patrick.net

I hate it when I start rewriting a sentence, and then do not quite finish. It makes for odd sentences.

EBGuy Says:
April 28th, 2009 at 5:15 pm
I’m not sure that the AMA can control numbers of graduates, specialisation college places, etc
Why don’t come over here and try to practice, DS. An extremely onerous process to become licensed (to protect the patient, of course, not to “limit competition”).

Does the AMA set those conditions? Or another licensing body? I thought there was one licensing body per state. One Dr Patel aka 'Dr Death' was barred from practising in NY and Oregon (only) recently after killing a few patients in Oz...

Apparently Oz graduates 2,000 drs a year, and has to import another 4,000 from overseas! Every year. Go figure...

sybrib Says:
April 28th, 2009 at 10:39 pm
When I was in college during the Cold War, I met two medical students who the Navy was putting through medical school.

I wonder if the Navy still has that kind of a program.

The Australian Defence Force has a tri-service scholarship scheme like this, where they will pay for n-1 years of an undergrad med course or all 4 years of a graduate one -- salary, textbooks, fees, and maybe a few other perks. Nice gig to get. Your ROSO is n+1 years of their assistance, plus 2 years internship in the civilian system as an officer after graduation. So can vary from 7-13 years all up depending. Army, Navy or Air Force.

About the Medical Board of California

The mission of the Medical Board of California is to protect health care consumers through the proper licensing and regulation of physicians and surgeons and certain allied health care professions and through the vigorous, objective enforcement of the Medical Practice Act, and, to promote access to quality medical care through the Board's licensing and regulatory functions.

http://www.medbd.ca.gov/board/Index.html

Just sos youse all know - yes, I'm looking at you, EBGuy.

I am a doctor, and I don't play one on TV.

American medicine has become schizophrenic. It is a rigidly controlled and regulated and yet no one can truly regulate or control it. Cash "customers" pay the highest rates(!) Insurance adjusters with a high-school education (or less) determine medical care using a preprinted algorithm. I could go on and on.

Doctors don't like it. Patients don't like it. So why not change? Because I think we all fear that if the government took over health care there'd be a trail of dead bodies in the streets. Let's face it, do you really want your health care totally controlled by the same people who run the Post Office?

Let me correct some prior postings. The AMA does not determine how many doctors are graduated. (I'm not and never have been a member of the AMA.) And that New England Journal of Communism (I meant Medicine) article -- pure left-wing BS from a once honored journal. Fact is, their 1995 projection of a surplus of specialists has become, in the real world of 2009, a worsening deficit of specialists. A deficit of doctors all around. So the force that actually DOES controls the number of doctors, the funding of the Federal Government, is now markedly increasing the number of medical students.

The forces that actually DO control the number of specialists, the specialty Boards, probably do limit their numbers to keep reimbursements high -- but who knows, since they are all self-selected and secretive.

One huge misuse of medical spending is on defensive medicine. Of course, all the lawyers are saying: "What? Outrageous! Take that back or I'll sue you. We have studies that show only 1 or 2% of medical spending goes towards defensive medicine." BS. I have ownership in an MRI unit. Probably 40% of the tests ordered are done "just to make sure we don't find anything dangerous". Notice I did not say the tests were "unnecessary". They are very necessary under our present laws -- to protect the doctor. If the doctor didn't do the test, he vastly increases his likelihood of being sued. The entire system is rife with these expenses for defensive tests and procedures. I should know, and I do.

Some of the posters have correctly pointed out that a large portion of expenses are incurred in the last 6 months of life. Then there are posters questioning pacemakers for 90 year olds, and expensive chemotherapy for terminal cancer patients. OK -- so the solution is to have a Federal bureaucracy with an algorithm telling doctors who should live and who should die? I think we've already seen this: was it Nazi Germany or the Soviet Union? I forget. But not places I'd want to live (or die!). When you walk down this road of "economic credentialing" you better watch out for the land mines.

