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Sasquatch:
NCVol, I also don't know if you are making an argument for Obamacare or not when you post the doctors per patient ratios. What we see in Europe is long wait times for surgeries and other procedures and they mostly have MORE doctors per patient, according to your data. Think our wait times will decrease or increase when we have the ultimate ends : single payer?

I know this is opinion right now, but I also have historical fact when looking at other systems.

Meantime, I hope you will address my questions in the previous post. Unless you like to cherry pick whose OPINIONS you respond to?  //BIB/

NCVol:
Quote from: Sasquatch on February 11, 2011, 11:37:39 AM

Amen to that! I posted data too, from European doctors and medical groups, which apparently refudiated what was said earlier:

From FL: ...there would be a major shortage of doctors all across Europe. There isn't. Nor will there be in the USA when Obamacare begins.


No, you didn't actually post data, you posted a few stories about shortages.  One of them was about Germany, in rural areas.  OK.  We have the same issues no.  Another was France, which defunded medical positions and, predictably, got a shortage.  Both countries STILL have much higher doc/person ratios than we do right now.  

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Now you are saying we already have a shortage of doctors in the US. Doesn't that also refudiate what FL said in regards to there won't be any doctor shortages in the US when Obamacare begins? Or do you believe when it kicks in we can expect a flow INTO the medical profession that will eliminate the shortages? If so, please provide those facts instead of what FL did: OPINION.


We do have a shortage of doctors.  Part of it is hidden because we ration care by denying most of it to poor people.  The issue about Obamacare is MILLIONS of people who are rationed out of the market - use the ER for their primary care doctor - will finally get to see a real family doctor.  That's a good thing, but there will be shortages because there are shortages now.  So yes, I disagree with FL on that.  

It's something reasonable people, as well as conservatives  /spin/, should get together and work towards a solution.  The HCR bill has some proposals that START the process of addressing the shortage.  I'm waiting on the conservative response.  

And the thing about the number of doctors is it's controlled by the number of slots at medical schools and residencies.  If we increase those, yes we will see a flood of people INTO the profession.  For years the AMA has put a lid on those to maintain a sort of shortage.  Every medical school class is full.  Most residencies are full, and the ones that aren't, according to all the EVIDENCE that I've seen, are those in the primary care field because it pays less.  The "be afraid" thing about doctors taking their balls and going home to the golf course is just about entirely made up.  

There's a poll that I know you've seen that say doctors will all retire in true Galtian fashion if "Obamacare" comes into law, but unfortunately it's highly suspect.  You can read about the issues here, but if they don't offer the questions asked, and don't reveal details of the sample and responses, it's really hard to take a poll seriously.  They're response rate was 6%.  Anyone who has ever done a poll by mail has to demonstrate that such a low response rate didn't color the results.  It might be the 6% were overwhelmingly John Galt I'm-mad-as-hell types and the rest of them didn't bother.  Or not, we don't know, but you have to demonstrate the respondents didn't vary from the population - as step one.  

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I sent a request last week to both IBD and their pollster asking for the exact wording of published questions, a description of the population sampled, the sampling method, the dates of interviewing and the response rate. Both the National Council on Public Polls and the American Association for Public Opinion Research mandate disclosure of the first four in all public reports. AAPOR also requires public disclosure of response rates, while NCPP says pollsters should provide them on request. So far, the IBD/TIPP poll fails on all counts.


It's always a clue when someone chooses secrecy over openness on these things.  Why?  

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I know I am asking a lot (for you to comment on something that left of centers say that contradict what you say), but I would like for you to once at least acknowledge their OPINIONS.


I think I just did....

NCVol:
Quote from: Sasquatch on February 11, 2011, 12:09:35 PM

NCVol, I also don't know if you are making an argument for Obamacare or not when you post the doctors per patient ratios. What we see in Europe is long wait times for surgeries and other procedures and they mostly have MORE doctors per patient, according to your data. Think our wait times will decrease or increase when we have the ultimate ends : single payer?


Without Obamacare, we survive with lower doctor/person ratios because we ration care to the poor - they don't get any until they get REALLY sick.  To me, and it's just me, this is a major downside to our system that has 50 million or so without insurance and many more millions with inadequate insurance.  So it's neither an argument for or against Obamacare to point out the implementation issues.  If the GOP plans to increase access with "free market" solutions, their plan will have the SAME ISSUES.  If they want to continue rationing care to the poor, by not providing any until crisis hits, the problem is less severe.  It's really that simple.  

