patrick.net

Ok, the next time you need a bypass surgery, I want to see you get one done by someone who’s never finished high school. Yeah right, you’re probably the type that will DEMAND that you get your surgery by no other than someone at UCSF or Stanford! ARE YOU A MORON...don't you understand that given a choice , i would prefer a good doctor from UCSF for my bypass surgery..most people will.ALL i am saying is that there should be FREEDOM OF CHOICE.BTW, i believe you are the type of person who takes appointment with the ENT surgeon for a flu ( which i wouldn't)

hanskung23 is completely correct that even with the strict standards, there are some really really bad doctors out there so opening the flood gates will make things even worse. And I also know a bunch of people who just barely didn't get in that absolutely do not have the intelligence and moral character to take care of another human being, let alone an animal. But I disagree that most go into medicine for the money. I certainly did not. I was considering going into investment banking, which most of my college friends did and many have already retired after making literally tens, and some hundreds of millions. But one only has one life and I didn't want to devote my life just to making money. Money in medicine is good(I'm sure that I'm not making the $$ like Mr. Rad Onc-some make millions a year), but most, like myself, want to feel that helping others is a worthy goal.

DT says

hanskung23 is completely correct that even with the strict standards, there are some really really bad doctors out there so opening the flood gates will make things even worse. And I also know a bunch of people who just barely didn’t get in that absolutely do not have the intelligence and moral character to take care of another human being, let alone an animal. But I disagree that most go into medicine for the money. I certainly did not. I was considering going into investment banking, which most of my college friends did and many have already retired after making literally tens, and some hundreds of millions. But one only has one life and I didn’t want to devote my life just to making money. Money in medicine is good(I’m sure that I’m not making the $$ like Mr. Rad Onc-some make millions a year), but most, like myself, want to feel that helping others is a worthy goal.

Agree.

homeowner_for ever_san jose, I can tell your level of stupidity by having to yell and call someone a moron because you don't have the intellect to say anything creative. Good job. As a physician, I know enough to find the right specialist if I needed a procedure. But most people, like the illegal immigrants I serve for virtually nothing, would not know a good doctor from a bad one. And only very naive individuals like yourself would rely on website that rate doctors to determine who is really a good doctor or not. However, even someone like you doesn't deserve to go to some quack just because there were no standards because people like you screamed to open the flood gates.

Hey DT, I am going to go out on a limb here, and hope I won't get reprimanded for practicing over the internet without a good faith prior examination, but I am 95% sure that homeowner_for ever has just about met ICD-9 criteria for a personality disorder without even meeting him. good night to all.

pbenson says

Hey DT, I am going to go out on a limb here, and hope I won’t get reprimanded for practicing over the internet without a good faith prior examination, but I am 95% sure that homeowner_for ever has just about met ICD-9 criteria for a personality disorder without even meeting him. good night to all.

Totally agree with that!!!

agree on what ? that patients should not have the freedom of choice ? it sounds ridiculous ..isn't it ? standards should be consumer driven not somebody sitting somewhere and deciding.medical board can decide certification so that people are better informed about doctors credentials but not shove it down people's throat by licensing. licensing is a cheap and old trick abused by special interest groups through out history.

Atleast DT is honest enough to agree that he/she believes that many people don't have the intelligence to make choices for themselves.Anyway, i see a future when there will be H1b for doctors which will open the medical field in US to outside labor ( doctors) like anyother skilled labor and help drive the costs down. you guys did a good job arguing to stop US citizens access to international skilled labor pool ( doctors). interesting !

pbenson : "but I am 95% sure that homeowner_for ever has just about met ICD-9 criteria for a personality disorder without even meeting him" 95% sure by reading internet posts ...Your diagnosis style is pretty interesting..little hasty ..don't you think ? i hope you don't do this with your patients. Do some thorough analysis and evidence based diagnosis alteast with your patients before jumping to conclusions.

homeowner_for ever_san jose says

agree on what ? that patients should not have the freedom of choice ? it sounds ridiculous ..isn’t it ? standards should be consumer driven not somebody sitting somewhere and deciding.medical board can decide certification so that people are better informed about doctors credentials but not shove it down people’s throat by licensing. licensing is a cheap and old trick abused by special interest groups though out history.