You really want to save money fast? Then change the malpractice laws, stop giving free ER care to anyone who shows up, get rid of Medicare and Medicaid (and let doctors deduct discounted or free care from their taxes -- they'd line up to do it), allow cross-border medication purchases by pharmacies, and (just once in a while) thank your doctor for putting up with all this nonsense.

Wow -- I feel better already.

DesertDoc Says:
April 29th, 2009 at 12:49 am
You really want to save money fast? Then change the malpractice laws, stop giving free ER care to anyone who shows up, get rid of Medicare and Medicaid (and let doctors deduct discounted or free care from their taxes — they’d line up to do it), allow cross-border medication purchases by pharmacies, and (just once in a while) thank your doctor for putting up with all this nonsense.

All the other countries just socialised their medicine at half the cost per capita of the current US system and provide a universal healthcare guarantee to boot... effectively they've extended Medicare and Medicaid to the entire population.

Doctors' salaries in Oz are lower than US, but I believe UK salaries are comparable -- although with an NHS and socialised medicine.

Single payer has much lower admin costs per item and is more efficient.

Cross-border purchases are required simply because big pharma has the US citizenry by the proverbials. Oz manages to negotiate even cheaper drug prices than Canada through the PBS, somehow. They require that a new drug is proven to be more effective than an existing drug to pay any more than the old price. If big pharma want to sell any product into Oz, they have to play by the rules and adjust their prices. Canada also negotiates tougher prices (obviously). The culprits re US pharma pricing are prolly corrupt Congressmen passing laws favouring big pharma with either personal kickbacks or political donations, from what I've heard -- bit hard to address this problem with the current setup...

OO,

Well said across the board. Most doctors -are- over trained! Their reliance on 'tests' borders on maniacal. Dude, make the call, o.k?

Actually one of our long time posters ( SFWoman ) shared that the "end of life" expenditures are even -more- dramatic. I believe those costs are actually compressed into the last 90 days of one's life?

NOW... if they could give us that 90 days at an -earlier- time of our lives, well... then it might be worth it? But when the nurse comes by twice a day to wheel you into the sun like a potted plant..? No f@cking thanks!

If we let the 90 yr olds die, can we also let the 30 yr old lazy, uninsured, good for nothing couch potato's die along with them please???

A note from an Israeli here:

The Israeli system is halfway between the Canadian and the US (not sure how it compares to the UK or Oz):

There is good universal healthcare that covers mostly everything, which is paid for by a 5% income tax (unlike general income tax, which is progressive, "medical insurance tax" is a constant at 5%, and it does cover the unemployed as well even though they don't pay it). Copay toggles between $2 /quarter and nothing depending on a random dice roll made by the minister of health. (that is, if you used services this quarter, you pay $2, otherwise you don't)

The system is NOT single player -- there are 3 big players and possibly one or two smaller ones I'm not aware of. There is active competition between the players, to everyone's benefit. Everyone must register with a player, and they get their money from the state accordingly. (The bureaucracy behind this is surprisingly efficient).

A government committee comprised of 2 politicians and something like 8 doctors (some affiliated, but most unaffiliated with any player) determines what the players MUST cover freely, what they can charge more money for and how much money. Furthermore, this committee determines which non essential treatments and medicine are subsidized (basically, all life saving is subsidized).

The players make their money by offering additional services. E.g., I pay $20/month more to my HMO to get coverage that includes any non-referral 3 specialist visits I choose every year (That is, if my primary care physician doesn't think I should see a specialist but I want to, that's 75% covered up to 3 times a year; Specialists can charge $200/hour). They offer many other additional services.

All emergency room visits with referral are covered. All emergency room visits without referral that were justified in retrospect are covered.

Private medicine is alive and well -- if you want to see a specialist and willing to pay for it, they will be happy to accept you. But everyone gets a good level of medicine for free (as much as you can call 5% tax "free").

