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Health care costs ...Too much GOVT is the problem.
invite response
2012 Dec 16, 4:24am 30,083 views 91 comments
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cost of undergraduate + about 200-300K in medical school tuition + living costs.
Other factors not considered here is the loss of earning potential since it can take 7-12 years of training before you can actually start working and earning money.
I don't understand the your math. Look at the chart. Out of 144 medical schools there are 30 are under 10k a year, 60 are under 20k, 103 are under 40k. Only 10 are over 50k, the highest is 60k. How do you come up with 200-300k a year medical school tuition? Even if everyone paid out of state tuition (most don't) it doesn't come up anywhere near that.
You have living costs no matter what. If you go to grad school (pretty much de rigour since a masters is now what a bachelors used to be) you have living expenses and loss of earning potential for 6 years of school.
Yes, it's expensive to become a doctor. It's expensive to become a doctor in many countries. But part the expense is undergrad which everyone needs any more (why you need a bachelors degree for most jobs is a different debate). A very, very small percentage are spending 500k and those that do usually have a reason. People aren't going to Harvard and Yale to look at kids runny noses and infected ears all day for a living. You can go to Texas Tech for that. The schools with prestigious reputations and prices are graduating people to be leaders in the field like high powered researchers or heads of departments.
The US system is 2 years longer than everyone else, but that's undergrad. Most of the first 2 years of college is "core requirements" like philosophy, history, and English composition which have no relevance to being a doctor. The British system doesn't bother with that bs which is why it takes 6 years everywhere else. Other countries figure that if doctors want to learn philosophy and history then they can do it on their own time rather than using up expensive education resources. There are 6 year programs in the US that are 2 years including summers of accelerated undergrad courses skipping the core curriculum crap then 4 years of medical school.
David Losh
2012 Dec 23, 4:28am
How do you come up with 200-300k a year medical school tuition?
That would be a total cost of medical school.
David Losh
2012 Dec 31, 7:22am
"Most" hospitals/private clinics are open 8 am to 9 pm ( including weekends)...just like all other stores.
So, what does that cost?
Doctors in India, or doctors from India, are brilliant and they are everywhere. What makes them so different?
David Losh
2012 Dec 31, 9:33am
Have you ever actually travelled in the third world?
Yes, I have, extensively. Students work to get through school, and some work in the hospital. Others are brought into the hospital to assist.
As far as the cost of medical school, it's expensive, long, and runs up huge debt. Opening a practice runs up huge debt, and that 2 years of philosophy are ususally business classes, because a doctor's going to need that.
I have long advocated for open borders for doctors, and government grants for students who have an aptitude for medicine. We would be dollars ahead.
David Losh
2012 Dec 31, 9:37am
The day Govt mandated emergency services to general public , it created a huge sink hole in the system.
Emergency room services are twice the price of our over inflated health care costs. The emergency room is no bargain for any one.
The emergency room treatment, and triage were mandated because of health care rationing that put many homeless in life or death situations. The emergency room is so we don't have people dying in the street.
The emergency room is a profit machine when it is well run, and many are.
I don't understand the your math. Look at the chart. Out of 144 medical schools there are 30 are under 10k a year, 60 are under 20k, 103 are under 40k. Only 10 are over 50k, the highest is 60k. How do you come up with 200-300k a year medical school tuition? Even if everyone paid out of state tuition (most don't) it doesn't come up anywhere near that.
Many are out of state BTW. You might want to check out these stats as these are the most accurate. I dont know where you get your info. I dont know ANYONE who paid less than 10k.
https://services.aamc.org/tsfreports/report.cfm?select_control=PUB&year_of_study=2013
https://services.aamc.org/tsfreports/report.cfm?select_control=PUB&year_of_study=2013
You have living costs no matter what. If you go to grad school (pretty much de rigour since a masters is now what a bachelors used to be) you have living expenses and loss of earning potential for 6 years of school.
Yup, those are costs, whether you go to med school or any other grad school. Regardless, it is a cost.
Yes, it's expensive to become a doctor. It's expensive to become a doctor in many countries.
In many other countries, this is all subsidized.
People aren't going to Harvard and Yale to look at kids runny noses and infected ears all day for a living. You can go to Texas Tech for that. The schools with prestigious reputations and prices are graduating people to be leaders in the field like high powered researchers or heads of departments.
Do you have any idea what you are talking about? Yes they are. BTW if you knew anything, you wouldnt think that only ivy league grads are in research or administrative positions and people from non-ivy league schools go into clinical practice. THis clearly shows your lack of knowledge in this subject matter.
