It doesn’t have to be that way…we just have to have legislators that want to work FOR the public…for their constituents…instead of, to the highest bidder. We need complete reform in our government…only then (imho) can we come to common sense legislation for us, as a nation. Not the top 1%.
well, I live in California and am shocked you paid about 50% of your income in taxes; are you counting things like sales tax in this equation?
We pay about 35 to 40% of our income in taxes (State and local) but we take literally $0 in deductions, as we are not homeowners and have no other factors at play (we paid less when I was freelance and deducted home-office expenses).
Still, live in San Francisco and as such can get access to a universal health care program as long as I’m employed and live in the city, along with 12 weeks fully paid maternity leave. These programs actually have a negligible impact on my total tax contribution; by far the biggest cost is federal taxes, which go to a bunch of services that are much less visible to me, many of which I disagree with.
So I think paying 75% of income in taxes is a bit of hyperbole, personally. But yes, providing health care access for more people will likely result in higher taxes. Personally I’m in favor of increasing those health-care-related expenditures and then decreasing tax expenditures for other things.
Didn’t even think of sales tax. I’m talking about federal income and FICA tax, self employment tax (I was not incorporated), state income tax (not insignificant), property tax.
You would also be shocked at the business taxes, fees and assessments that I paid from my gross practice income. Next time you go to your dentist all him why he charges $1500 for a crown.
BTW, I don’t care about which agency it goes to, it’s still money out of my pocket.
huh, I think this may be the difference between being in private practice versus employed by someone else.
As a total aside, my dentist billed $600 for my first-ever crown a few months ago I paid $300 out of pocket. I had no idea if that was expensive or reasonable. So that’s cheap?
That is less than half of the Delta Dental acceptable fee for a crown in the Bay Area. I was in the East Bay (Contra Costa Co.) as of five and a half years ago, and my accepted Delta fee was $1250.
Maybe there was some other fee that was separate. Maybe that was just the crown and the filing down and the temp crown were billed separately…
Interestingly here, we have a pretty good discussion going about why things cost more here in the healthcare field. If we decide to socialize our healthcare, as with every government decision there will be winners and losers.
Losers would likely include, all specialty physicians whose income will go down precipitously, insurance companies who would have to go out of business, pharma companies who would have to sell to one insurer, highly paid hospital executives who would likely have their salaries capped.
Winners would likely be the government employees who would need to multiply many times over to administer the system.
Interesting things to noodle.
It is very unclear what effect this would have on hospitals.
I use Delta Dental of California. My last crown was billed for $650 (I had to pay $130 out of pocket.)
@ClaudnDaye I assume you don’t live in California. Delta allows maximum fees according to the provider’s zip code. It varies widely across the country.
1 Like
Yep, I live in VA (arguably the most beautiful state in the country.) 
Unintended consequences include losers being patients, as a result of lower quality providers coming on board due to lower income possibilities, and existing good providers exiting the system for the same reason.
Believe it or not, bright young people go into medicine in large part because they think that it can provide them with an above average income for the rest of their lives.
1 Like
I agree completely with your assessment. This is the problem that tinkering with this will have. If they come up with a way to modify it, but still capture the best and the brightest great, but I don’t think that is what they are looking at.
I’m not concerned about the quality of provider because I am not convinced the best and brightest are the ones who become doctors now anyways, and I don’t actually think most people get such great care as it is. I am also suspicious of the notion that a person who goes into medicine solely because it pays well will necessarily be good at their job, no matter how smart they are (I’ve met and even dated a few of these types – I would NOT want them as my doctors).
Call me cynical, but having come from a community where the only acceptable professions were doctor or engineer (lawyer = failure), I can say with confidence that many of the people who became doctors were not the best and brightest, not by a long shot, they were just the ones who cared most what other people thought of them. The smartest ones either became researchers, programmers or financiers, depending on how much they were driven by profit versus interest in science. A handful of the sharpest kids became doctors but most became something else.
Some of the specialties are rightly remunerative and essential, while others seem like they are overdue for market adjustment anyways. Is it really such a great thing to have so many dermatologists and so few endocrinologists, for instance? Do we really need so many orthopedic surgeons when most of the latest evidence suggests their most common and lucrative procedures are no better (and are sometimes worse) than placebo?
1 Like
I don’t have a problem calling you cynical. 
My experience is somewhat different. Warning, two unrelated examples coming
First, medicine is not in and of itself all that exciting, I have two very close friends who are electrophysiologists and both of them were very smart and were bored of the work by the time they got to 40, since there wasn’t much else to learn, and research on humans is quite limited unless you are at a center that supports this. One quit the profession and went into business and the other stayed because it would be difficult to make as much as he was making doing something else. So perhaps this supports your position that we don’t need the best and brightest.