I've heard people in the US saying "Oh, I'll only see a doctor if this gets worse because the cost is prohibitive". I've never heard an Israeli say that. Furthermore, when I need to, I prefer to go the $15/visit copay and come at the time I want to (usually 10pm, no waiting lines whatsoever) because I can afford to and waiting an hour in the middle of the day costs me more than that -- but most people use the $2/quarter copay.

Drug companies in Israel do not have the political power they have in the US, and neither do the HMOs; In fact, as far as I know, Teva -- the largest Israeli drug company, and the worlds largest generic drug manufacturer -- has more influence on US policy than it does on Israeli policy.

State managed does not necessarily mean single player, and there are numerous examples around the world in which it actually works.

There could be lot of instances where single payer or some other version of it could work provided the people managing would look out for the little guy and keep the system efficient. I am not that optimistic about it working here, the lobbies are way too powerful and they always get it their way.

"[the insurance bureaucracy] give employees bonuses for how much coverage they [sic] deny to you."

Citation, please. This is the stupidest thing I've read on your blog yet.

For an interview with insurance company employees who get bonuses depending on how much coverage they deny, see the movie "Sicko" by Michael Moore.

The Israeli system sounds pretty good.

Just sos youse all know - yes, I’m looking at you, EBGuy.
DS, Let's put it this way, I was in the room with two female doctors in a social situation. One educated and licensed in California, the other, educated in Europe and trying to become licensed in California. The practicing doctor personally apologized about the US system and how onerous it was for foreigners educated and licensed abroad to become licensed in California.

DesertDoc,

>> Cash “customers” pay the highest rates(!)

This is what I've been saying. The main reason I have insurance is to get the negotiated rates.

>> Get rid of Medicare and Medicaid (and let doctors deduct discounted or free care from their taxes

I see no real difference between getting paid from taxes to provide care, versus avoiding paying taxes on other income by providing discounted/free care.

However, the latter has the negative effect of creating a tax lloophole: Charge high nominal rates and then "discount" them to create tax avoidance for the medical profession. Not a good idea in my book.

>>You really want to save money fast? Then change the malpractice laws, ...

In California there is a 2 year statute of limitations on malpractice suits. Seems more than reasonable to me.

But what is the percentage of healthcare costs that goes towards malpractice costs? And WHY? I could not find a number. There is a good article in Wikipedia, though.

http://en.wikipedia.org/wiki/Medical_malpractice

It appears that lots of cases have merit, from the stats indicated there.

I work as a Lead Sr Financial Analyst at the largest HMO in California. And I can tell you exactly what is raising costs and why a single payer system would be a disaster.

First off Health Care right now is a beauracratic system. It is almost guaranteed continued revenue because everyone needs to go to a hospital. Much like the government where they are guaranteed funding. With this very little desire to make operations efficient exists.

Secondly hospitals are extremely unionized. Most staff never get fired even for gross incompetence and poor performance. The only person that has ever been fired here, in the three years I have worked here, was for a HIPPA violation. Also pretty much everyone who is not a receptionist or a medical asst makes $70k and up. If you have an AA degree in respiratory therapy or radiology technology $100k. And again you will not get fired even for getting into a fist fight infront of patients (this has happened). I constantly hear from the managers I deal with how they can't get rid of their worst performers.

Thirdly my boss, the associate controller at the medical center I work with, has a grandmother in England who has heart problems. He constantly has first hand experience with the single payer system there and its complete ineffeciency. Would he ever suggest going to this system. Heck no!

More competition and less unionization is the way to get health care costs down. Right now Nursing unions have set into their contracts 5% increases for the next 6 years! This when all of the other non-union staff has either had either a pay freeze or a tiny increase. Keep in mind that the average RN makes well over $110/yr. After 5 years that's $147k. And you wonder why health care costs are rising.

Guaranteed funding to the health care system by the government is ridiculous. More competition like any thing else, is the only solution to bringing down costs.

"Taxes will go up, but insurance premiums will go away. Probably a net win. Works pretty well in Canada, Europe, Japan."

sorry but my health insurance premium is currently $0. i chose not to have health insurance. as a citizen living in a free society it is my right to decide whether i want to spend money on health care or not. telling me i must have health care and must pay for it via increased taxes is a form of oppression. why do so few people realize this? and dont try and tell me i should have insurance and i'm foolish to not. thats laregly besides the point and again is asserting that i am not free to make such decisions for myself.