The US system is 2 years longer than everyone else, but that's undergrad. Most of the first 2 years of college is "core requirements" like philosophy, history, and English composition which have no relevance to being a doctor.
Here are commonly core requirements:
General biology
Physics with lab
General chemistry (inorganic chemistry) with lab
Organic chemistry with lab
Calculus
English
Sociology
Psychology
What do you think is not needed or not relevant to being a doctor?
Many are out of state BTW. You might want to check out these stats as these are the most accurate. I dont know where you get your info. I dont know ANYONE who paid less than 10k.
Ok my numbers are from an out of date source and don't include fees, but the vast majority of the numbers on your chart are mid teens to mid 30's total, all fees included. That's still a far cry from 300k tuition for 4 years. Most people do in state. Entry requirements are about the same state to state so if there's a slot people go in state. Of my wife's medical school class less than 20% were out of state, that's not unusual in a state medical school.
The average debt for doctors is something like 190k last year, including undergrad. It's expensive, very expensive. I wrote the checks to medical school so I certainly know a lot better than you. But it's not anywhere near as expensive as some of the numbers being thrown out. Getting a advanced degree is expensive no matter what it is, which is my entire point that people seem to be missing.
The big expense for doctors that you don't get in any other field is the loss of earning power doing 4-7 years of near minimum wage residency after getting your degree while the interest on student loans piles up.
Do you have any idea what you are talking about? Yes they are. BTW if you knew anything, you wouldnt think that only ivy league grads are in research or administrative positions and people from non-ivy league schools go into clinical practice. THis clearly shows your lack of knowledge in this subject matter.
Where did I say "only" or "all", a large bit of assumption on your part. Most people that do so have a specific reason to go to a very expensive prestigious medical school over a state school. Sometimes it might be as simple as daddy will pay for it and I got in, usually it's a lot more goal orientated than that. They want to be top people and are willing to do whatever it takes. Very, very few Harvard/Stanford/Yale/etc. med grads are gp's for life in place like North Dakota or Kansas or Alabama. Many (a vast over representation based on percentages) become in time (obviously, they build up clinical experience first) top researchers, heads of departments at leading institutions, top level sub specialists, or leading academics who would not have reached their position by going to a podunk U state medical school. If you think this expanded explanation is still an inaccurate depiction of the situation then feel free to use your extensive knowledge of the subject matter to enlighten me.
What do you think is not needed or not relevant to being a doctor?
Core undergraduate courses from my university, University of Texas:
English Comp 2 semesters.
Humanities 2 semesters.
American Government.
American History.
Social Sciences: philosophy, geography, anthropology, etc.
Visual and Performing arts.
Undergraduate Studies. IE how to go to college.
That's almost 2 years of expensive study that is not required anywhere else in the world for people to become doctors. If you don't know how to read and write English you shouldn't be in college to start with. The rest have no relevance to a science degree. You certainly can read up on history or join a local theatre company if you are interested. But requiring spending 2-3 semesters of college on it, why?
Curiosity overwhelms me. What university did you go to that didn't have similar undergraduate requirements?
I wrote the checks to medical school so I certainly know a lot better than you
I actually went to medical school... so no, you do not know better than me.
Getting a advanced degree is expensive no matter what it is, which is my entire point that people seem to be missing.
No i got that point. My only point was that medical school is expensive. I made no comparisons to other advanced degrees.
Where did I say "only" or "all", a large bit of assumption on your part.
You implied it in your statement, otherwise why else would you even state it?
Very, very few Harvard/Stanford/Yale/etc. med grads are gp's for life in place like North Dakota or Kansas or Alabama. Many (a vast over representation based on percentages) become in time (obviously, they build up clinical experience first) top researchers, heads of departments at leading institutions, top level sub specialists, or leading academics who would not have reached their position by going to a podunk U state medical school.
Of course they dont go into GP in ND or Alabama. Why would anyone go to ND or Alabama unless they had some connection there. BUt that is not what you said. You said people who go into research or dept heads come from Harvard/Stanford/Yale. The truth is that a small percentage go into research or academics at all, regardless of where they went to med school. Sure the percentage may be slightly higher but to make a point of this is entirely pointless. BTW, majority of grads from these places end up going into primary care. BTW, you can easily get into academics, research, etc ,etc by going to a "podunk" U state medical school. Most people in medical school do not wish to go that route however if you wanted to, going to a top medical school is NOT necessary at all, as you imply.
What university did you go to that didn't have similar undergraduate requirements?
I listed requirements for medical school. You are listing undergraduate requirements for graduation. Are you not comparing apples to oranges?
