I don’t understand how a light conversation about errands led to unlocking my husband’s side of an argument we’ve been having for 7 straight years, but thank you ladies! You may have just saved my marriage!
I can’t count how many times the phrase “banal guilt” has run through my mind since listening to this episode last Friday. It has me seeing things with a new lens in so many situations.
Another physician adding a comment to say that I think Sarah missed the mark on this one by pointing to physician salaries as one of the main issues. I’m a pediatrician (the lowest paid specialty). My perspective is that I do make enough. I live in a high COL area (outside DC) so we don’t feel like we live a particularly rich or upper class lifestyle compared to our neighbors but it’s enough to have a good life. I don’t feel like I necessarily deserve more. I think when you start talking about “deserving” it gets so tricky because people start to feel like you are talking about their worth as a human. And how do you compare the stress level of a pediatric oncology nurse to say an air traffic controller to a preschool teacher. All stressful. All important. All deserving. We aren’t paid by how much we deserve or even by stress level.
I thinks there is so much wrong with the healthcare system that it’s hard to know where to start, which I think is part of the reason for the lack of discussions in the election cycle. For profit insurance companies are definitely part of it. As are in my mind the unethical business practices that healthcare insurance companies engage in. It is clear to anyone that works in healthcare that insurance currently is just out to find ways not to pay. I’m sure any of us has 1000 stories we could tell. The most recently egregious one I know is a 17 year old patient of mine with muscular dystrophy who has a ventilator for nighttime due to his muscle weakness. Insurance denied it, saying it wasn’t medically necessary. It took weeks and multiple calls by me and his pulmonary doctor to fix the situation which was beyond ludicrous. As one of my partners asked “ is breathing not medically necessary now?”
Honestly the anti physican vibe I am getting from pants suit politics these last few episodes is getting old. And the idea that health care cost so much because the physicians are getting paid too much is insulting. My spouse gets paid less now, not adjusting for inflation but actually less money, than he did 10 years ago. We have paid over $500k back in student loans and are still making payments, because of the nature of moving for medical school/residency/ residency/ fellowships my career was decimated every 3-5 years. He worked every single day for 18 months straight during the pandemic and made LESS money than the year before. We are encouraging our children to NOT become physicans because the paid does not equal the amount of education and hours worked it takes to make a living at it.
I want to say something about "big" healthcare. A huge reason healthcare in the US is so expensive is because we are not negotiating-at a national level-for drugs, for surgery supplies and every other thing used in healthcare. Canadians pay a fraction of the price for drugs bc their government says-we are buying these pills for the WHOLE country-and this is what we are willing to pay. This is way that "bigness" can actually really benefit a population. And until a few years ago-it was actually ILLEGAL for Medicare to negotiate drug prices this on behalf of seniors. That is a huge place were Americans are getting a raw deal (and where traditional capitalism breaks down bc there is no price tranparency so prices for medical supplies and drugs are just astronomical-especially in hospital settings). Secondly-remember that the administrative costs for Medicare are 5% and for private insurance it is 25%. So that "smallness" of many private insurance companyies is driving prices through the roof, not the bigness of Medicare. That is BILLIONS of dollars wasted on admin bc we have a privatized system.
I think of all the insurance jobs and coding/billing jobs that would go away with a public system-but those jobs are really a huge waste of healthcare dollars. BILLERS AND CODERS DON'T EXIST AS JOBS IN OTHER COUNTRIES.
I'm an OB/GYN. While I know this conversation was more nuanced than a single comment and I acknowledge I have a hard time not being insanely defensive when it is implied we should/would do our jobs for less compensation, I have to just say how demoralizing it is that discussions of healthcare costs so quickly turn to physician salaries. Physicians (and multidisciplinary teams- NPs/PAs, nurses, medical assistants, imaging and respiratory specialists, pharmacists etc)- are the only ones in this massive convoluted system who are actually providing CARE. For-profit insurance companies and massive hospital corporations are intermediaries who have injected themselves into OUR care relationship to get theirs, diverting money that should go directly to care. There is this idea that doctors are overpaid (we aren’t) and therefore the problem. Physicians just took yet another CMS fee cut this year and are paid less in just gross salary number than our mentors from 30 years ago. Adjusted for inflation I already make almost 40% less than partners in my practice did in the 90s. And they didn’t have loans or malpractice anywhere near what we have now.
The reality is that on a Saturday night I am charting and catching up on labs and results for patients I squeezed into every possible second of my days and nights, consistently working well over 80 hours weekly. This is significantly more than 2 full time jobs and is more the norm than the exception in my field. At least half of this is uncompensated work. Just this week I spent hours trying to get insurance companies to cover things like pelvic and breast MRIs, a second opinion for aggressive breast cancer treatment in a young mother, a very needed hysterectomy, and the RSV vaccine in pregnancy which United continues to deny despite FDA approval an insistence they'll cover it(!). There aren’t enough of us and the amount of patients waiting for care is daunting and endless.
