If Mort Divine ruled the world

[Dak]

My point is that using the word "slave" implies a particular perspective on the issue that in turn implies a particular ideological stance. You're still using "slave" as though it correlates to a definitive state of being in the real world. Doctors working in a modern society that guarantees universal healthcare aren't actual slaves.

Maybe not at the moment, but the precedent is set and the situation becomes real as forces constrain the ability to renumerate competitively and provide adequate services to the sick multitudes.

As far as your question goes, why would universal healthcare preclude the impetus for scientific development? Isn't it possible that people who go into medicine do so for the contribution it might have to a broader social good, as opposed to simply securing individual financial security?

A dozen years in school and 80+ hour work weeks to live the same material life as someone who just plays videogames all day? While some might still take the former, it wouldn't be enough to provide the services needed in a Brave New World.

 

[Einherjar86]

Maybe not at the moment, but the precedent is set and the situation becomes real as forces constrain the ability to renumerate competitively and provide adequate services to the sick multitudes.

The precedent is not there. You're imagining a precedent based on your disposition. If doctors weren't allowed to quit their jobs, or received corporeal punishment for refusing to work, then I'd concede your point.

Very very few doctors would even dream of not treating a patient no matter how much they didn't want to. It's simply not something they even consider. It's what they do--they treat people regardless of external factors. Our current situation is not establishing a precedent for doctors to become slaves in any fashion. The case I foresee is that potentially fewer people become doctors. That would happen well before they become slaves.

A dozen years in school and 80+ hour work weeks to live the same material life as someone who just plays videogames all day? While some might still take the former, it wouldn't be enough to provide the services needed in a Brave New World.

It wouldn't be the same material life. Why do you assume that universal care would so level the economic landscape that welfare recipients enjoy the same private luxuries as doctors? This is an absurd assumption.

 

[Dak]

The precedent is not there. You're imagining a precedent based on your disposition. If doctors weren't allowed to quit their jobs, or received corporeal punishment for refusing to work, then I'd concede your point.

Very very few doctors would even dream of not treating a patient no matter how much they didn't want to. It's simply not something they even consider. It's what they do--they treat people regardless of external factors. Our current situation is not establishing a precedent for doctors to become slaves in any fashion. The case I foresee is that potentially fewer people become doctors. That would happen well before they become slaves.

The claim that "healthcare is a right" places a claim of ownership over the property and labor of others. With few enough sick persons and enough healthcare providers of various types and general societal wealth, the problems with this arrangement are papered over, if you will. But if pressure is placed through any of these three vectors, cracks will emerge. I do agree that at some point, rational self-interested calculation would see doctors quit before becoming slaves - but then what of the claims about the right to healthcare when no one wants to doctor? Either the claim is revealed to be a sham, or doctors, nurses, etc must be forced back into the line of duty. A draft, if you will.

It wouldn't be the same material life. Why do you assume that universal care would so level the economic landscape that welfare recipients enjoy the same private luxuries as doctors? This is an absurd assumption.

https://www.statnews.com/2017/02/08/cuba-doctors-meager-pay/

Cuba is proud of its government-run health care system and its skilled doctors. But even with a raise two years ago, the highest paid doctors make $67 a month, while nurses top out at $40. That leaves many feeling demoralized — and searching for ways to improve their lives.

Compare this to the national numbers:

http://www.miamiherald.com/news/nation-world/world/americas/cuba/article89133407.html

The survey, which was conducted among 1,067 Cubans in Havana, Santiago de Cuba, Holguín, Camagüey, Pinar del Río, and Cienfuegos in May and June, found that about 27 percent of Cubans earn under $50 per month; 34 percent earn the equivalent of $50 to $100 per month; and 20 percent earn $101 to $200. Twelve percent reported earning $201 to $500 a month; and almost 4 percent said their monthly earnings topped $500, including 1.5 percent who said they earned more than $1,000.

So no, it's not an absurd assumption.

 

[arg]

Savage response. Then again, I wouldnt expect someone like you to even remotely understand basic morality. I already knew from the beginning that I was taking a controversial stance, but people who can look down on the downtrodden without any sort of empathy and say that they can "fuck off and die" are fucking assholes that deserve some crippling illness. And when you are sick, laying in bed unable to work, your funds drained attempting to sustain yourself, you will do what exactly? Fuck off and die apparently.



