)). What's more is this "justification" is rarely given to the care providers. The insurer is billed $50,000, they pay $47,000 and that's that. The cynic in me wants to say it's so they don't actually have to justify partial payment, but who knows.
I've always thought we should build a massive audio archive of people calling for a medical quote and getting the runaround. I know I'd have my phone on record if I ever had to start calling. I live in a one-party consent state, and I'd use that to the max to embarrass these institutions, and have a public record of this bullshit. Shine that bright light of viral media onto the soft underbelly of the US healthcare system.
The insurers all negotiate discount percentages, pecking order for discounts, exclusions, concessions from doctors, etc.
No human understands it.
Rather than a one-size-fits-all approach to healthcare through single payer or other subsidies, my fondest wish for government intervention would be for laws that force doctors and hospitals to provide price and likely outcome information to the general public. Give healthcare consumers the data they need to make informed decisions and the ensuing competition could drive down prices while improving outcomes.
You can. Routine, profitable procedures are not hard to arrange in the US. I have personally worked in a clinic where the exact experience described in this post happens every day.
>If you are a working, middle class person, the free market health care works extremely well.
It's pretty easy in most places in the world to get people to do something that makes them money, like the discectomy discussed here.
Managing a system where the poor and the unlucky get care is a little tougher. The US does it lousily, but so does most of the rest of the world. India doesn't do it at all.
edit:copy error
For the majority, this is simply not the case. I'm sure there are exceptions as our country is very large, but most people's experience would be very similar to the OPs. I'd suggest reading Healing of America by T.R. Reed if you're interested in the working of US compared to other systems.
This happened to most of the people that I know that needed some kind of quote from the hospital. The clinic you have worked was an exception.
My more subtle point is that when we are discussing an existing free-market based medical system, you can not just trot out all the standard arguments about why the US should not go free market, because they are all based on a discussion of a change in how we structure the system. Here we (appear to) have a free-market system, so, one must validate all the slurs actually apply before just flinging them at the existing system.
If free-market health is so guaranteed to be so utterly disastrous, instead of flinging quasi-racist slurs at the Indians, why don't you actually go find the guaranteed-disasters in progress? Ought to be pretty easy if it's even one-tenth as bad as everyone always claims in the US context.
(Though I'll warn you in advance I'm going to account for the situation on the ground; if the doctor's office in a far-flung village with a per-capita income of 50$/year isn't up to US standards, I'm not going to award you many points. India is not a wealthy country. Only the major medical centers are really that interesting. It's also generally invalid to complain about a government not providing services when they simply do not have the wherewithal to be providing them to everybody yet.)
Cheaper to Americans. Not cheaper to it's own people. Most of it's own people are still priced out of that market.
This is not some failing of the medical system, it's just a failing of India to be a wealthy developed nation.
I think 50% of the population engaging in open defecation is even higher than San Fransisco.
And if you're not?