I see and appreciate comments on how many other professions have long hours or risk of bodily harm etc, for too low wages. Firefighters are up all night and risk their lives, they should be paid more. Teachers have become heroes to me in so many ways and I'm SO grateful for them. So many people deserve better pay. At the same time, you'd be hard pressed to find a profession that has the combination of hurdles and challenges that medicine does. I spent 14 years, which is ALL of my 20s and into my 30s in class rooms and clinical settings 80+ hours a week, going half a million dollars into debt, while chasing my passion and “life’s calling” (not sarcastic- I absolutely love my work and would probably do it for free to the financial ruin of my family if they let me). I continue to work hours that leave me missing my kids and woken at all hours of the night. I have to pay ungodly malpractice premiums and ALSO worry that I would be a felon for doing my job ethically in half of America today (and who knows what tomorrow will bring). I do not seek pity here- I chose and love this life and I'd choose it again every single time. But honestly, I don't want my kids to choose it. And the idea that without MASSIVE reform of education costs, length of training, physician pay schedules, physician liability, etc, we would just do all the above out of the goodness of our hearts alone is so disappointing.
I worked in public health on my road to medicine and have long advocated for some kind of universal program that cuts out our private for-profit insurance model entirely. But unless the money that is poured into private insurance gets poured into this theoretical universal program, it doesn't work. Medicare For All doesn't work at current CMS rates- I would have to close my practice immediately if the Medicare rates were the rates for everyone. I wouldn't be able to pay my front desk staff and my rent let alone make a dollar of my own to keep. And there remains an issue of limited resources- government "rations" care while private insurance "denies your claim"- these are two sides of the same coin. We certainly have endless problems in healthcare with only painful and complex potential solutions. But physician salaries are NOT the problem. Our endless moral injury and the speed with which we are leaving our life's work may add to it though.
I appreciate your comment so much. I recently saw a billboard while traveling- it was a lawyer who offers to sue OB/GYNs up to 18-21 years past a birth. I cannot imagine the stress that causes you and the malpractice rates you must have to pay. That calls for reform and I am so sorry. I also concur with your points about government in other countries rationing care. I have lived in the UK, where a person might be on a 10 year waiting list for ADHD medication, and in Canada, where I probably would have died from my brain tumor while I waited for an MRI. Definitely the other side of the same coin.
Yes- I don’t think a lot of people realize this legal tidbit. Typical Medical malpractice claims have a 2-3 year statute of limitations (differs by state), but birth injury/OB claims in most states are 18-21 years. Just leaving practice is often difficult because you need tail/supplemental insurance that’ll cover you from 18-21 years after your last delivery. It’s an aggressive (and highly emotional) area of personal injury law and the toll of these lawsuits is huge in our field- I’ve seen it in so many excellent colleagues devastated by some of these cases.
I would direct my comment to all of the doctors and doctors' family members in this thread in saying, THANK YOU for taking the time to share these specifics! I have never necessarily "blamed" doctors for the problems I see and have experienced myself getting healthcare as a chronically ill person. But I definitely assumed doctors were doing better financially than it sounds like they are. I know I carry some bias against the medical profession because of my rough experiences (which in my calmer moments I can attribute to the system rather the individual doctors) so I needed these comments to set me straight on some things. I appreciate your thoughts and your dedication to your work, which I hope someday will not come at such a high cost to you and your family!
My husband, dad, and brother are all physicians and I hear you Katherine. I also think it’s an interesting add-on that all of these care-professionals would never organize and strike due to the Hippocratic Oath, “First, do no harm.” If for any reason conditions got rough for these workers, leaving the profession is seemingly their only option.
Katherine, I am so angry on your behalf! It should not be this way.
I would write you a novel, but I have 3 minutes at my metro stop, so my main point from my perspective living in Denmark is this:
There will still be massive amounts of money in a universal system and there will be fights over where they should go. But the headaches of insurance access and denials is just gone, and it makes a HUGe difference.
When we compare my family’s tax increase since moving to Denmark to the various places we needed to direct our money in USA (insurance premiums, child college savings), it evens out to about the same. So universal healthcare isn’t so much going to save anyone money, but it’s going to save everyone the headaches you describe. Again, I’m so sorry it’s this way.