Almost everyone I know in the healthcare industry legitimately sympathizes with sick patients and feels horrible about denying care to those who cannot afford it. I am part of an organization (an EMS squad with ambulances) that has many members who volunteer their time to safely transport ill and dying patients to hospitals. We are one of many thousands across the nation, and probably even more across the world. Nobody wants to kick patients to the curb, but at the moment US healthcare would cripple itself and crumble if it were to serve everyone regardless of their ability to pay. I am unwilling to accept this as an end goal. Even researchers who work feverishly on cures for diseases completely removed from direct patient care would want everyone who has it to be treated.

Yes I would rather accept death than ask the government to extort money from some billionaires even if the cost of my treatment would be a drop in a bucket for them.

 

[Einherjar86]

The claim that "healthcare is a right" places a claim of ownership over the property and labor of others. With few enough sick persons and enough healthcare providers of various types and general societal wealth, the problems with this arrangement are papered over, if you will. But if pressure is placed through any of these three vectors, cracks will emerge. I do agree that at some point, rational self-interested calculation would see doctors quit before becoming slaves - but then what of the claims about the right to healthcare when no one wants to doctor? Either the claim is revealed to be a sham, or doctors, nurses, etc must be forced back into the line of duty. A draft, if you will.

This isn't even an irrational vision, it's illogical.

Let's assume this scenario comes about. Doctors are being physically coerced to treat people; but let's face it, most of them end up being ferried between the residences of wealthy individuals and politicians, because those are the people that matter. With guns pointed at their heads, doctors are told they must see patients and perform operations. The enslaved physicians realize that if they all died, there would be no one to provide healthcare. They all go on strike and say "Go ahead, beat us, torture us, kill us--but without us in supreme working condition, you won't have anyone to treat your upper-middle-classes." The shoe's on the other foot now, and suddenly the "draft" doesn't look like such a good idea because--wouldn't you know--the military draft teaches soldiers the skills they need to know, whereas the "healthcare draft" requires its doctors to already be familiar with their craft (and unfortunately, they're the only ones who know how to do it... ).

https://www.statnews.com/2017/02/08/cuba-doctors-meager-pay/

Compare this to the national numbers:

http://www.miamiherald.com/news/nation-world/world/americas/cuba/article89133407.html

So no, it's not an absurd assumption.

Yes, it is. You're comparing a wealthy country's attempts to move toward wider health coverage with a third-world country that has suffered tremendously at the hands of the global economy. There's virtually no reason to assume that wider coverage here would look like Cuba's system now.

 

[Dak]

This isn't even an irrational vision, it's illogical.

Let's assume this scenario comes about. Doctors are being physically coerced to treat people; but let's face it, most of them end up being ferried between the residences of wealthy individuals and politicians, because those are the people that matter. With guns pointed at their heads, doctors are told they must see patients and perform operations. The enslaved physicians realize that if they all died, there would be no one to provide healthcare. They all go on strike and say "Go ahead, beat us, torture us, kill us--but without us in supreme working condition, you won't have anyone to treat your upper-middle-classes." The shoe's on the other foot now, and suddenly the "draft" doesn't look like such a good idea because--wouldn't you know--the military draft teaches soldiers the skills they need to know, whereas the "healthcare draft" requires its doctors to already be familiar with their craft (and unfortunately, they're the only ones who know how to do it... ).

There are worse things than death to some people, and why would people rather die than do the thing they know how to do, just for poor compensation. That's also the transition phase. A switch to a draft process or "slotting" would later involve such training, albeit potentially poor/increasingly poor

Yes, it is. You're comparing a wealthy country's attempts to move toward wider health coverage with a third-world country that has suffered tremendously at the hands of the global economy. There's virtually no reason to assume that wider coverage here would look like Cuba's system now.

Always the excuse for failed socialism/communism. There is reason to assume things would be similar when similar systems are implemented. How about Venezuela? The global economy had rewarded them for a while, and venezuela was held up as a shining example by people like Bernie in 2011 - before it became necessary to forget them:

http://www.newsweek.com/venezuelas-economic-crisis-has-forced-doctors-become-prostitutes-672035

http://money.cnn.com/2017/07/02/news/economy/venezuela-minimum-wage-hike/index.html

Based on these two sources, even the old structure - from when oil revenues were booming - only showed doctors being paid roughly double what the total welfare package paid (a paltry sum in dollars on both accounts). This hasn't changed now, simply shifted up, but not as fast as inflation. When you have a system oriented towards "equality", it makes sense that pay structures are flat, even including those who do nothing.

 

[Einherjar86]

I'm not going to get into an argument about communism/socialism. Every single communist/socialist economy have vastly different origin stories than the rise of liberal democratic capitalism in the West. We're not having that discussion here.