"For an interview with insurance company employees who get bonuses depending on how much coverage they deny, see the movie “Sicko” by Michael Moore."

ha ha ha ha

Given Moore's reputation for, uhh, "creative editing," (see Roger & Me and everything he's done since), I'll pass on wasting my time with Sicko. You're saying that your source is Michael Moore. Seriously? You couldn't even find a journalist?

moonmac,

I don't even charge for that! No probalo.

Just yesterday I was returning some cans for the deposit ( which NO one else in my family has -ever- done ) and there were these 3 "emo" guys really making a day of it? I stood there ( somewhat annoyed ) as each-and-every movement they made was exaggerated to the 'nth degree and the one kid ( w/ mismatched sneakers ) finally... finishes.

So ( like you didn't know what was coming? ) his butt-buddy starts feeding cans over into his shopping cart, and I mean these things are crumpled and nasty... Anyway way I say "Huh uh dude, you're done!" Predictably he launches into a windy explanation as to why their egregious behavior is perfectly "acceptable" and I completely shut him down. "You're DONE!" More objections ensue. "You're DONE!" Grab your receipt and pack it in.

"It's not OUR fault we have bottles and cans to bring back!?" (Ever the victim)

"OUR"? What, are you guys "goin' steady"? You're done. Huffs off in protest. So just keep in mind, -whatever- Health Care System we elect, this is what's coming behind you to 'support' it! Btw, it's usually like this every time.

The Israeli system works reasonably well. It's not perfect, but it seems to avoid the worst of both single-player (uk and canada) and totally-for-profit (us) systems.

And to make a comparison more meaningful:
Average Israeli yearly salary is $20K (median is very different)
Minimum yearly wage for full-time employee is $10K
All income taxes (medical insurance tax, social security, income) get paid by the employer before the employee sees a penny.
Lowest tax bracket is 20% (5% medical + 5% social security + 10% IRS), which is for 0-$12K
Highest tax bracket is 56% (5% medical + 5% social + 46% IRS), which is for earnings above $100K.

In general, products are expensive (e.g., food costs about 50% higher) but services are cheap (university tuition is $2500/year in a state university, and $5000/year in a private university; most people study in a state university).

All of you people in favor of national health care need to carefully think about how the system REALLY works in Canada, Great Britain, and the rest of Europe. There are many, many horror stories. Do your duty as a citizen, take off your partisan blinders, and look at both sides of the issue. Don't just accept statistics thrown out by partisan sources. The issue is just not as simple as "have the government pay for everything." The money has to come from somewhere and there will be unintended consequences.

I'm not saying that nationalized health care is all bad. I can tell you that the health care system in Austria, has some good points, but boy, it has some bad points as well. Costs are controlled by rationing, period.

Oh, and to the person endorsing free tuition. Austria tried that too. Even the socialists there had to admit it was a failure. Students stayed in school for seven and eight years taking one or two classes per semester. Great system.

Australia lets students go on the dole right out of college. The result? Two years of sitting on the beach at taxpayer expense for thousands of students.

But I digress...

I'm with a small company and routinely employ men in their 20's. None of theme have health insurance. They could buy it for $75 per month or less, but don't bother. They sure as hell spend plenty of money on other things, I can tell you that. Is this my problem as a taxpayer?

Given that the U.S. does not have a single entitlement program that is under control, what reason do I have to believe that a medical entitlement system will be any different?

The ridiculous argument I hate the most is that preventive medicine will lower health care costs. Nothing could be further from the truth. Death from a heart attack at 55 is cheap. Three bypasses and several years in a nursing home in the ensuing 30 years are expensive. Morally, the question is more complicated, but mathematically, it's simple.

Our system has problems, that I freely admit, but let's not blindly hope for some miracle cure and end up throwing the baby out with the bath water.