I came on to point out that healthcare’s rising costs has little to do with physician pay and I see that many others beat me to the punch! I am a primary care pediatrician who works in a clinic for the underserved. Believe me when I say that my salary is not driving up the cost of healthcare ;)
Medical school should be fully publicly funded. At least at state schools. I am 5 months away from a PhD in physics, and it has been fully paid for by government grant money and one year of working as a teachers assistant for my university. There are estimates that it costs on average 500,000 for one physics PhD. Not only are our tuition and fees (and even our shitty student health insurance) fully paid for, we also get paid a stipend. It’s right at the poverty line, but it’s enough to live on. With all due respect, a physicist is not as valuable to the country as a medical professional. Especially because most physics PhDs go into private industry because there aren’t enough faculty job openings to support the number of physics PhDs graduating each year. So where is all that government grant money going? Why can’t we significantly limit the number of science PhDs we fund every year and instead put that money into MDs and nurses? We know how to do this, we just choose not to. I get that it isn’t super simple, but we’ve fucked ourselves by letting medicine be overrun by capitalism. If medical professionals didn’t graduate with massive debt, they wouldn’t need to make quite as much for all their stress and pressure to be worth it. It’s one way to start tackling the healthcare un-affordability and inaccessibility problem in the US.
Hello! I’m only at minute 15, but Beth mentioned hesitation around making something that’s not working even bigger, and I told my husband to ‘hold my ginger beer’ so I could tap this out.
I spend A LOT of time thinking about universal healthcare as an American living in Denmark.
One thing I think we miss so much is that universal healthcare can be broken down into smaller pieces! Denmark has 5.5 million inhabitants. The national law has legislated it. But 5 (or 6?) different regions actually execute it. So even in this tiny country, they decided 5.5 million is too many under one system.
And what’s great about the US is that it’s already broken into states. How lucky are we?! Imagine Ohio have 8 healthcare regions, California having 50, etc.
…and then the question of salary incentives for a hard life for doctors. I was nodding, “Yes, Beth, yes!” when you came around to needing to reform the higher education/debt system, remove the profit incentives that spawn burnout, etc. There is SO much at play here.
Things are not perfect in Denmark, to be sure, but doctors here make a reasonable living. Are they the richest? No, but they make a fine living. Generally there’s a smaller range of salaries here (aka there aren’t many ultra rich; the middle class is huge).
Looking to the US from abroad, I feel like it has placed doctors at the apex of all people—the most important. As if the sanitation workers who save us from disease don’t save lives. As if (volunteer) firefighters don’t also save lives. As if artists don’t save lives. As if the neighbor who checks in neighbors doesn’t save lives. I feel like everyone plays a role, and generally salaries should be more even.
I also wonder if we treat US doctors as near-gods BECAUSE of how much money they make. As if their salary must indicate an omnipotence.
Thought 1 - a friend of mine is an employee of United Healthcare. She was watching the investor call that the CEO was arriving to. Her sharing the story of being in the office when the news broke really brought this story to ground level for me.
Thought 2 - my new errand equivalent is a train commute. I have always lived within a 10-15 min drive from my work, but recently took a new role with a 45 min train ride into the city. I was really nervous about this change but, so far, I LOVE IT. You cannot do anything on the train but be on the train. I have given myself a screen moratorium during the commute so I read or just sit and look out the window. In some terms, it’s definitely inconvenient. But it’s also a big chunk of each day where I am being vs. doing.
After listening to the episode, I am wondering if any of the following could be potential solutions to the health insurance issues.
- should the government pay off all student loans / non-consumer debt for healthcare workers upon their graduation? (I also think this for teachers and other common good jobs)
- should health insurance providers only cover emergency/catastrophic situations and employers or medicaid for all only cover preventative health? (making the system smaller) essentially tiering our insurance.
I wonder if these would help at all. Because I think the biggest problem is that there are no motivating factors to make people feel seen and cared for. Paying off loans shows care. Prevention for all seems like a good compromise. Just some thoughts.
I think you bring up interesting ideas. But just to push back on each a little bit… To your first point, what defines a “healthcare worker”? Last year when buying a car and providing my employer, I was told I could get a discount if I were an RN or MD. Now I do not consider myself a “provider” but I do allow care to be provided, in a way. To your second point, we would have to clearly define emergency care, likely by a definition in a regulation. We do have this somewhat defined in emergency use of “test articles” - drugs and devices that are not FDA approved yet, but probably more complicated in regular clinical care. Totally not trying to call you out, but I thought you brought up interesting points. As Beth has said “We can do hard things!”
You are totally right. Every solution will have unintended consequences that we can’t predict. Thanks for your insight! Definitely did not feel called out at all!