Well, I may have to agree that licensing isn't just about making sure that someone is qualified or not. Certainly economic issues play a role. But it's just not that easy to know who is a good doctor or not. I knew an anesthesiologist who lost his license for drug addiction, but up until he lost his license, he had a stellar record. But I was his resident when he was a medical intern and I had major concerns about this guy and wondered how he got into medical school. Not very intelligent, lazy, very low morals, no empathy towards patients, etc. and I expressed those feelings in my evals, but he was still was allowed to go through. I checked up on this guy periodically but it always showed no violations. But one day, sure enough, I read that he lost his license.

i understand that its a fine balance ...but i honestly believe that there is protectionism in medical field in US. This is not the time to play protectionism when people are losing lives and so many people cannot get medical care. I would prefer a guy gets attention from a mediocre doctor ( more supply) than getting none (limited supply)

Although one assumes that more doctors would mean that patients pay less, that's actually not true. Even if we let every quack become a doctor, it's really the insurance company that decides what a doctor gets paid anyway. Maybe if we increased the numbers of physicians 10 fold, that may be the case. But then the 'real' physicians, or the ones who know what they are doing and not harming patients(because bad doctors truly harm more patients than they help), would demand MUCH higher rates than the bad doctors, so nothing would really change, other than for the fact that some unlucky person would end up going to one of these bad docs and getting harmed.

But then the ‘real’ physicians, or the ones who know what they are doing and not harming patients(because bad doctors truly harm more patients than they help), would demand MUCH higher rates than the bad doctors, so nothing would really change by increasing the supply , you also increase the supply of ‘real’ physicians along with bad ones...atleast there is net increase in ‘real’ physicians ( if you have H1B doctors). Supply also influences how much insurance pay's. If it was completely upto insurance, then whats stopping them from paying all the doctors just $5 a visit ?

homeowner_for ever_san jose says

i understand that its a fine balance …but i honestly believe that there is protectionism in medical field in US. This is not the time to play protectionism when people are losing lives and so many people cannot get medical care. I would prefer a guy gets attention from a mediocre doctor ( more supply) than getting none (limited supply)

As I said before, there are many many mediocre doctors already out there. And there are some bad ones. In some cases, some care is better than no care. If you have a skin infection, then a mediocre physician can take are of that. But as it is now, in some urgent care departments or ERs, PAs and NPs take care of those simple cases anyway. So why would we need more mediocre doctors to take care of those patients? But as you said yourself that you would go to UCSF for a bypass. If someone doesn't have money, should that person go to a mediocre heart surgeon? Absolutely not, because probably, the risks of the procedure would be much higher than the potential benefit. We don't need more mediocore doctors. We need more good doctors. How do we get more good doctors? We'll, we can take the best from India and China, but we shouldn't take their mediocre doctors. We could make medicine more lucrative to attract more good people to go into it, but people are already furious that doctors make too much.

I personally know many good doctors from india ( some from top 1% in thier school ) who told me that there is too much red tape in US which prevents them from landing in US as a doctor. it was easy in 80's and then AMA made it tough. BTW, these are same doctors who treat patients from US who go to india for best in the class treatment. I am pissed off that i can get a world class treatment in india for 1/10 th the cost of US but can't use the same labor arbitrage (so called globalization) in US.

homeowner_for ever_san jose says

But then the ‘real’ physicians, or the ones who know what they are doing and not harming patients(because bad doctors truly harm more patients than they help), would demand MUCH higher rates than the bad doctors, so nothing would really change by increasing the supply , you also increase the supply of ‘real’ physicians along with bad ones…atleast there is net increase in ‘real’ physicians ( if you have H1B doctors). Supply also influences how much insurance pay’s. If it was completely upto insurance, then whats stopping them from paying all the doctors just $5 a visit ?