Eliminating personal responsibility from almost any aspect of society is a dehumanizing mistake. Health care is no exception. This will sound awful, but here it is anyway: Stand at the entrance of a Wal-Mart for 20 minutes and tell me how much those people care about their health? How much effort do they spend taking care of themselves and their families? Now, tell me that you want to pay for their health care without making them suffer the consequences of their own actions.

Patrick seems to have lost his free market chops when it comes to paying his doctor's bill. Take it from me, watching people who can't pay their doctor's bill is as much fun as watching people who can't pay their mortgage. Losers.

There's no free market in medical care anyway. You shop around when you're bleeding?

Not that I would deny anyone the right to choose doctors or pay for private insurance. Only that our current system is _worse_ than a single-payer system.

"....pb3030 Says: All of you people in favor of national health care need to carefully think about how the system REALLY works in Canada, Great Britain, and the rest of Europe. There are many, many horror stories."

Wow. OK, how about health car rationed by insurance companies and poverty. Horrible enough? Well, then there's the old one of people turned away from emergency rooms because they didn't have insurance.

Look, the bottom line is, almost every other advanced country in the world somehow manages to provide national health care. Are you telling me that the USA is somehow too stupid or too poor to afford this?

Yes, single-payer health care is not a panacea. There is none. It's just better than the greedhead, unregulated every-man-for-himself free-for-all that we've got now.

Does anyone have examples of what they pay for insurance?

I am under Tricare so I only pay $114 per quarter. So far I have paid nothing out of pocket for daughters birth (including sonograms), 2 colonoscopies (ancestor med history had me get probed much earlier than normal), any meds, annual physicals (including MRIs) and lots of blood labwork. I am in very good health, I can't imagine what they put a sick fellow through.

My English Grandma bought trip medical insurance before coming to USA for a visit. She cought pneumonia on the flight and ended up in the hospital for a week. No out of pocket expence for her private room, meds, and care.

My mom was in a nasty car wreck last year that broke some ribs. She had a private room in a local hospital for a few days, hooked up to what reminds me of the Star Trek sick bay instrumentation, where a screen shows heartbeat, ph0 and a few other visual graphs. Ambulance trip was paid by county, emergency treatment was covered, and medicare paid for
the remaining treatment.

I paid medical insurance for my nephew up until a few months ago. The cost was $238/mo.

Even if we do not get a NHS style coverage, I wonder how many Americans could accomplish the same by choosing a less expensive house and/or more practical car and use the savings to buy insurance. Emergency room care is already free.

Headset,

We pay around $200 a month for (2) empty-nesters ( 46 and 50 y.o ) in decent health. BC/BS thru wife's emp.

Our problem is that we'd be better off going w/ LifeWise and just getting a catastrophic policy and recoup premiums off of Sched. C but it's difficult for people that have always been on an emp. based system to "just let go".

I'll be on Tricare @ 60 but I'm sure it will be different by then.

I pay around $500/month for wife and kid. Our premiums are little higher than that, our employer is covering that amount right now. My insurance is covered by employer. My wife started work around 6 months back and she started to get coverage from her work. They didn't do her paper work correctly and she only got her paper work a month back. Weird thing is, they put effective date as 2 months back. I go to my HR to cancel my wife's insurance and they ask for document of her coverage from her work initiated in last 30 days. Now, I got to wait till june for the changes.

No wonder, i love this system so much.

An example of medical costs: Trip to primary doctor, think only 15 min. May have gotten billed for 30min because we covered two topics? Got a referral and some advice.

Billing description:

Ov Est PT Level 4 Joe The Doctor MD $255.00
I paid 10.00, insurance the rest.
(California.)

MeanGreen, I can agree that nurses are overpaid, again using teachers as the yard stick.

Headset, my insurance is $431/month (this is the full cost) for one person, as of May. This is an HMO with the 10/10/100 copay/prescription/ER structure.