My husband and I were just talking last night about our disastrous health insurance system. Something needs to change, but I am not sure how you do it because it is so huge and so intertwined with other things. We can't just rip it down and start over unless we want complete chaos and limited access to health care for 5-10 years. We have to change incrementally. ACA was a feeble but good start. Now we need to improve that rather than try to get rid of it.
Universal health care does not necessarily mean Medicare for all or government-run health care. Lots of countries have other models. Germany has universal health care, and much of it is run by private entities. Perhaps they aren't a good model since they are the second most expensive health care system in the world, but their costs are still 35-45% less than the US (depending on if you are looking at it as a percentage of GDP or a per capita basis). And it might be easier for us to move to this system.
We also need to subsidize medical workers' education more. (And the education of people in many other fields). Medical workers make significantly less in most other countries, but they do not have the education costs that we do. Other countries also have many more workers that have less education to address common health issues. I do not know how Americans would react to that, though, since I already hear people complaining when they have to see a PA rather than an MD, and the workers I am referring to have less training than a PA or even RNs in the US. Another factor is that there is a better social safety net in most of Europe, so employees do not feel the same need to make high salaries as they do in the US.
I recently learned that the average teacher salary in Europe is lower than in the US, but a big difference is that people in other highly educated fields, such as doctors and attorneys, make significantly less than they do in the US, so the gap between all those fields is smaller, making teachers feel less disgruntled and unappreciated.
I have so many thoughts on the errands thing! My husband became our designated tribute during the pandemic (if someone had to go out to get a thing, it was him) and we retained that habit for far too long. I finally snapped one day because I wanted to go to Target and he said he'd just grab what I needed next time he was out. I was like, I don't need [the thing on my shopping list], I need to get out of the house and mingle with strangers and stroll aisles mindlessly and grab a Starbucks while I'm out and maybe see if the shop around the corner has anything new I might want to read! I need the act of the errands!
We realized he had seen it as taking tasks off my to-do list, and I had seen it as one more way I was trapped in the house with the kids while he got precious solo time (not answering 5 million kid questions! Listening to whatever music he wanted! SILENCE!)
We're much better at vocalizing this now, but I do occasionally still get to a point (because I mostly work from home and I'm the primary parent for all pick-up, drop-off, after-school, weekend, you name it activities) that I become Chili from the Bluey episode where she says that she just needs 20 minutes where nobody talks to her, except I need an hour at Target with a latte in hand.
As a Canadian I have a lot of experience with public healthcare, and trust me, it’s not perfect. But also, I’ve never once worried about what I’ll do for healthcare if I lose my job. I don’t know a single person that has thought twice about starting a business or taking a break for work because of health care. I’ve never had to worry about going bankrupt because I lost the health chaos lottery. I’ve never had to put off going to the doctor if something is wrong just because I don’t have the money. Yes, there’s lots of room for improvement, but the lack of worry and stress I feel over healthcare has probably helped me to be healthier up to this point.
Yes, I have many Canadian relatives who work in a low-paying industry, mostly self-employed - fishermen and lobstermen. These are some of the most dangerous jobs out there, but in the US they are likely to be un or underinsured. One of their kids had a rare disease. The only thing they had to have a fundraiser for was the travel back and forth to Toronto. They really don't understand why we put up with our system.
Yeah, most Canadians think that public health care is an obvious choice and don’t understand the reluctance to switch. The only people I know here that want private healthcare are a couple people that are independently wealthy and don’t want the inconvenience of flying to the US when they want to skip the line.
My thought regarding why this was not part of the election. Maybe we have given up on healthcare like “it’s bad, it always has been, always will be”. Insurance is tied to jobs that not everyone has, and it is extremely opaque. Groceries and gas have prices people can see go up and down.
As for Drs. salaries, I don’t think that’s the worst part of the system. They are people that do a lot to preserve our lives. Insurance and for profit hospitals put pressures on them from the financial point of view that many PCPs and other first line of care can’t stand because they have limitations even on how much time they have with each patient. They have unique skills that are useful. In a world we’re a grown man makes millions a year to chase a ball I will not complain for Drs. making the money they make.
The idea of reducing pay to medical professionals because people will still do the jobs anyway? Yes, they will, but you will absolutely and significantly diminish the quality of people still willing to do the work. The best and brightest won’t bother. That OB/GYN mentioned who was willing to quit despite good pay? Multiply that by tens of thousands plus saying “f*ck this noise” if the salaries were to get slashed. Then the shortage of providers would be untenable.
Absolutely!! And let’s not gloss over how much more at risk we would be with less doctors/nurses/medical personnel. All you have to do is look at states and counties who no longer have obgyns or medical facilities close to home. How many people are living and will live in medical deserts, but let’s keep paying athletes, celebrities, lobbyists millions and millions of dollars 🙄
I don’t understand how a light conversation about errands led to unlocking my husband’s side of an argument we’ve been having for 7 straight years, but thank you ladies! You may have just saved my marriage!