Some insurance tries to pay that low, but no one accepts that. That's what's happening for almost all MediCal patients in the Bay Area. Since MediCal literally pays $5 a visit, those patients can't find anyone who'll see them. The reason why it doesn't happen with private insurance is this. If one bought a policy and it only paid doctors $5 a visit, no doctor would accept this insurance, and the policy holder would have bought worthless insurance. A competing insurance company would attract these policy holders by saying, if you buy our insurance, you can actually see a real doctor instead of an imaginary doctor who accepts $5 a visit. But you have to pay more. If it's an employer trying to attract an employee with an insurance plan that doesn't allow them to see any doctors, an employee may take a job with another company that offers an insurance plan that allows them to actually see a doctor if needed. So my point is, economics 101. It's not just supply. It's supply and demand.

The reason why it doesn’t happen with private insurance is this. If one bought a policy and it only paid doctors $5 a visit, no doctor would accept this insurance, and the policy holder would have bought worthless insurance. A competing insurance company would attract these policy holders by saying, if you buy our insurance, you can actually see a real doctor instead of an imaginary doctor who accepts $5 a visit. But you have to pay more. If it’s an employer trying to attract an employee with an insurance plan that doesn’t allow them to see any doctors, an employee may take a job with another company that offers an insurance plan that allows them to actually see a doctor if needed. So my point is, economics 101. It’s not just supply. It’s supply and demand. So you agree that supply and demand work even with insurance industry..then how come if we increase the supply of good doctors ( assuming same demand), then the prices they command won't go low ?

I'm not saying that all doctors from India are not good doctors. We need good doctors period. But as I said before, I know plenty of doctors from India who got through. There's plenty of family practice, pediatrics, and internal medicine programs who would be more than happy to take physicians from India. But they need to practice up to the standards set in the US. I had a medical assistant who used to be a physician in Mexico who could not become a physician in the US because he kept failing his exams. It was not an English problem because his English was fine. But he had VERY LITTLE medical knowledge. That's why he kept failing his exams. Maybe India has excellent medical schools that teach evidence based medicine, but not every other country does.

But as I said before, I know plenty of doctors from India who got through believe me, the % is very low due to the red tape.

homeowner_for ever_san jose says

The reason why it doesn’t happen with private insurance is this. If one bought a policy and it only paid doctors $5 a visit, no doctor would accept this insurance, and the policy holder would have bought worthless insurance. A competing insurance company would attract these policy holders by saying, if you buy our insurance, you can actually see a real doctor instead of an imaginary doctor who accepts $5 a visit. But you have to pay more. If it’s an employer trying to attract an employee with an insurance plan that doesn’t allow them to see any doctors, an employee may take a job with another company that offers an insurance plan that allows them to actually see a doctor if needed. So my point is, economics 101. It’s not just supply. It’s supply and demand. So you agree that supply and demand work even with insurance industry..then how come if we increase the supply of good doctors ( assuming same demand), then the prices they command won’t go low ?

There are two main factors that determine the price in a medical transaction, what is considered "reasonable and customary"(what the doctor feels his/her services are worth) and what insurance is willing to pay. Insurance prices are based on what Medicare sets. So if medicare pays $30 for a 30 minute office visit, then Blue Cross will pay $90. Whether there are 10 doctors or 1000 doctors in an area, they will pay the same. The reason is that the amount of patients are fixed in a particular area. Lets say that there are 10 doctors taking care off 1000 patients versus 1000 doctors taking care of 1000 patients. The cost to the insurance company is the same. If these 1000 patients see the doctor once, then it costs Blue Cross $90,000 regardless of whether these patients are seen by 10 doctors or 1000. Of course as you said, in a free market, if there are 1000 doctors why wouldn't they compete and offer to see patients for $85, $80, $70? There is some of that going on, but for the most part, there is a 'floor' to what the doctors will accept. And actually, often, the 'reasonable and customary' is actually ALOT higher than what the insurance company is willing to pay. So the doctor actually feels that the office visit is worth really $120, but is taking a 'discounted fee' from the insurance company to see the patient. Sometimes, if the doctor is popular, he/she, unless it is against the rules in that state, will make the patient pay the difference between 'reasonable and customary' and what the insurance pays.