DinOr, sa, justme,

Those costs sound reasonable. Did you ever have trouble getting the care you needed? Long lines? Good quality?

justme says:

Got a referral and some advice

It took willpower for me not to take advantage of a straight line like that. Just think of the quips that would apply! I am sure everyone here can come up with a good one.

Headset,

I really wish I 'could' respond to that? It's a constantly moving target. Of late we're paying on an 80/20 and the deductible is $500 per person per year. The... copays vary depending on whether the HC providers are in or "out" of Network and we have to regularly end relationships if they are dropped or the company changes the insurance provider.

We 'were' w/ CIGNA forever. Then they decided to go w/ BC/BS and you start to wonder if these changes aren't made to keep people off balance? By keeping the shell game it's almost impossible to plan ahead. IMHO.

Headset.

I must be dense, I do not see the potential for quips. Enlighten me.

DinOr,

I presume that you can plan a yearly physical, get care for any sudden illness, and get meds like the high dose niacin they push on anyone over 50. Just that you can never can determine in advance what the costs will be? Or perhaps where to go for treatment?

justme,

I doubt that you are dense, just politically misguided. :-)

Perhaps I am a bit sophomoric, and assumed others were as well. When you write of a doctor giving "referral" and "advice," the quip that immediately comes to mind is:

Referred to the local "clinic" and advised to wear a condom next time.

Like the fellow who has something to say to a group that is gathering up to leave an event. The fellow blurts out "Mine's real short" in an effort to get the group to pause an listen. Of course that line also evokes an obvious quip, along the line of "Your poor wife!" Nothing mean or personal, just taking advantage of an opportunity.

Bingo! Patrick, the real problem is limited supply! Government license requirement in cahoots with AMA! If anyone and everyone is allowed to practice medicine, prices will come down.

The 31% administrative cost is peanuts when compared to the 87% administrative cost in government-run single-payer welfare. Only 13 cents out of every dollar allocated to welfare budget actually reach the intended recipient. What residual competition there is among insurance companies and among hospitals (for those who pay their own bills, especially for things like dentistry, which is usually not covered in most plans now) is what's keeping administrative cost down to 31%. Without competition, an industry would be almost entirely taken up by administrative cost, just like government-run single-payer welfare industry. Comes to think of it, under a single-payer medical system, medicine will indeed be like welfare: from each according to ability (i.e. tax on ability to earn), to each according to need . . . i.e. the presumption of perfect knowledge in resource distribution without any cost associated with acquiring such knowledge. In real life, every single piece of knowledge on where resource is most urgently needed comes at a cost; market price signals are what transmit those pieces of knowledge.

If you want to see how much health insurance will cost you, go to http://www.ehealthinsurance.com/ Just enter your gender, zip code and birth date.

Health insurance is relatively affordable here in CA, but really expensive in NY , NJ and MA because of guaranteed issue.

1. The health care system of a nation is a product of its culture. Imagine the case of two hypothetical countries:

Country A
- People are health conscious and try to take good care of themselves.
- People don't like going to the doctor unless they have to.
- People do not see prolonging life at all costs to always be the best decision.
- People are willing to pay out-of-pocket for visits to their doctor to take care of minor health problems.
- People do not consider the co-existence of a private and a public health care system to be unfair.

vs.

Country B
- People are not as health conscious.
- People go to their doctor for every little problem and expect to be cured.
- People regard prolonging life at all costs to be an inalienable right.
- People see health care as an entitlement and want it to be 'free' or provided at a low cost that may not be realistic.
- People see a two-tiered private/public health care system as a product of class discrimination.

It would not be unreasonable to conclude that Country A would likely have a health care system with lower overall cost.

2. People will pay for what they consider worthwhile.
Consider the amount of money that people are willing to pay out-of-pocket to have beautiful teeth, bigger boobs, smoother skin, etc., not to mention McMansions, granite counter tops, SUV's and big screen TV's.