As far as your first comment, why would people do what they know how to do for poor compensation when they're the only ones who know how to do it? That's supply and demand, isn't it? Extending healthcare doesn't mean abandoning market principles. You seem to think it can only be either/or.

The entire scenario is ridiculous, not to mention a strawman. It's a fantastical extrapolation based not on plausibility but on ideologically driven fears.

 

[Dak]

I like how you refer to my real world examples and brief logical examples of the problems caused when demand outstrips supply as strawmen and "fantastical ideologically driven extrapolation". Good thing no Venezualan was engaged in such fantastical extrapolations about the problems of socialism. Even Sweden has had to swing back towards privatization because why? Demand outstripping supply as can be delivered by the state. That's exactly the scenario the US is headed for, yet even moreso because at least the Swedish exercise and eat reasonably well. Americans are fat and sick, as well as increasingly old (like the rest of the developed world). Extending coverage further would just cause the trainwreck faster.

Physician burnout is real and a growing problem, and imagine what these numbers would look like if the pay wasn't even good:

https://wire.ama-assn.org/life-career/report-reveals-severity-burnout-specialty

https://www.centerforhealthjournali...etire-or-flee-doctors-are-leaving-health-care

Apparently not. Deloitte’s 2013 survey of over 20,000 physicians notes 62% say that “it is likely that many physicians will retire earlier than planned in the next one to three years. This perception is fairly uniform among all physicians, irrespective of age, gender, or medical specialty.”

And if they’re not retiring outright, doctors say they believe physicians will “scale back practice hours (55 percent) based on how the future of medicine is changing.” None of this is surprising when Deloitte reports that “six in 10 physicians (57 percent) say that the practice of medicine is in jeopardy.”

 

[Einherjar86]

None of that disproves anything I've said. As I mentioned, we would likely see a decrease in people entering the medical profession well before we see anything remotely like "slavery," which is the scenario you suggested--at which point it would be much harder to institute something like a "healthcare draft," since there would be so few people to whom it could be applied.

The strawman and fantastical scenario you're imagining is that the right to healthcare would lead to an authoritarian dytopia in which healthcare professionals are somehow forced to work. The far more likely and plausible scenario is that medical professionals leave their field and we stop talking about any "right to healthcare" altogether. The right comes with the opportunity and the applicability. No one talks about a right to healthcare in a society with no doctors.

I can't believe I'm discussing the scenario of doctors being slaves, to be honest.

 

[arg]

It can’t be done in the US without increasing taxes to 50% give or take, so fuck that

 

[Dak]

The strawman and fantastical scenario you're imagining is that the right to healthcare would lead to an authoritarian dytopia in which healthcare professionals are somehow forced to work. The far more likely and plausible scenario is that medical professionals leave their field and we stop talking about any "right to healthcare" altogether. The right comes with the opportunity and the applicability. No one talks about a right to healthcare in a society with no doctors.

I can't believe I'm discussing the scenario of doctors being slaves, to be honest.

The emboldened scenario is the more likely scenario. I'm not disagreeing there. Which means the entire "right to health-care" idea is a farce from the beginning.

 

[EternalMetal]

I was wondering how long it would take for our token capitalist right-wingers to start crying communism, guess I got my answer. Our government seems to spend an exorbitant amount of money on military action that is supposed to protect the lives and freedoms of its citizens, yet when it comes to actually doing it via healthcare, there is some big problem. What the fuck do we need trained killers who never see combat for when we cant even provide for the sick?

While I admit that my scenario is a rather lofty ideal (I dont think I ever suggested it was easily achievable), I think that there should be at least some oversight by the government that allows healthcare to at the very least be affordable by the vast majority of citizens. I have seen hospitals charge $16 for a fucking band-aid at the ER, because in the past insurance companies were paying for pretty much everything. Drug prices are through the roof for similar reasons. The exploitation of this system (due to the idea that everyone who gets sick wants to get better) has crushed the entire industry, and costs are bloated ridiculously across the board. Doctors are overworked because the schooling is excessive; there has been an ongoing attempt at alleviating this by focusing on the training of "middle-men" such as PAs and Nurse Practitioners.

Are you the staff MD or something?

I said EMS didnt I? Im just a volunteer EMT.

Yes I would rather accept death than ask the government to extort money from some billionaires even if the cost of my treatment would be a drop in a bucket for them.

Ok.

 

[CiG]

 

[The Ozzman]

I said EMS didnt I? Im just a volunteer EMT

Okay but aren't you in medical school too or something? I'm just confused dude.