When I went to get my car checked for a 50K checkup, with replacement of minor parts, my bill came out to be $1600. My car is only worth about $8,000. Despite the high cost, I was glad to get it checked up so that I could drive my car to work and go on with my life. I didn't complain that we needed more less qualified mechanics so that I could pay a lot less. My mechanic seems to be well trained. I hope there are some standards. You get what you pay for.

I didn’t complain that we needed more less qualified mechanics so that I could pay a lot less. whats your problem if somebody wants a less qualified mechanic ? why are you so much worried ? people know whats good for them.I would prefer if people mind thier own business and not decide whats good for others

chrisborden says

Here it is (sorry, I get a D at tech). 40058 Kelly St FREMONT CA 94538

What do you think the annual rent 40058 Kelly would be? From that and the prevailing 30-year fixed interest rate, you can get a pretty good idea of fair purchase price: annual rent / interest rate

>>well thats what happened in engineering…whats so special about medicine. Two things, Bad engineers just fail in the marketplace (well, most of the time :)), and their company fails selling products. But the good products will still get designed. And if we import a mix of good and bad engineers from India or elsewhere, the GOOD products will get designed, manufactured and sold around the world. Bad doctors fail curing patients, and leave dead, suffering or permanently injured patients in their wake. Each patient is unique, and medical service can not as easily be mass produced. There is quite a bit of difference here. We can afford failed products and companies. Most people would not like to be a failed patient.

>>Much like the public teachers suck nuts now, due to liberal ideas, I don't think this is true, but to the extent teachers are less qualified or capable than they should be I'd say it is because they are underpaid and under-respected by parents. Police, Firefighters and, many nurses (yes) are overpaid.

Don't forget that "death panels" already exist. They are run by insurance companies who decide who will live and who will die. If you're comfortable with that, what's wrong with you?

Tenpoundbass says

excuse me, tell me how they are different? Most programs are handling the same volume of data and transactions in the same time execution time. Moore’s law makes sure of that. So it’s all relative.

You also have no idea what you're talking about. At the most basic level you're wrong -- we can process nearly 100x as much data per kilowatt of energy used today than we were back in 1995. "Moore's Law" has nothing to do with what you're saying (and, hell, Moore's law hasn't held true since the beginning of the decade anyway). Bap made the COMPLETELY WRONG assertion that newer just means "more bells and whistles". It's the sort of thing that only somebody who has no fucking idea what they're talking about would say. You may as well say that forced air heating systems are just "bells and whistles" and we should all go back to having open fires in our one-room cabins.

Tenpoundbass says

Um that article came from CNN from my point of is the Liberal equivalent of Fox is for Conservatives.

No, that would be MSNBC. CNN actually believes in being "objective", which is usually bullshit, and the reason why they actually have "debates" about whether or not torture is OK. Tenpoundbass says

The bill does nothing to address these issues.

Nor is there any bill that will pass any time in the next 20 years that will get you what you want. The only thing that is going to work is a slow, gradual conversion to single payer. It has been 40 years since Medicare was passed. Most other countries have had a system better than medicare for just as long. Unfortunately for us, the Kennedy's got assassinated and we have to unwind 40 years of pro-insurance policies.

bap33 said Good doctors, much like good teachers, preachers, and coaches, are BORN and do not learn their craft from a book nor do it for a dollar. More “education” does not equate to being better doctors. Lots of highly eduated people are idots that can’t change a tire or solve a basic life problem. They are idiots with degrees Excellent point. The red tape in medical education and licencing does not make bad doctor a good doctor...it just increases the barrier to entry, cost of education ..etc. Actually we might be losing out on many good potential doctors because they could not afford to become doctors. just me says :Two things, Bad engineers just fail in the marketplace (well, most of the time :)), and their company fails selling products. But the good products will still get designed. And if we import a mix of good and bad engineers from India or elsewhere, the GOOD products will get designed, manufactured and sold around the world. Bad doctors fail curing patients, and leave dead, suffering or permanently injured patients in their wake. Each patient is unique, and medical service can not as easily be mass produced. There is quite a bit of difference here. We can afford failed products and companies. Most people would not like to be a failed patient. You are right when its a individual doctor but when medicine becomes market driven...doctors tend to gravitate towards working for hospitals. hospitals tend to start building brands ( to attract more patients) because patients don't want to take too many chances and value credibility of hospitals a lot.hospitals don't want to risk thier brand due to some bad doctor screwing up big time.its a self correcting system. Do you think good airlines will hire a pilot without proper training just because there is no restriction from govt...no ! They won't because thats bad for business.People in US have not seen true market driven Medicine so its hard for them to comprehend but i have seen this in other countries where there are bad hospitals and good hospitals and people know about it and avoid bad ones.