I can’t count how many times the phrase “banal guilt” has run through my mind since listening to this episode last Friday. It has me seeing things with a new lens in so many situations.
Another physician adding a comment to say that I think Sarah missed the mark on this one by pointing to physician salaries as one of the main issues. I’m a pediatrician (the lowest paid specialty). My perspective is that I do make enough. I live in a high COL area (outside DC) so we don’t feel like we live a particularly rich or upper class lifestyle compared to our neighbors but it’s enough to have a good life. I don’t feel like I necessarily deserve more. I think when you start talking about “deserving” it gets so tricky because people start to feel like you are talking about their worth as a human. And how do you compare the stress level of a pediatric oncology nurse to say an air traffic controller to a preschool teacher. All stressful. All important. All deserving. We aren’t paid by how much we deserve or even by stress level.
I thinks there is so much wrong with the healthcare system that it’s hard to know where to start, which I think is part of the reason for the lack of discussions in the election cycle. For profit insurance companies are definitely part of it. As are in my mind the unethical business practices that healthcare insurance companies engage in. It is clear to anyone that works in healthcare that insurance currently is just out to find ways not to pay. I’m sure any of us has 1000 stories we could tell. The most recently egregious one I know is a 17 year old patient of mine with muscular dystrophy who has a ventilator for nighttime due to his muscle weakness. Insurance denied it, saying it wasn’t medically necessary. It took weeks and multiple calls by me and his pulmonary doctor to fix the situation which was beyond ludicrous. As one of my partners asked “ is breathing not medically necessary now?”
Honestly the anti physican vibe I am getting from pants suit politics these last few episodes is getting old. And the idea that health care cost so much because the physicians are getting paid too much is insulting. My spouse gets paid less now, not adjusting for inflation but actually less money, than he did 10 years ago. We have paid over $500k back in student loans and are still making payments, because of the nature of moving for medical school/residency/ residency/ fellowships my career was decimated every 3-5 years. He worked every single day for 18 months straight during the pandemic and made LESS money than the year before. We are encouraging our children to NOT become physicans because the paid does not equal the amount of education and hours worked it takes to make a living at it.
I want to say something about "big" healthcare. A huge reason healthcare in the US is so expensive is because we are not negotiating-at a national level-for drugs, for surgery supplies and every other thing used in healthcare. Canadians pay a fraction of the price for drugs bc their government says-we are buying these pills for the WHOLE country-and this is what we are willing to pay. This is way that "bigness" can actually really benefit a population. And until a few years ago-it was actually ILLEGAL for Medicare to negotiate drug prices this on behalf of seniors. That is a huge place were Americans are getting a raw deal (and where traditional capitalism breaks down bc there is no price tranparency so prices for medical supplies and drugs are just astronomical-especially in hospital settings). Secondly-remember that the administrative costs for Medicare are 5% and for private insurance it is 25%. So that "smallness" of many private insurance companyies is driving prices through the roof, not the bigness of Medicare. That is BILLIONS of dollars wasted on admin bc we have a privatized system.
I think of all the insurance jobs and coding/billing jobs that would go away with a public system-but those jobs are really a huge waste of healthcare dollars. BILLERS AND CODERS DON'T EXIST AS JOBS IN OTHER COUNTRIES.
I'm an OB/GYN. While I know this conversation was more nuanced than a single comment and I acknowledge I have a hard time not being insanely defensive when it is implied we should/would do our jobs for less compensation, I have to just say how demoralizing it is that discussions of healthcare costs so quickly turn to physician salaries. Physicians (and multidisciplinary teams- NPs/PAs, nurses, medical assistants, imaging and respiratory specialists, pharmacists etc)- are the only ones in this massive convoluted system who are actually providing CARE. For-profit insurance companies and massive hospital corporations are intermediaries who have injected themselves into OUR care relationship to get theirs, diverting money that should go directly to care. There is this idea that doctors are overpaid (we aren’t) and therefore the problem. Physicians just took yet another CMS fee cut this year and are paid less in just gross salary number than our mentors from 30 years ago. Adjusted for inflation I already make almost 40% less than partners in my practice did in the 90s. And they didn’t have loans or malpractice anywhere near what we have now.
The reality is that on a Saturday night I am charting and catching up on labs and results for patients I squeezed into every possible second of my days and nights, consistently working well over 80 hours weekly. This is significantly more than 2 full time jobs and is more the norm than the exception in my field. At least half of this is uncompensated work. Just this week I spent hours trying to get insurance companies to cover things like pelvic and breast MRIs, a second opinion for aggressive breast cancer treatment in a young mother, a very needed hysterectomy, and the RSV vaccine in pregnancy which United continues to deny despite FDA approval an insistence they'll cover it(!). There aren’t enough of us and the amount of patients waiting for care is daunting and endless.