 

[Dak]

I was wondering how long it would take for our token capitalist right-wingers to start crying communism, guess I got my answer. Our government seems to spend an exorbitant amount of money on military action that is supposed to protect the lives and freedoms of its citizens, yet when it comes to actually doing it via healthcare, there is some big problem. What the fuck do we need trained killers who never see combat for when we cant even provide for the sick?

While I admit that my scenario is a rather lofty ideal (I dont think I ever suggested it was easily achievable), I think that there should be at least some oversight by the government that allows healthcare to at the very least be affordable by the vast majority of citizens. I have seen hospitals charge $16 for a fucking band-aid at the ER, because in the past insurance companies were paying for pretty much everything. Drug prices are through the roof for similar reasons. The exploitation of this system (due to the idea that everyone who gets sick wants to get better) has crushed the entire industry, and costs are bloated ridiculously across the board. Doctors are overworked because the schooling is excessive; there has been an ongoing attempt at alleviating this by focusing on the training of "middle-men" such as PAs and Nurse Practitioners.

Healthcare is the most regulated and subsidized thing in this country outside of defense and banking, and the costs reflect this. You're incredibly offbase. Secondarily, doctors are not overworked as doctors because medical school is too hard or lengthy or whatever. That would be medical school/student burnout, a topic I research and an undergraduate thesis on. Doctors are burning out because of being overworked and not able to meet all the demands of their job, and compensation is increasingly getting siphoned to administration to deal with the regulations.

 

[arg]

I was wondering how long it would take for our token capitalist right-wingers to start crying communism, guess I got my answer. Our government seems to spend an exorbitant amount of money on military action that is supposed to protect the lives and freedoms of its citizens, yet when it comes to actually doing it via healthcare, there is some big problem. What the fuck do we need trained killers who never see combat for when we cant even provide for the sick?

While I admit that my scenario is a rather lofty ideal (I dont think I ever suggested it was easily achievable), I think that there should be at least some oversight by the government that allows healthcare to at the very least be affordable by the vast majority of citizens. I have seen hospitals charge $16 for a fucking band-aid at the ER, because in the past insurance companies were paying for pretty much everything. Drug prices are through the roof for similar reasons. The exploitation of this system (due to the idea that everyone who gets sick wants to get better) has crushed the entire industry, and costs are bloated ridiculously across the board. Doctors are overworked because the schooling is excessive; there has been an ongoing attempt at alleviating this by focusing on the training of "middle-men" such as PAs and Nurse Practitioners.




I said EMS didnt I? Im just a volunteer EMT.



Ok.

Ways to make healthcare costs go down naturally by themselves without force

1. Remove the government requirement to treat everyone. When you guarantee that someone will be treated and that someone will pay for it, healthcare providers can jack up the costs as high as they want.

2. Allow insurance companies to reject high risk patients. Or allow them to charge high risk patients a lot more than everyone else. Sick people unfairly make insurance more expensive for healthy people so they should be charged more or be rejected.

3. Make it easier to become doctors so there will be more of them and they will compete with each other by lowering their prices.

4. Make the rules for pharmaceutical companies copying each other’s medicines much more relaxed / make patents expire faster so they compete with each other by lowering their prices. Also, make it easier for foreign drugs to be sold in the us.

5. Yes I agree we should massively defund the military and lower taxes across the board for everyone putting more money in our pockets so we can afford our own healthcare.

Health insurance should be affordable but optional depending on your personal condition, and healthcare should be affordable even without insurance for those who don’t need it.

But it should not be universalized to extent of fully curing every penniless homeless bum with cancer, aids, diabetes and tuberculosis while they pay nothing because that will destroy the industry and the economy. I may be ok with a “shitty” version of universal healthcare that gives them a cheap drug that will knock them into a coma and thus make them unaware of the pain til they die.

 

[Einherjar86]

The emboldened scenario is the more likely scenario. I'm not disagreeing there. Which means the entire "right to health-care" idea is a farce from the beginning.

It's not a farce, it's a conditional possibility. We have the potential to realize it, but it's too bad that the top one percent own forty percent of private wealth in the U.S.

Of course, it's entirely legal and legitimate that they own that wealth, so I'm not complaining about ethics violations. But you're off-base too when you suggest that improving the situation in a more egalitarian way is impossible.

 

[EternalMetal]

Okay but aren't you in medical school too or something? I'm just confused dude.

Unfortunately no. I was a biochemistry major in college and have been applying to PA schools for the past couple years. In the meantime I decided not to go back to school and am aiming to find a job as a chemist starting next year. Even if I were to be accepted, most PA schools expect you to keep GPAs in excess of 3.5-3.8, of which I am not sure I am willing to risk doing (I graduated with a modest 3.4).

