TED Conversations

Martin Odber

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Can the shortage of doctors be solved using an adaptation of the third law of supply and demand?

The third law of supply and demand states "If demand remains unchanged and supply increases, a surplus occurs, leading to a lower equilibrium price."
( http://en.wikipedia.org/wiki/Supply_and_demand )

If we increased the rate of new doctors entering medicine (using mechanisms such as but not limited to; subsidizing doctors education, further compartmentalizing aspects of health care etc ) until we reached a surplus state then would waiting times and the cost of healthcare go down accordingly?

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    Sep 12 2013: It seems clear to me that the bottleneck is our system of education which has a vested interest in limiting competition for those who pay them dues and an even more obvious interest in bloating curriculum to try and justify their ludicrously high tuition. The Netherlands where I lived for more than a decade has affordable universities that are open to anyone with reasonable aptitude and not surprisingly they have affordable healthcare and even export some medical grads. They also do not allow Pharma to loot the populace and regulate insurance companies and make it unprofitable to sue a doctor for malpractice both for the patient and his lawyer. IF we could make the term "internationally accredited" mean what it sounds like this problem would soon evaporate. Instead jump through and over the barriers to get ones diploma recognized is more difficult than writing a dissertation in many cases. These artificial "protections" do not actually assess competency. If they did I would be support them, they just protect the monopoly of the diploma mills.
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      Sep 13 2013: Chad, would it be possible for you to provide us some more specific information on how the Netherlands manages the tasks you spoke of and what the levels of service etc are? It does sound very interesting but I have to admit I'm ignorant of how things are done there.
      • Sep 13 2013: Yes, information such as population of the Netherlands and individual income tax rate. Also, is there an immigrant problem in the Netherlands ? Do they have thousands of people flacking to the country on a monthly basis ?
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        Sep 13 2013: Martin tuition has been 1500 Euros per year, regardless of course of study. My niece paid the same for medical school. Luis the population is a little over 16 million. No they do not have as much of a problem with illegal immigrants but they do have a Muslim population that is resistant to integration. They do not have fancy facilities nor multi million dollar sports programs but I know their professors get better benefits if not more pay. Income taxes are a bit higher but peak at 50% with the average about 30%.but a lot of deductions are still possible so that the burden is not heavy. Sales tax had been 19% but has recently gone to 21% though none on food. Overall I would say living standards are better although space is tight. The big difference is that they have truly affordable health care and good public transportation + longer life expectancy instead of bragging rights about having the best military.. They walk their talk when it comes to taking care of their people. a third less infant mortality speaks volumes. Higher GDP per capita also speaks to a better educated populace.
    • Sep 13 2013: I would like to amplify Chad's point regarding education and doctor costs. A friend of mine is currently in medical school. The four year experience will likely cost around $250,000. Had he skipped medical school, but instead become a chemist, he would have been earning around $70,000/year. He calculates, though I have not checked his math, that to break even over his lifetime, he must earn $250,000/year as a physician. This takes into account the earnings he has forgone for the eight years between the start of medical school and the end of residency, including the interest on the loans he must take to get through medical school. Assuming he is an average medical student, this means that we must pay an average of about $250,000/ year to physicians in order to ensure an adequate supply. The Netherlands subsidizes education, and can therefore pay less. My knowledge of Canadian medical school costs is limited; I am pretty sure it is less than in the US, but more than the Netherlands. Either way, I think we must realize that the supply of physicians is bounded by the need for them to earn a profit over other professions over the course of their lifetime.
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        Sep 13 2013: So essentially if we were to devise an inexpensive way to educate physicians to current standards that would prove a key component to downsizing expenses and increase supply?

