Thread: A Health Care Scenario

Having read through several of the healthcare debates, I have a serious question with a scenario of a recent friend of mine, for those both for and against socialized (or nationalized or whatever) health care.
Suppose Tom leaves high school and decides to go play baseball at a private university because he has an academic and athletic partial scholarship. Four years later he graduates with honors and has acquired roughly $20K in debt for a 100K education (I'd say thats a good deal). Then he decides to go to medical school and works up $250K in debt. Lets even go so far and say he wants to be a surgeon with 5 years of training where the interest on his loan of which only $100K is in low interest (<3%) and he ends up finishing his training with roughly $310K in debt.
So he decides to be a true doctor and work in a rural setting where docs are needed. In his first year he bills $150K in unpaid medicaid and medicare fees and private insurance. He then does over $300K in indigent (immigrant, uninsured or otherwise) work for which he receives nothing.
Now, he works hard and has billed over $1,000,000 in revenue in his first year. By the time he pays his taxes for his business, his personnel, his malpractice, his rent, office costs, and everything else he makes a grand $150K form which he has to pay a mortgage, taxes, and school loans.
The question I have to those who agree with nationalized healthcare.
Why is it fair that the doctor goes to school and training for 13 years after high school and has to work for the government (that will the only insurance left under ObamaCare)?
Why is it wrong for the doctor to expect payment just like the plumber gets paid when he is called, or the electrician, or better yet your mortgage company?
I want to know why a student feels like its ok not to have health coverage when schools provide options for it (they have too legally at all ages) and then complains about the bills when they get sick?
When did the US people start thinking everything should be free, and if healthcare everywhere else is better, why don't the people who don't want to work or pay their bills or healthcare leave to other countries with free healthcare?
I think docs everywhere, especially the pediatricians who get screwed, should make at least $500K/year. I think the hospitals should be able to deny care to illegal aliens unless they agree to pay something (even if its a quarter). Why not demand responsibility.
Why not let docs set a fee schedule and require insurance to pay for it, or else be unable to cover health?
Why can a doctor not tell a CEO of an insurer that he demands everything he has in order to treat his disease since the insurance companies have been making billions and yet their pay scales have continued to decrease the past 10 years?
I got angry after seeing a 23 year old recent college grad say he shouldn't have to buy health insurance and yet he shouldn't have to pay for healthcare either. Is this really the road the US is headed? The scenario above is an example of a friend of mine who just finished a surgical residency and now works in rural Mississippi.
I want responses both for and against because although I am not and Obama fan, he at least told the companies owing TARP money that they couldn't pay out obscene bonuses.

I want to start off by saying that I fully intend on emigrating after I am done with school. I am also pro universal health care. The real issue, in my mind, is that universal health care cannot stand alone. It is true that it would not be worth the cost of education to be a doctor making $50k-$100k a year. To make universal health care an option, education has to be cheaper.

I am currently a college student who, due to the fact that I didn't want to go to college in Indiana, currently has $90k in debt. If it were possible for me to go to school for $1000 plus cost of living a semester, then I would be okay with making less after I graduated. But I am going to be at roughly $125k in the hole when I am done, so it really isn't an option.

I want any children I may have in the future to avoid that problem. I have no issue with paying higher taxes, even around the 50% mark, provided I get something in return. For example, education and healthcare.

I like to think I at least know a little about what I am talking about. My major is Language and International Trade and Finance.

Originally Posted by treydampier

Having read through several of the healthcare debates, I have a serious question with a scenario of a recent friend of mine, for those both for and against socialized (or nationalized or whatever) health care.
Suppose Tom leaves high school and decides to go play baseball at a private university because he has an academic and athletic partial scholarship. Four years later he graduates with honors and has acquired roughly $20K in debt for a 100K education (I'd say thats a good deal). Then he decides to go to medical school and works up $250K in debt. Lets even go so far and say he wants to be a surgeon with 5 years of training where the interest on his loan of which only $100K is in low interest (<3%) and he ends up finishing his training with roughly $310K in debt.
So he decides to be a true doctor and work in a rural setting where docs are needed. In his first year he bills $150K in unpaid medicaid and medicare fees and private insurance. He then does over $300K in indigent (immigrant, uninsured or otherwise) work for which he receives nothing.