As part of my professional life I have been exposed to a lot of physicians in the US, the EU, parts of Asia, and South America. Interestingly, US and UK trained physicians are held in very high esteem. Once you get to mainland Europe physicians aren’t held in as high regard, and so there is a lower proportion of the best and the brightest in my opinion. Also, in mainland Europe you are likely to find many physicians becoming sales reps and trainers for medical companies rather than doctors because there are more graduates than positions. Also in mainland Europe positions are very hierarchical and you need to be politically motivated and have a lot of patience to get ahead.
In my experience having watched all of these physician operate on patients, I feel most comfortable with the US/UK approach when it comes to my care.
1 Like
that’s interesting, @Chris.
I’ve only ever received care in the US, India, Australia and a few places in Europe. I would say hands down the doctors in India and Australia were the best at treating my conditions. In India the doctors aren’t always the brightest (although because placement in schools is based solely on the results of a final high school test PLUS some allocations based on caste, they certainly are the top scorers in the country, especially if your doctor comes from a high caste), but their training involves seeing so.many.patients, so much more hands-on clinical training and so many people with weird, weird conditions that they really just get good at the pattern recognition. Also, the doctor came to your house in India, which was huge when I was ill. However, I would be very wary of going to the hospital in India, which are really all over the map – either they’re boutique hospitals or filthy and full of inattentive or even cruel staff.
In Australia a general practice doctor at a free clinic immediately identified a skin condition that had been missed by two dermatologists in the states. In Europe the doctors seemed adequate but I wasn’t exactly tasking them with medical mysteries, so it’s hard to say. In the US, I’ve definitely had a mixed bag. Some great doctors, and a lot that missed diagnosis that even I could come up with using Google. And then of course, because of the shortage of doctors, you often get stuck with NPs or PAs, and with those the quality has been very uneven. A PA stitched up my finger after I stuck it in an immersion blender and absolutely mangled the job.
@TiaG Either you are over cynical or I am just too old to understand the current thinking.
When I went to high school almost 50 years ago, only the best and brightest could even hope of getting into med school, or dental school for that matter. Competition was ferocious. The second tier students went into law or business.
I think that had something to do with our health care system attracting patients from throughout the world.
I value my healthcare, and the healthcare that my children and grandchildren will receive. I fervently hope there will be continued incentive for the best students to go into medicine, but with your analysis of what’s happening now, that may just be a pipe dream.
P.S. I’ve been to a lot of doctors in my life, and the best ones always seemed to be from my generation or older. Maybe that should have tipped me off to how the situation has devolved.
I know we’re only talking “physicians” here…but if we’re talking overall “best and brightest”, I’d only say…
(I’m sure any of the below guys “could have” been physicians had they opted to be.)
Person - Born where?
- Albert Einstein - Germany
- Nikola Tesla - Croatia
- Leonardo Da Vinci - Italy
- Isaac Newton - UK
- Galileo Galilei - Italy
- Stephen Hawking - UK
- Charles Darwin - England
Lots of modern extremely intelligent people from Europe could also be added the the above list. Historically…the “best and brightest” come from MAINLY Europe.
I never meant to say or infer that smart people don’t come from Europe, what I tried to say, perhaps inelegantly, is that the smart people in Europe choose professions other than physicians.
1 Like
Hi @docslotnick, I think things have changed since you went to medical school.
I went to a pretty decent high school in Dallas and just looked again at what our top 10 in the class did after school. I couldn’t do the same for college because UT Austin is huge and I have no idea who the “top” students were other than in engineering and my other major. (Obviously, top grades is an imperfect measure of “best and brightest” but it’s a pretty decent sample.)
In the top 10 in high school: Four went into science or research and got PhDs, one went into law but eventually became a freelance writer, another became a science fiction writer, another became a marine/businessman, and three went into finance/business. Only one became a doctor). From the valedictorians/salutatorians I knew at other schools, I would say that’s a fair estimate: about 1 in 10 of those top students went into medicine.
That’s not to say that competition for medical school isn’t fierce; it’s just that the crowd that chooses to compete in this arena is no longer, in my opinion, the absolute smartest of the smart. To give you a sense of what I mean, it is now more competitive to get into PA school than to get into med school; fewer years of school, easier work-life balance, decent pay, etc., have made it hugely attractive. And yet I would say across the board PAs I have met have been less intelligent than the doctors I have met. So the competitiveness alone doesn’t really determine the caliber of people entering it.
It’s funny that you prefer doctors of your generation; I tend to prefer doctors who are maybe 10-15 years older than me (maybe 45-55), though the best have been all ages (except residents). Not sure why. they seem to have that good mix of research savvy, caring about the patients, and less paternalism than older ones. So I guess to each his own.
@TiaG Are we uncovering a generation gap? 
1 Like