I see and appreciate comments on how many other professions have long hours or risk of bodily harm etc, for too low wages. Firefighters are up all night and risk their lives, they should be paid more. Teachers have become heroes to me in so many ways and I'm SO grateful for them. So many people deserve better pay. At the same time, you'd be hard pressed to find a profession that has the combination of hurdles and challenges that medicine does. I spent 14 years, which is ALL of my 20s and into my 30s in class rooms and clinical settings 80+ hours a week, going half a million dollars into debt, while chasing my passion and “life’s calling” (not sarcastic- I absolutely love my work and would probably do it for free to the financial ruin of my family if they let me). I continue to work hours that leave me missing my kids and woken at all hours of the night. I have to pay ungodly malpractice premiums and ALSO worry that I would be a felon for doing my job ethically in half of America today (and who knows what tomorrow will bring). I do not seek pity here- I chose and love this life and I'd choose it again every single time. But honestly, I don't want my kids to choose it. And the idea that without MASSIVE reform of education costs, length of training, physician pay schedules, physician liability, etc, we would just do all the above out of the goodness of our hearts alone is so disappointing.
I worked in public health on my road to medicine and have long advocated for some kind of universal program that cuts out our private for-profit insurance model entirely. But unless the money that is poured into private insurance gets poured into this theoretical universal program, it doesn't work. Medicare For All doesn't work at current CMS rates- I would have to close my practice immediately if the Medicare rates were the rates for everyone. I wouldn't be able to pay my front desk staff and my rent let alone make a dollar of my own to keep. And there remains an issue of limited resources- government "rations" care while private insurance "denies your claim"- these are two sides of the same coin. We certainly have endless problems in healthcare with only painful and complex potential solutions. But physician salaries are NOT the problem. Our endless moral injury and the speed with which we are leaving our life's work may add to it though.
I appreciate your comment so much. I recently saw a billboard while traveling- it was a lawyer who offers to sue OB/GYNs up to 18-21 years past a birth. I cannot imagine the stress that causes you and the malpractice rates you must have to pay. That calls for reform and I am so sorry. I also concur with your points about government in other countries rationing care. I have lived in the UK, where a person might be on a 10 year waiting list for ADHD medication, and in Canada, where I probably would have died from my brain tumor while I waited for an MRI. Definitely the other side of the same coin.
Yes- I don’t think a lot of people realize this legal tidbit. Typical Medical malpractice claims have a 2-3 year statute of limitations (differs by state), but birth injury/OB claims in most states are 18-21 years. Just leaving practice is often difficult because you need tail/supplemental insurance that’ll cover you from 18-21 years after your last delivery. It’s an aggressive (and highly emotional) area of personal injury law and the toll of these lawsuits is huge in our field- I’ve seen it in so many excellent colleagues devastated by some of these cases.
I would direct my comment to all of the doctors and doctors' family members in this thread in saying, THANK YOU for taking the time to share these specifics! I have never necessarily "blamed" doctors for the problems I see and have experienced myself getting healthcare as a chronically ill person. But I definitely assumed doctors were doing better financially than it sounds like they are. I know I carry some bias against the medical profession because of my rough experiences (which in my calmer moments I can attribute to the system rather the individual doctors) so I needed these comments to set me straight on some things. I appreciate your thoughts and your dedication to your work, which I hope someday will not come at such a high cost to you and your family!
My husband, dad, and brother are all physicians and I hear you Katherine. I also think it’s an interesting add-on that all of these care-professionals would never organize and strike due to the Hippocratic Oath, “First, do no harm.” If for any reason conditions got rough for these workers, leaving the profession is seemingly their only option.
1,000,000%! All of this.
Katherine, I am so angry on your behalf! It should not be this way.
I would write you a novel, but I have 3 minutes at my metro stop, so my main point from my perspective living in Denmark is this:
There will still be massive amounts of money in a universal system and there will be fights over where they should go. But the headaches of insurance access and denials is just gone, and it makes a HUGe difference.
When we compare my family’s tax increase since moving to Denmark to the various places we needed to direct our money in USA (insurance premiums, child college savings), it evens out to about the same. So universal healthcare isn’t so much going to save anyone money, but it’s going to save everyone the headaches you describe. Again, I’m so sorry it’s this way.