As to Europe, it's not ONE place, it's many places and wait times vary tremendously from place to place.  England is the worst, and the reason is clear - they have HALF the number of docs per person as some of their neighbors and spend about a third what we do per person.  If you chronically underfund something, it should be no surprise you have shortages.  Other countries do BETTER than the U.S. on many measures, including access to primary care physicians, but we clearly rule the world in access to elective surgery and to machinery like MRIs etc. since those make a ton of money for providers, and so wait times are essentially zero for them.  And most of the EU has very good access to non-elective surgeries and procedures, with wait times for most countries extremely good, although England again has some true horror stories.  So you can't say "wait times" without talking about for what, and you can't say "Europe" without telling us WHERE in Europe.  Worldwide, Japan has by the accounts I've seen by far the best record on wait times, with fewer doctors.  Go figure.  Let's see how they do it!  

Here's one study http://www.oecd.org/dataoecd/24/32/5162353.pdf p. 11

The wait times ranged from 13 weeks in Hungary, and 16 in Switzerland, to 42 in the UK and 58 in Portugal.  Generally these are either all surgeries or electives.  Non elective surgeries are typically good in most advanced countries.  



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I know this is opinion right now, but I also have historical fact when looking at other systems.


I'm waiting on the facts...  

And BTW, at some point we have to address the trade-offs.  We really can't have it all, and it's just like with other areas of spending, if you can afford to spend double the rate of the rest of the world, some clear advantages will come from that - higher use of cutting edge technology because it is more profitable, outstanding physicians who are drawn to pay levels at the high end several multiples of other countries, near zero wait times for profitable elective surgery.  AND you'll have some downside which is we do basic medicine TERRIBLY - treating asthma, diabetes, chronic heart disease, etc. - those things that are doctor time intensive rather than profitable procedure intensive.  We have terrible records on those measures, because a doctor gets paid a ton for putting you through an MRI, or doing gastric bypass surgery, and not much at all for talking to you about how to control your weight with diet and exercise, etc.  

Sasquatch:
Quote from: NCVol on February 11, 2011, 01:29:31 PM

Here's one study http://www.oecd.org/dataoecd/24/32/5162353.pdf p. 11

The wait times ranged from 13 weeks in Hungary, and 16 in Switzerland, to 42 in the UK and 58 in Portugal.  Generally these are either all surgeries or electives.  Non elective surgeries are typically good in most advanced countries.  

I'm waiting on the facts...  


Uhhhh, didn't you just post "one study" that addresses what I said was historical fact: Waiting time for procedures, surgeries, etc.?

If you don't believe your own facts, here are some more:

Report on Criteria for the management of waiting lists and waiting times in health care

http://www.coe.int/T/DG3/Health/waitinglistreport_en.asp

NCVol:
I agree wait times are a problem, and we have some issues with that as well in regions, and we have access issues more broadly because of lack of insurance - the uninsured don't GET ON the waiting lists, for example.

And I fully recognize, said so in a couple of ways, that Obamacare will bring a shortage of doctors.  What I also said was it's because we ration care and any plan that increases access - decreases rationing for the poor - will experience shortages, and the answer isn't to talk about the shortage, but talk about how we FIX the problem that we already have. 

Yes, we do great on waits for profitable elective surgery.  Fine.  It's on the positive side.  There's a lot on the negative side.  We have to weigh all those and make some trade offs because we simply cannot go down the same road - it was disastrous. 

And really, if the GOP wants to end Obamacare, go for it.  Propose a plan, let's evaluate it and if it's better, I'll jump on board.  But they voted on repeal with "nothing" as the genius plan to replace it with, and last plan they proposed that had enough detail to actually be evaluated was found to basically do NOTHING for the uninsured, or access or affordability.  But I'm open, seriously, to other options.  Obamacare is FULL of problems, but so is the status quo and the GOP has talking points or "nothing" as their alternative plan.  Life gets harder when you put facts down that can be fully evaluated, you know, an actual plan.  I think they're learning that now with the budget too.  It's easy to talk about cutting $100 billion, much harder to actually CUT $100 billlion. 

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