homeowner_for ever_san jose says

Excellent point. The red tape in medical education and licencing does not make bad doctor a good doctor…it just increases the barrier to entry, cost of education ..etc. Actually we might be losing out on many good potential doctors because they could not afford to become doctors.

This is mostly a load of bullshit. Education is certainly not everything -- but it's a form of experience, and you need to get experience before anybody will trust you. Everybody starts with 0 experience. How do you propose that medical professionals get experience? Do you want to let any random jackass start practicing medicine, and after he kills a few people when performing surgery you decide that he shouldn't do it anymore? That's what we had hundreds of years ago. People started demanding some way to know if someone was legitimate, so certification programs were created. Today we have universities and medical boards. Whether the government is involved or not is meaningless -- the end result will be the same. You can certainly argue for industry regulation instead of government regulation, but I would point out that the track record of industrial self-regulation is piss poor, regardless of what economic theorists who support a free market model might claim "should" happen. Now, medicine isn't my field, but I've seen first hand what a lack of education can do -- I'm a software engineer. In my experience, most "self taught" engineers know a little bit about applied engineering and jack shit about the fundamentals that back it up. Most don't know anything about physics and even less about math. They think that knowing how to write some Java code is what makes them 'good', even though they don't know the first thing about algorithms and data structures. As a result, they're crappy engineers who produce crap (and, worse, inefficient crap). For the most part, these are the people who claim that there are "plenty of good engineers" because they look at the people around them and determine that they are as good or better than themselves -- not realizing that they are in that group of "bad" engineers. This is also the same group that think that computing requirements haven't changed fundamentally since 1995. They don't have the slightest clue what it costs to decrypt a message using RSA, to implement a secure operating system kernel, or to detect that a program has been modified while it is running. I say this as a self-taught engineer who dropped out of school because I thought the teachers were full of shit, only to realize nearly a decade later what it was that I had missed. It's amazing how many people who lack an education claim that said education has little or no value. If the medical industry was as full of incompetent, unregulated "professionals" as the software industry, you would go in with a broken arm and come out with two broken legs and a nose job. Your arm is still broken, but the doctors insist that your arm was always broken and if it happened to work correctly before it was unintended behavior.

you make a valid case..but you missed my point.I am not saying the education is not needed. We need educated doctors but consumers need to decide if they need that educated doctor or somebody else..they need the freedom of choice. would you like , if government madated that companies can only hire Ph.d's for all software engineering jobs ? companies know whom to hire based on thier need and the job. Govt should only be in the business of creating certification programs and not force it on people.