Healthcare is the most regulated and subsidized thing in this country outside of defense and banking, and the costs reflect this. You're incredibly offbase.

You are assuming that I said the lack of government oversight has caused the failure. I am suggesting that the government should still oversee the industry, but that it should be overhauled in a way that isnt so damn corrupt. Obamacare was a farce.

Secondarily, doctors are not overworked as doctors because medical school is too hard or lengthy or whatever. That would be medical school/student burnout, a topic I research and an undergraduate thesis on. Doctors are burning out because of being overworked and not able to meet all the demands of their job, and compensation is increasingly getting siphoned to administration to deal with the regulations.

I was actually implying that there was a shortage of doctors because it takes so damn like to get an MD, so most students go down a different path. I am actually unsure whether this is reality or not, but there are other reasons why people dont want to be doctors (medical malpractice being a major factor from what I know). The utilization of PAs and Nurse Practitioners to pick up the slack has been one thing the medical industry has been focused on for years.

Quite frankly im about done discussing this, as I think enough has been said.

Ways to make healthcare costs go down naturally by themselves without force

1. Remove the government requirement to treat everyone. When you guarantee that someone will be treated and that someone will pay for it, healthcare providers can jack up the costs as high as they want.

Everyone who is sick already wants to be treated. I dont think this would really do anything. Also you cant just kick someone to the curb if they come in dying in an ambulance.

2. Allow insurance companies to reject high risk patients. Or allow them to charge high risk patients a lot more than everyone else. Sick people unfairly make insurance more expensive for healthy people so they should be charged more or be rejected.

Healthy people generally dont need healthcare. Im guessing that you are talking about the pre-existing conditions issue? While what you are saying is true, I really dont like the idea of not treating sick people, which is basically what you are proposing.

3. Make it easier to become doctors so there will be more of them and they will compete with each other by lowering their prices.

What I was saying before, about the medical industry starting to take advantage of "middle-man" positions such as PAs and Nurse Practitioners, is basically this. Lowering the standards required of MDs will just mean more shitty doctors, which is a bad idea.

4. Make the rules for pharmaceutical companies copying each other’s medicines much more relaxed / make patents expire faster so they compete with each other by lowering their prices. Also, make it easier for foreign drugs to be sold in the us.

This sounds like it would discourage research into better drugs, but something does have to be done about the price of drugs. I dont have a solution.

5. Yes I agree we should massively defund the military and lower taxes across the board for everyone putting more money in our pockets so we can afford our own healthcare.

If only this was as easy as it sounds.

Health insurance should be affordable but optional depending on your personal condition, and healthcare should be affordable even without insurance for those who don’t need it.

It is kind of impossible to say you dont need health insurance. You never know when an expensive illness with strike, or whether you will get in a serious car accident that makes you take time off your job while also having to pay for other types of expensive procedures. Otherwise, going to my doc for antibiotics for a sinus infection or some other frivolous thing atm costs me a little under $100 (which is affordable).

 

[arg]

If a doctor wants to treat a patient who can’t pay, it should come out of his and his nurses’ salaries, or a special fund that the private hospital pools from the salaries of all its doctors for such patients. So the burden is on them, as it should be, and not the taxpayer, who has nothing to do with that transaction. Doctors get paid shitloads in this country anyway.

@EternalMetal DOCTORS took the hippocratic oath, not me! why use MY money to fulfill THEIR (YOUR) oath? put your money where your mouth is and use your own!

 

[Dak]

You are assuming that I said the lack of government oversight has caused the failure. I am suggesting that the government should still oversee the industry, but that it should be overhauled in a way that isnt so damn corrupt. Obamacare was a farce.

When you say "there should be at least some government oversight", when there is already a shitload of oversight and subsidization, and no one said there should be zero oversight, it sounds like you mean we need more because you think we have little to none. Obviously an overhaul would be helpful, but no governmental overhaul ever goes from a lot to a little, unless maybe in the financial sector because the reasons.

I was actually implying that there was a shortage of doctors because it takes so damn like to get an MD, so most students go down a different path.

I provided a link showing that's not the primary issue.

It's not a farce, it's a conditional possibility. We have the potential to realize it, but it's too bad that the top one percent own forty percent of private wealth in the U.S.

Of course, it's entirely legal and legitimate that they own that wealth, so I'm not complaining about ethics violations. But you're off-base too when you suggest that improving the situation in a more egalitarian way is impossible.

Improved acute (reactionary) healthcare won't stop people from killing themselves with shitty lifestyles. That's the actual problem, at least in the US.