2003 BushCare voted by the then GOP controlled congress has a provision of $250K/year/hospital for emergency illegal immigrant care... maybe somebody should ask them to extend that to all doctors the next time they control both houses and the presidency.

Originally Posted by treydampier

Now, he works hard and has billed over $1,000,000 in revenue in his first year. By the time he pays his taxes for his business, his personnel, his malpractice, his rent, office costs, and everything else he makes a grand $150K form which he has to pay a mortgage, taxes, and school loans.
The question I have to those who agree with nationalized healthcare.
Why is it fair that the doctor goes to school and training for 13 years after high school and has to work for the government (that will the only insurance left under ObamaCare)?

Various countries in the world with universal government-run healthcare and more private insurers than your state would tend to disagree with that assertion.Your average state has between 2 and 5 options when it comes to health insurance.

Originally Posted by treydampier

Why is it wrong for the doctor to expect payment just like the plumber gets paid when he is called, or the electrician, or better yet your mortgage company?

Doctors in various countries in the world with universal government-run healthcare are too busy driving their new sports cars to their secondary house or playing golf to scoff at the idea that they are poor.

Originally Posted by treydampier

I want to know why a student feels like its ok not to have health coverage when schools provide options for it (they have too legally at all ages) and then complains about the bills when they get sick?

My personal experience with school-mandatory (as a foreign student) option when I studied in America for a year: most expensive health insurance I paid to date, close to inexistant coverage for any serious condition, effectively canceled my own insurance with better coverage that would otherwise have covered anything that could happen to me while I was in the States.

Originally Posted by treydampier

When did the US people start thinking everything should be free, and if healthcare everywhere else is better, why don't the people who don't want to work or pay their bills or healthcare leave to other countries with free healthcare?

You friend could also move to a place with lower operational costs.

Originally Posted by treydampier

I think docs everywhere, especially the pediatricians who get screwed, should make at least $500K/year. I think the hospitals should be able to deny care to illegal aliens unless they agree to pay something (even if its a quarter). Why not demand responsibility.

Why should they expect to make at least $500K/year and not the other careers which also require 10+ years of post high-school studies and high education debt? Where do you suppose those $500K/year/head would come from?

Originally Posted by treydampier

Why not let docs set a fee schedule and require insurance to pay for it, or else be unable to cover health?
Why can a doctor not tell a CEO of an insurer that he demands everything he has in order to treat his disease since the insurance companies have been making billions and yet their pay scales have continued to decrease the past 10 years?

Like almost every profession actually. The salaries have been at best flat or in reality declining if you look at the purchasing power. Even with the current deflation, the purchasing power of the average household is lower than it was in 2000. That excludes, of course, the 1% of the population that increased their wealth in the last 8 years... but those had no purchasing power issues to start with.

Originally Posted by treydampier

I got angry after seeing a 23 year old recent college grad say he shouldn't have to buy health insurance and yet he shouldn't have to pay for healthcare either. Is this really the road the US is headed? The scenario above is an example of a friend of mine who just finished a surgical residency and now works in rural Mississippi.

Maybe he should consider moving to an area where people have health coverage? Let's say I decide to create a huge IT service company and decide to set up shop in rural Alabama... should I blame anyone but myself if the business is generating less money than needed to cover the establishment and running costs?

Irony has it that the states the most likely to opt-out of the public option are actually the states that currently have the largest uninsured population. Want to venture a guess as to which party they usually vote for?

Why shouldn't he work for the government?

Clearly you are unhappy with the current system. universal healthcare is not free. It's free at point of service, but it's not free.

I would hope that doctors get into the gig to help people, and not just make a ton of cash. I would imagine demanding money before treatment would end up destroying most doctors emotionally.

Thank you Greg and Michael. I'm completely with you guys. And hopefully *fingers crossed* I will be headed to the fine nation of Germany post school. At the very least I will be headed somewhere where the citizens receive something in return for their tax dollars.

By the way Trey, things may be different here in the South (I sure noticed that they are) but where I grew up everything sure is a lot worse. Take my word for it.