I would argue that consumers are not in a position to judge whether or not a doctor is qualified to treat them in the first place, and even if licensure was completely private instead of the current hybrid public/private licensure that takes place, the result would be more or less the same. Insurers certainly wouldn't enter into any contract with unlicensed professionals, and as I've said before, there's no chance in hell of going to an insurance-free system (other than possibly single payer) anyway so it's a pointless conversation. That would leave us with exactly what we have today: A bunch of people who are medical professionals but are not licensed to "practice medicine". This includes everything from legitimate practitioners like nurses and midwives (who are still somewhat regulated, though nothing like what physicans have) to crackpots like homeopaths and aroma therapists. Do you know what the license to practice medicine actually does? For the most part, it allows you to write prescriptions. This is an important function because the vast majority of medications are controlled substances. If you want to eliminate licensure you're also going to have to eliminate all pharmaceutical regulations. Funnily enough, you can still perform many types of surgery without a license, you just can not claim to be licensed to practice medicine when you do so (this is why you can get horns implanted in your skull in a strip mall -- just don't expect any pain medication). For the most part, board certifications are what does the job here. So, yeah, eliminate the government licensure. The hospitals are still going to require that you have an equivalent certification, and that certification authority will still require that you have a Ph.D. I actually would be in favor of licensing requirements for software engineers, to be honest. For a long time I thought this was a bad idea, and then I observed how much better the quality of work from civil engineers (who require certification) is. Certification doesn't make someone "good", but it does ensure that you filter out most of the people who have no business in the profession at all, thus insuring that few practitioners are "bad". I like knowing that when I talk to a licensed physician, they actually tend to know what it is that they're talking about. It is rarely the case that this is true with software engineers -- it's just that so few non-engineers know what they're talking about to know the difference anyway.

I thought it was very interesting to get some healthcare insider perspective from DT, hanskung23 and pbenson, thanks guys. Hanskung23 said: >>a good 10-20% of the students that we graduate have no business being practicing physicians. That was a bit of an eye-opener, but presumably it would not apply uniformly across all universities. On second thought, perhaps I am not all that surprised. I think it is pretty common in many of the learned professions that about 10-20% practitioners are fairly clueless, and it would be surprising if medicine was fundamentally different.

actually would be in favor of licensing requirements for software engineers, to be honest. For a long time I thought this was a bad idea, and then I observed how much better the quality of work from civil engineers (who require certification) is The only issue is that you are giving somebody else the power to decide what the licensing requirements would be. When a third party gets the power ( without the right incentive) they abuse it. Actually it would be nice if govt can also decide and distribute everything we use so that we have better quality control in everything ( food production, clothes, toilet paper..) ...back to soviet style centralized govt ( sarcasm alert)

homeowner_for ever_san jose says

I personally know many good doctors from india ( some from top 1% in thier school ) who told me that there is too much red tape in US which prevents them from landing in US as a doctor. it was easy in 80’s and then AMA made it tough. BTW, these are same doctors who treat patients from US who go to india for best in the class treatment. I am pissed off that i can get a world class treatment in india for 1/10 th the cost of US but can’t use the same labor arbitrage (so called globalization) in US.

BS. If they can get a visa (which is a major problem post 9/11 and has nothing at all to do with the AMA), pass the same USMLE exams as American medical grads, and get hired by a residency program they can go through a residency program and practice here. If they are in the top 1% it should be a breeze. Or are you saying that having to actually pass the test is too much red tape? Or are you saying that the entire idea of testing is invalid? Your basic argument seems to be that testing people for competency is some kind of conspiracy to prevent competition. Eliminating it would certainly increase the supply of people like doctors and airline pilots. They could just self certify their skills and we would have some kind of web based satisfaction survey. That should work out nicely for the people that survive to be surveyed. Are you working in India? If not, how is it you are talking to so many Indian doctors who say they wouldn't come to America because there is so much red tape? How could they be from India but didn't come to America? Are they living in Poland? This statement doesn't add up. You sure have a lot of crtiticisms about the system, but don't seem to offer any alternatives except the vague idea of some type of H1B system that somehow attracts qualified docs without some onerous third party actually checking if they are qualified. I have no idea how that would actually work. Are you saying we don't want or need licensing here, but that we should accept licensing from other countries for qualifications? You don't see a little contradiction in this thought? Or should we just accept anyone who claims to be a doctor in another country, let them start operating on people and see how it works out? Hey Bap33, did a doctor rape your sister or something? If you really believe 80% of the people who become doctors are unqualified you are a seriously warped individual. That's one of the stupidest things I've ever seen posted. What exactly do you do for a living (or in life) that makes you so qualified to pass judgment on people who spend 11-15 years and hundreds of thousands of dollars to pursue their profession.