I listed requirements for medical school. You are listing undergraduate requirements for graduation. Are you not comparing apples to oranges?
I was comparing why it's 6 years to become a doctor everywhere else compared to 8 years in the US. You have to graduate college to go to medical school so all the subjects are pre med requirements in the US system.
BTW, majority of grads from these places end up going into primary care.
And where to many end up eventually? I'm sure there are some Harvard law grads doing wills and divorce filings also. The biggest reason to go Ivy league is contacts and opportunities. No one going to an Ivy league school, undergrad or advanced degree, is unaware of that. I know plenty, they are very well aware of it. That's why they worked so damn hard to get there in the first place. Many do use it down the road.
Why do you keep putting words in my mouth. "all" "necessary" words never said or implied. No it is not necessary to have an ivy degree degree to become a researcher. But it will be a hell of a lot easier to become a big league highly funded leading edge researcher with one. You can become an Ibanker going to pudunk state, but it's a lot easier and you have a lot better chance with a Williams degree. That's the way the world goes round.
David Losh
2013 Jan 3, 11:21am
Plenty of people go to state schools and state medical schools.
When people talk about how the government can't do anything right, many point to education. You have made a strong argument here that the government does provide quality education, at a reduced cost.
monkframe
2013 Jan 3, 2:04pm
So, my earlier comments were deleted by the worthy who started this thread and can't seem to argue his point: We are dead without government run and/or paid for health care. If you have employer-paid-for health care, bully. The rest of us not only don't, but there are 46 million people in this country without health care, and emergency rooms are not the place for it to start!
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Here is my take on the root cause of Healthcare cost in USA. I am focusing on costs because focusing on redistributing the costs ( which is mainstream media focus) does not fix the problem.
Fact : Healthcare cost is rising significantly faster than inflation in USA.
Reason : Given that health care is not a new industry and such a broad industry, the only reason for this divergence can be that its not a "FREE MARKET". In any free market, a broad established industry's "long term" inflation is always inline with rest of the economy.
Analysis : My whole analysis will be to focus on why its not a "FREE MARKET"
Divergence from free market happens primarily because GOVT comes in between consumer and services/goods provider. Generally, once the GOVT gets involved, a third party will use its lobbying power to influence the industry ( through GOVT) to its own advantage .
1) Insurance (GOVT SUBSIDIES and MANDATES) :
PROBLEM : GOVT + INSURANCE LOBBY:
Govt subsidizes health insurance ( In 1954 Congress codified this practice into the tax code ). This forced people to go through the insurance system because subsidies slowly destroyed cash driven non insurance based payments. NON catastrophic insurance is a flawed system because it makes everybody price insensitive. Since insurance pays the costs and is a pool system, nobody cares what the health industry is charging them.
imagine if insurance pays for your grocery store purchases.We will buy excessively things we don't need and waste everything.The grocery store charges will be excessive as well. There are some market forces at play here though. if the wastage goes up, insurance premium goes up and we chooses an insurance which has less premium.This creates motivation for insurance company to control costs.
But this cost control mechanism is not as efficient as free market though. its akin to soviet style centralized system versus free market capitalist system to control costs. insurance itself is a in-efficient system and should only be used for protection against catastrophic events where it serves an important function.In a free market , hospitals strive to have good reputation and offer services for low prices to attract consumers. The latter part is definitely not happening because the consumer is not price sensitive
Cosmetic surgery does not have insurance system and you can see the difference between regular industry versus cosmetic industry. The advancements in cosmetic surgery are at par with other areas of medical fields but at reduced cost because market forces are at work.
SAME WITH LASIK which is not covered in insurance.
2) GOVT PROTECTED Licensing of doctors and nurses and PROTECTIONISM:
PROBLEM = GOVT + DOCTORS/NURSES/DRUG lobby :
Licensing Doctors means that doctors need the permission of govt to provide their services. This system was not a big issue long time back when there was no globalization. As globalization started, most of the goods and services started to get cheap. Goods got cheaper because of stuff getting manufactured in foreign countries and services got cheap due to immigrants filling lot of positions. Most of the farm jobs were taken by farm labor from mexico. Engineering jobs were primarily filled with immigrants as well. This phenomenon didn't happen in medical field but only happened in field where there is no licensing needed for services ( like farming, engineering , restaurants..etc). Licensing enables protectionism. Since most of the functions of medical field are licensed including doctors, nurses and hospitals, they are protected from globalization and competition from foreign doctors/nurses who want to practice in US. This disparity caused medical field to look more expensive RELATIVE to the other fields. In essence the US consumer is not getting the benefit of cheap international labor in medicine . This probably is not the complete story and i am guessing more components of the medical bill are protected from market forces like prescription drugs..etc.