Thanks to everyone for replying to this. I agree with a lot of what you all are saying. Americans get very little from their taxes comparatively in my OPINION. Clemson, SC is a small area of the south though ( Go Tigers, yes I like Clemson) and my cousin is studying engineering there. If you move to Germany (I assume they let people in) great! I have heard its beautiful, however, you will pay substantially higher taxes for your healthcare, but from what I have heard you get a lot for your taxes. As for the GOP and Bush bill on indigent care, you should know that docs do not see a single penny of that money, only the hospitals get that so your point on that is unclear in my mind (I inquired about that money and docs do not get a dime of it)
Your point on Doctors going into the practice for cash is well taken. The fact is most students entering go for that reason. The rest just lie about it. Most of the idealist docs (like pediatricians) go for the right reason as did I. That is why I want to go to rural area because the cities have more docs per population and healthcare is more readily available.
The school insurance I agree stinks, but you should have to pay it (I do). I moved a 450lb (200kg) unconscious woman onto a CT scanner by myself, and and ruptured a disc between the L3-L4 vertebrae. The co-pay and deductible cost me over $1200 and I didn't get an MRI! That was the equivalent to 1 month's groceries, rent, and electricity for me. However, I do not feel it is the responsibility of taxpayers to pay for an injury to me. I also did not file it under worker's compensation or other entity because no one forced me to go to medical school.
My salary suggestions although sound greedy are not meant to be that way, but many docs are changing their fields or changing careers because they can't run and office and should not have to work for hospitals because in the south, most physicians are in private practice. I also believe teachers should be paid like CEO's because my kindergarden and 1st grade teachers taught me the most important skills I use every single. Besides, very few professions (practically none) require the amount of time to complete the training as physicians, because even PhDs can get their degrees in 8-9 years after high school in many cases.

All are good points, and I appreciate the responses. Healthcare needs an overhaul. The government option is scary though because small businesses are going to just tell their employees to get their government insurance. The only reason in my mind to entertain it is because the CEO's and insurance industry have made more money in the last 40 years than any other business, and they continually seek ways to pay docs and hospitals less. Plus we all agree that there is a ridiculous amount of waste. We'll see where it goes, it can't get much worse.

In most European countries with centralized health care the education is pretty much free, so no doctor ends up with debt.

Originally Posted by treydampier

The government option is scary though because small businesses are going to just tell their employees to get their government insurance.

I really don't understand why this is a bad thing?

Very very few people have private healthcare insurance in this country. Our government is bending over backwards to support the national healthcare system because they know there will be riots if they don't.

Originally Posted by mainaman

In most European countries with centralized health care the education is pretty much free, so no doctor ends up with debt.

Exactly. My grandparents moved here in the 30s to make a better life for their families, not to see their grandkids unable to afford schooling or insurance.

I know that Clemson is a small area of the South, and I do my best not to judge the entire region based on it. However, I live less than 2 hours from Chicago, less than an hour from Gary, and only a few hours from Detroit. Elkhart, IN had the highest unemployment rate in the country for a long time, and it is only 30 minutes away. All I'm saying is that things could very well be much worse here than they are now.

PS: Trey: You are a big man for actively considering the opinions of other people, and not simply getting angry to defend your beliefs. I just wanted to say thank you for that, and I applaud your character.

I had a crazy thought about the whole public option the other night.

One of the arguments for having a public option is that it will increase the amount of competition in the industry and lead to better service/lower prices through general market pressure. The problem is this: The health industry doesn't work well under traditional free market rules. Consider the following:

Insurance companies are able to compete on price by having market share.
They go to a hospital and say: "Here is what we will pay for a basket of services and we can demand this price because we have THIS MANY insured under our program."

The smaller insurance companies aren't able to leverage their members for better pricing because they can't promise to bring in as much business.

So what happens if we add competition to the market? It could be that everyone in the industry ends up with a smaller piece of the pie and NO ONE has the leverage to demand better pricing out of the hospitals/providers.

I think the Government, should it be involved, would do better to focus on the PRICE of healthcare and not the insurance end of it. Make a law that says EVERYONE (individuals, large insurance co's, small insurance co's) pays the same thing for every service.

Make them compete on quality not quantity.

-Rob