I came on to point out that healthcare’s rising costs has little to do with physician pay and I see that many others beat me to the punch! I am a primary care pediatrician who works in a clinic for the underserved. Believe me when I say that my salary is not driving up the cost of healthcare ;)
Medical school should be fully publicly funded. At least at state schools. I am 5 months away from a PhD in physics, and it has been fully paid for by government grant money and one year of working as a teachers assistant for my university. There are estimates that it costs on average 500,000 for one physics PhD. Not only are our tuition and fees (and even our shitty student health insurance) fully paid for, we also get paid a stipend. It’s right at the poverty line, but it’s enough to live on. With all due respect, a physicist is not as valuable to the country as a medical professional. Especially because most physics PhDs go into private industry because there aren’t enough faculty job openings to support the number of physics PhDs graduating each year. So where is all that government grant money going? Why can’t we significantly limit the number of science PhDs we fund every year and instead put that money into MDs and nurses? We know how to do this, we just choose not to. I get that it isn’t super simple, but we’ve fucked ourselves by letting medicine be overrun by capitalism. If medical professionals didn’t graduate with massive debt, they wouldn’t need to make quite as much for all their stress and pressure to be worth it. It’s one way to start tackling the healthcare un-affordability and inaccessibility problem in the US.
Hello! I’m only at minute 15, but Beth mentioned hesitation around making something that’s not working even bigger, and I told my husband to ‘hold my ginger beer’ so I could tap this out.
I spend A LOT of time thinking about universal healthcare as an American living in Denmark.
One thing I think we miss so much is that universal healthcare can be broken down into smaller pieces! Denmark has 5.5 million inhabitants. The national law has legislated it. But 5 (or 6?) different regions actually execute it. So even in this tiny country, they decided 5.5 million is too many under one system.
And what’s great about the US is that it’s already broken into states. How lucky are we?! Imagine Ohio have 8 healthcare regions, California having 50, etc.
…ok that’s all for now.
…and then the question of salary incentives for a hard life for doctors. I was nodding, “Yes, Beth, yes!” when you came around to needing to reform the higher education/debt system, remove the profit incentives that spawn burnout, etc. There is SO much at play here.
Things are not perfect in Denmark, to be sure, but doctors here make a reasonable living. Are they the richest? No, but they make a fine living. Generally there’s a smaller range of salaries here (aka there aren’t many ultra rich; the middle class is huge).
Looking to the US from abroad, I feel like it has placed doctors at the apex of all people—the most important. As if the sanitation workers who save us from disease don’t save lives. As if (volunteer) firefighters don’t also save lives. As if artists don’t save lives. As if the neighbor who checks in neighbors doesn’t save lives. I feel like everyone plays a role, and generally salaries should be more even.
I also wonder if we treat US doctors as near-gods BECAUSE of how much money they make. As if their salary must indicate an omnipotence.
Thought 1 - a friend of mine is an employee of United Healthcare. She was watching the investor call that the CEO was arriving to. Her sharing the story of being in the office when the news broke really brought this story to ground level for me.
Thought 2 - my new errand equivalent is a train commute. I have always lived within a 10-15 min drive from my work, but recently took a new role with a 45 min train ride into the city. I was really nervous about this change but, so far, I LOVE IT. You cannot do anything on the train but be on the train. I have given myself a screen moratorium during the commute so I read or just sit and look out the window. In some terms, it’s definitely inconvenient. But it’s also a big chunk of each day where I am being vs. doing.
After listening to the episode, I am wondering if any of the following could be potential solutions to the health insurance issues.
- should the government pay off all student loans / non-consumer debt for healthcare workers upon their graduation? (I also think this for teachers and other common good jobs)
- should health insurance providers only cover emergency/catastrophic situations and employers or medicaid for all only cover preventative health? (making the system smaller) essentially tiering our insurance.
I wonder if these would help at all. Because I think the biggest problem is that there are no motivating factors to make people feel seen and cared for. Paying off loans shows care. Prevention for all seems like a good compromise. Just some thoughts.
I think you bring up interesting ideas. But just to push back on each a little bit… To your first point, what defines a “healthcare worker”? Last year when buying a car and providing my employer, I was told I could get a discount if I were an RN or MD. Now I do not consider myself a “provider” but I do allow care to be provided, in a way. To your second point, we would have to clearly define emergency care, likely by a definition in a regulation. We do have this somewhat defined in emergency use of “test articles” - drugs and devices that are not FDA approved yet, but probably more complicated in regular clinical care. Totally not trying to call you out, but I thought you brought up interesting points. As Beth has said “We can do hard things!”
You are totally right. Every solution will have unintended consequences that we can’t predict. Thanks for your insight! Definitely did not feel called out at all!