i am just saying that you need "CERTIFICATION" and NOT LICENCING !!!!!! There is a difference. Also, if a requirement tests your patience ( length of training ) and desire for money ( expensive training needs bigger ROI) guess what you get : stupid , greedy and ambituous doctors ! In most countries, the requirement is such that , the person needs to be competent and smart. BTW, i go to india ofter and travel back and forth a lot.I have very good insurance in US but i prefer to get treated in india because i have found much "SMARTER" doctors who had the "NEEDED" training. I have GENERALLY found that doctors in US are more ambituous and money oriented but don't have the same IQ level ( for what they are paid). The barrier of entry in US to medicine due to the cost and length of education gives the avergage IQ guys (who have deep pockets , greed and focus on money ) advantage over the smart ones (but less fortunate). Thats one reason i mostly find that the smart people in US do Entrepreneurship and other fields than medicine. Nothing comes for free.. if you make the training excessively lengthy and cost prohibitive, you will ofcourse loose something ( smart people) and be left with dumb and greedy people. By the way my generalization does not apply to all doctors...i am just pointing to a trend in US versus other countries.I have found really good , passionate doctors here but the % does not match up to what it should be. I'll prefer to go to a less trained SMART guy who is passionate than a guy who is dumb , has trained for 15 years, and has spent thousands on education.

Some Guy : "Great. Why don’t you move to India and shut the fuck up, then?" BTW, Who the fuck are you to tell me that ? I will move as i wish ha..ha.. I enjoy best of both worlds ( which you can only dream of ) Has it become a norm to tell whoever complains about care in US to go to some other country.

I don’t want some hack with no medical training treating me. You are free to choose one with the training you want ...who is stopping you ?

i am anyway's getting my treatments in India..thanks for the tip though. i stay in US and have the flexibility to go anywhere i want depending on what i want. I like everything about US except healthcare so i don't want to move to any other country. Anyway, you didn't answer my question. I don’t want some hack with no medical training treating me. You are free to choose one with the training you want …who is stopping you ?

homeowner_for ever_san jose says

i am just saying that you need “CERTIFICATION” and NOT LICENCING !!!!!! There is a difference.

Uh, yeah, the difference is that practicing without a license gets you thrown in jail. Other than that they're the same thing. zetabeos1 says

Have you taken some time to mentor/train these ‘bad’ engineers? Your job, if you are a manager, is make your staff leaders for years to come.

I'm not currently in management (managers aren't engineers -- it's a completely different role for people with completely different skill sets, and good engineers rarely make good managers and vice versa), but your argument could still apply to a limited extent. The short answer is "yes", but that doesn't change the fact that 80% of people who are employed as software engineers aren't very good at it. We make do with what we have, but it would be a lot better if we just had better people, period. I'm all for more H1-Bs because it would mean a larger pool of good people to choose from. I don't have 10 years to spend training someone to make up for their own incompetence; technology can't wait that long. Bap33 says

There is no healthcare issue. None.

You don't consider the fact that we pay twice as much per capita for health care as any other country in the world to be an issue? You don't consider the fact that our medical costs account for 16% of GDP to be an issue? You don't see the fact that the only medical care program available for the elderly is going to be insolvent in 20 years as an issue? Are you on medication right now? Bap33 says

it would appear that free healthcare don’t work over yonder.

Uh, you do realize that the Japanese just elected a new liberal government that wants to expand their social safety nets (including health care), don't you? Why on earth would you point to this to support your argument? homeowner_for ever_san jose says

You are free to choose one with the training you want …who is stopping you ?

If I can't be reasonably confident that the practitioner is providing verifiable credentials, that's a pretty big barrier. How do I know that the less qualified guy is qualified enough to handle whatever my particular issue is? How do I know that he's going to be aware of the side effects and interactions when he tells me that I need some particular medication? Without some significant penalty for misrepresenting one's abilities and training, there's nothing to stop someone from outright lying about them -- which is exactly what we see in other industries. We have a bunch of shitty software engineers and shitty mechanics and shitty general contractors, but we put up with those because it's unlikely that anybody is going to die if they screw up. We don't take that same risk with physicians and civil engineers and similar professions because somebody will die if they screw up.