Licensing also forces some arbitrary body to decide what kind of service providers the consumer needs.If it were a free market, the market will decide what kind of training the doctors need to satisfy the demand.The salaries will also be based on the market prices. If the society is not rich , it will decide to go for doctors who are trained cheaper ( like in India). ofcourse, the quality will be lower but that's what the society can afford and is most effective. people who can afford higher quality will choose a doctor with more training. Its a self correcting system. in car industry, some consumers buy honda civics and some consumers buy a Porsche.IF govt mandates that people only buy cars with standards of porshe, most consumers will have to take public transportation because they cannot buy civic and cannot afford Porshe. Current licensing system forces a over trained doctor down the throat of consumers. actually a third party licensing body would never be able to decide what training is most effective to consumers just like soviet style centralized planning could never decide what products are needed by citizens. Free market is the answer.
Certification is better than licensing as it informs the consumer of the choices but does not force a particular choice. Hospitals will always choose the doctors with the right certification for the right job without being dictated by a licensing body. this will drive down prices.hospitals will also vet the doctors to save hospitals reputation.
from wikipedia http://en.wikipedia.org/wiki/Health_care_in_the_United_States#Licensing_of_providers: "American Medical Association (AMA) has lobbied the government to highly limit physician education since 1910, currently at 100,000 doctors per year,[111] which has led to a shortage of doctors[112] and physicians' wages in the U.S. are double those in the Europe, which is a major reason for the more expensive health care.[113]"
113: http://reason.com/archives/2009/08/27/the-evil-mongering-of-the-amer
3) Mandating Emergency services (GOVT MANDATES) :
PROBLEM : GOVT + FREE LOADERS - Vote bank:
The day Govt mandated emergency services to general public , it created a huge sink hole in the system. Mandating hospitals to perform any services to general public irrespective of their ability to pay means in essence they are forcing some people to pay for other peoples expenses. When a hospital is performing a emergency service and the consumer does not pay it, the hospital passes on the expenses to other people. Anytime you create a system where the consumer does not have to pay himself , he becomes price insensitive and this creates lots of waste. Most countries don't have this kind of mandates. Also this creates incentive for too many people coming to emergency services instead of getting care early on which could have reduced the overall medical cost for the society.
In the absence of Govt mandate, new charity based hospitals ( partially funded by govt or private) will pop up ( like pre insurance period of 1930's) and give some form of cushion to the most needy.
MANDATING ONE PERSON TO PAY FOR ANOTHER PERSON'S EXPENSES IS NEVER A GOOD IDEA. Be it through insurance mandates, court system ( malpractice litigation expenses) or hospitals ( mandating emergency services)
4)Medical Malpractice insurance costs (GOVT forcing other people to pay a litigation winner -through malpractice insurance ):
PROBLEM : GOVT + LAWYERS LOBBY :
Giving Patients the option to Waive certain Rights to Sue for Medical Malpractice for certain services is important to address this issue. Since Medicine is not an exact science and involves considerable risk, GOVT cannot force everybody to pay for the costs of not being perfect. In essence the GOVT through their court system is forcing doctors to work overtime to make a service more risk free than its possible. after certain point there are diminishing returns in trying to reduce risk.I have heard stories that some doctors spend more time filling paperwork/unnecessary expensive tests than actually treating patients. There is some inherent risk in certain services and patients should have the option of allowing the doctors to take the risk so that the patient can get the service from doctor at reduced cost. of course driving a car involves risk but that does not mean we force all the car manufactures to design risk free cars. even if its designed, it will be unaffordable by many consumers. Another aspect of the medical malpractice is the money awarded by the courts.
The primary focus of the court system should be to create incentive for the hospitals to reduce recklessness and malpractice which can be accomplished by other punitive measures rather than awarding large sums of money to patients. example: you can suspend a doctor from practicing if he does some fraud/malpractice rather than award 1 million dollar to the patient ! The focus should be to reduce fraud not make the attorney's rich.ofcourse the money awarded should be reasonable so that attorneys are motivated to take the case but it should not be ridiculous amounts since we all have to bear the cost.
AT THE END OF THE DAY EVERYBODY IS RIPPING OFF HARDWORKING MIDDLECLASS-INSURANCE-PAYING AMERICANS.
SOLUTION WHICH WILL WORK : FREE MARKET PRIVATE HEALTH CARE SYSTEM for the majority and GOVT OR CHARITY RUN HOSPITALS FOR THE POOR AND NEEDY.