My husband and I were just talking last night about our disastrous health insurance system. Something needs to change, but I am not sure how you do it because it is so huge and so intertwined with other things. We can't just rip it down and start over unless we want complete chaos and limited access to health care for 5-10 years. We have to change incrementally. ACA was a feeble but good start. Now we need to improve that rather than try to get rid of it.
Universal health care does not necessarily mean Medicare for all or government-run health care. Lots of countries have other models. Germany has universal health care, and much of it is run by private entities. Perhaps they aren't a good model since they are the second most expensive health care system in the world, but their costs are still 35-45% less than the US (depending on if you are looking at it as a percentage of GDP or a per capita basis). And it might be easier for us to move to this system.
We also need to subsidize medical workers' education more. (And the education of people in many other fields). Medical workers make significantly less in most other countries, but they do not have the education costs that we do. Other countries also have many more workers that have less education to address common health issues. I do not know how Americans would react to that, though, since I already hear people complaining when they have to see a PA rather than an MD, and the workers I am referring to have less training than a PA or even RNs in the US. Another factor is that there is a better social safety net in most of Europe, so employees do not feel the same need to make high salaries as they do in the US.
I recently learned that the average teacher salary in Europe is lower than in the US, but a big difference is that people in other highly educated fields, such as doctors and attorneys, make significantly less than they do in the US, so the gap between all those fields is smaller, making teachers feel less disgruntled and unappreciated.
I have so many thoughts on the errands thing! My husband became our designated tribute during the pandemic (if someone had to go out to get a thing, it was him) and we retained that habit for far too long. I finally snapped one day because I wanted to go to Target and he said he'd just grab what I needed next time he was out. I was like, I don't need [the thing on my shopping list], I need to get out of the house and mingle with strangers and stroll aisles mindlessly and grab a Starbucks while I'm out and maybe see if the shop around the corner has anything new I might want to read! I need the act of the errands!
We realized he had seen it as taking tasks off my to-do list, and I had seen it as one more way I was trapped in the house with the kids while he got precious solo time (not answering 5 million kid questions! Listening to whatever music he wanted! SILENCE!)
We're much better at vocalizing this now, but I do occasionally still get to a point (because I mostly work from home and I'm the primary parent for all pick-up, drop-off, after-school, weekend, you name it activities) that I become Chili from the Bluey episode where she says that she just needs 20 minutes where nobody talks to her, except I need an hour at Target with a latte in hand.
As a Canadian I have a lot of experience with public healthcare, and trust me, it’s not perfect. But also, I’ve never once worried about what I’ll do for healthcare if I lose my job. I don’t know a single person that has thought twice about starting a business or taking a break for work because of health care. I’ve never had to worry about going bankrupt because I lost the health chaos lottery. I’ve never had to put off going to the doctor if something is wrong just because I don’t have the money. Yes, there’s lots of room for improvement, but the lack of worry and stress I feel over healthcare has probably helped me to be healthier up to this point.
Yes, I have many Canadian relatives who work in a low-paying industry, mostly self-employed - fishermen and lobstermen. These are some of the most dangerous jobs out there, but in the US they are likely to be un or underinsured. One of their kids had a rare disease. The only thing they had to have a fundraiser for was the travel back and forth to Toronto. They really don't understand why we put up with our system.
Yeah, most Canadians think that public health care is an obvious choice and don’t understand the reluctance to switch. The only people I know here that want private healthcare are a couple people that are independently wealthy and don’t want the inconvenience of flying to the US when they want to skip the line.
My thought regarding why this was not part of the election. Maybe we have given up on healthcare like “it’s bad, it always has been, always will be”. Insurance is tied to jobs that not everyone has, and it is extremely opaque. Groceries and gas have prices people can see go up and down.
As for Drs. salaries, I don’t think that’s the worst part of the system. They are people that do a lot to preserve our lives. Insurance and for profit hospitals put pressures on them from the financial point of view that many PCPs and other first line of care can’t stand because they have limitations even on how much time they have with each patient. They have unique skills that are useful. In a world we’re a grown man makes millions a year to chase a ball I will not complain for Drs. making the money they make.
The idea of reducing pay to medical professionals because people will still do the jobs anyway? Yes, they will, but you will absolutely and significantly diminish the quality of people still willing to do the work. The best and brightest won’t bother. That OB/GYN mentioned who was willing to quit despite good pay? Multiply that by tens of thousands plus saying “f*ck this noise” if the salaries were to get slashed. Then the shortage of providers would be untenable.
Absolutely!! And let’s not gloss over how much more at risk we would be with less doctors/nurses/medical personnel. All you have to do is look at states and counties who no longer have obgyns or medical facilities close to home. How many people are living and will live in medical deserts, but let’s keep paying athletes, celebrities, lobbyists millions and millions of dollars 🙄