3. One size cannot fit all.
As a Canadian, I have access to essentially free 'universal' health care at the following costs:
- Big Brother keeps over half of what I make
- Mediocre health services due to chronic underfunding and bureaucratic waste and inefficiency
- A lack of choice - If I wanted and was willing to pay for better service or essential service that was not available where I live, I would have to look for it in another country. Note that this could be a matter of life and death.
- Long wait times because of inefficiency and a lack of incentive for health care personnel to work hard, thanks to the pervasive union mentality. I like Michael Moore's films in general but I can tell you that his depiction of the Canadian system in Sicko is biased.

4. The pragmatic system
- Coexistence of an appropriately regulated private, for profit system and a public health network
- Allow free market mechanics to work to lower costs (for those who argue that this has not worked in the US, note that it is the corrupt political system and crony capitalism that is in the way of a truly free market)
- Encourage citizens to utilize the private system, especially for primary health care and elective procedures
- Encourage citizens to save up for their health care needs through tax incentives, etc.
- Use the public health network as the system of last resort so nobody dies on the street and that the poor will have access to basic care (think soup kitchen - it keeps people alive but ain't no five star gourmet buffet)

5. Two guiding principles
- Let (force) people to make the best choice for themselves but also make them suffer the consequences of their unwise choices
- If you want to be a chooser, make every effort not to become a beggar

It's interesting to compare and contrast systems internationally, so I'll post thoughts as they occur to me.

I don't think it's necessarily 'single payer' that's the solution to high healthcare costs, altho just about every single payer country costs about half of the US system per capita, according to one analysis I've seen. It's probably also worth separating the primary care MD visit/script/pharmacy experience vs going into hospital or outpatients as 2 very different sorts of cost bases.

US medical salaries seem quite high, most nurses in Oz are paid $50-70K only (which has roughly equivalent buying power domestically to USD), and there are very few NPs, almost non-existent, so there's no career path there for nurses, and PAs don't exist at all. Many nurses have to work nights just for the shift penalty loading of say 10% to make ends meet. No wonder it's one of the most abandoned careers going in this country.

Drs in hospitals in their intern years are on a $45K p.a. salary, and choose to work 16 hour shifts to compensate for it!

GPs that I've quizzed only make $70-90K in private practice generally after overheads are paid. The govt rebate for a 10 minute consultation is not very high, compared with that $255 bill above -- I think it's about $30 only, and many practices do not charge patients any more than that (a potential 'gap' amount). That means if they can manage 6 patients an hour, shovelling them through, that GP is grossing only $180 per hour, out of which they have to pay receptionists, their own superannuation, practice overheads and ongoing training, etc. Hence why they end up with $80K a year or similar.

Even top surgeons make no more than $300K p.a. in this country which is a very comfortable living but nowhere near US pay rates. And it takes many years of specialisation study and some pretty expensive exams to qualify.

There is an extra tax in Oz called the 'Medicare levy' which is an extra 1.5% of income at tax time -- this was added a while back once pollies realised they really couldn't continue to pay out of general income tax revenue. There was some stuff (tax changes) in the last govt to encourage movement to private health insurers a la the US model, but it's been mostly a failure, and the govt actually paid 1/3 of the premium to encourage people to join! and put in some penalties for not joining. The new Labor govt may well undo a lot of it tho.

In terms of 'free market' approaches and alternatives, I understand NSW Health (responsible for the running of public hospitals at a state level) is really over-administered and micro-managed by too many bureaucrats, but I could suggest a number of models to try to deal with that -- particularly selective outsourcing of functions to the private sector to manage staffing etc. This would not change the 'single payer' model at the Federal level at all though, simply improve the running of hospitals. I happen to work for a company that specialises in taking on outsourced govt contracts of any type at all, and it's very clear to me efficiencies can be made without absolving govt of accountability and responsibility. So reported 'inefficiency' in such systems does not mean the death knell of single payer or a guarantee of universal health care -- it just means some of the bureacratic bloat could be dealt with one way or another. All the state govts here are now meant to be broke as a result of the GFC and reduced revenues, and I know they are looking increasingly to cheaper outsourced options as a solution to their woes.