        Tina Wang,
        So then the government is interfering with supply and demand by limiting how many spots there are in schools for aspiring doctors. That's a new wrinkle I was not aware of.
        • Sep 13 2013: I cannot say that I understand the politics and economics behind Canadian medical schools but as far as I know, the supply is there. There are far more premed students aspiring to gain entrance into medical schools than there are spots for them, and the ones turned away will probably make an equally good physician as the ones accepted. The schools themselves are even agonizing over having to turn away these other above exceptional applicants. The problem is that the spots each school can offer is limited by the public authority. Canadian medical school tuition is already largely subsidized by the government and hence they have the final say in how many positions there will be available, which is based loosely on the anticipated demand for physicians, which loops back to the question if a surplus will lead to lower healthcare cost, which means that we can afford to put more doctors into our system...

          I do not think lowering education cost is the point here as there will be more who are willing to pay more to become a doctor.
        • Sep 21 2013: Indeed, finding a less expensive way to educate physicians would allow more physicians to be educated. Both the US and Canada limit the number of medical school positions available. The reason, basically, is that physicians are enormously expensive to educate. The tuition paid in the US covers at most one-third of the cost of physician education. Limiting that subsidy would raise tuition beyond any level of affordability; presumably the same problem exists in Canada. To limit total costs, the number of slots is limited. The supply of physicians therefore has little relation to the need.
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    Sep 7 2013: Martin,

    The problems along the way are diverse.
    Simple answer goes as such, invest more in training doctors, arrange a clear and simple set of laws and base line of care which protects the poorest and needier, control and punish the persons in charge of the hospitals and clinics not fulfilling the laws and standards of care.
    The problem is not only on the scarcity of staff, the problem is that people in charge, wealthy or with power can afford health care by paying the exclusive services or corrupting the public. They don't feel the pain of waiting countless hours, they don't get there hearts smashed watching close one''s suffering while waiting. For them the system works just fine for they hold the power.

    You don't even have to have public hospitals you just need to have a government/state that basically says: this is my country, those are my people, you insurance companies and hospitals have the privilege to be allowed to care for their health and in this specific set of rules to have profit. Then pay your workers, suppliers, your taxes and your suppliers pay their taxes (corresponding to the payed in that particular country) here too.

    Here we reach other and probably the major problem. Suppliers. What it's payed for drugs and materials is obscene. The rules "protecting" the patient are only to ever speculate over prices.

    So cut short, you want a better the health care? you have to beat the lobbies controlling the system from top to bottom. For that you need politics, directors, chiefs, capable enough, value and technically wise, with a good amount of ethics not to be corrupted and bought by the different lobbies and so perpetuating this cycle. But then again, you hardly get some one in a position of relevance if not sold already somewhere the line. But do as I try to do, be the best you can be, respect your values and hope to make a difference in the measure you are allowed to. PS_ hope no one with power feels threaten by what you stand for.
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    Sep 6 2013: Martin, Sounds like Socialist Central Planning. We need less government NOT more. I took my son who just got out of the military to the doctor ... he did not have a job or insurance at the time. His appointment cost was $25. I went home and looked at my medical billing statement and my appointment cost was $150 with insurance. I went through all of the items on the bill and found out if I saved XX amount a week for medical and went uninsured I would be way ahead .... the reason I keep insurance is for catastrophic events. Insurance for him to practice drives costs up ... insurance on my part drives his profits down. Equipment costs are extravagant ... Doctors are in debit for a long time due to operating expenses. Look at your billing statement at what was charged and what the insurance actually paid. It is a big middleman game.

    The Canadian 13 hour wait is based on triage assignments. Since the law was passed that no one can be turned away in the US at the emergency room .. we have the same problem. All of the illegals that desire free care go to the emergency room for a cold or less even. They completely tie up staff ... cause long waits ... do not pay .... etc .. That is the type of government interference that has caused the problem you mention.

    Obamacare is based on wellness ... numbers support fewer doctors and more clinics staffed by technicians and maybe a nurse.

    The waiting time for surgery in Canada is off the chart and lucky if you get the operation you need .... for those of us in the US that have read the new medical plan (Obamacare) see this in our future as well. It has little to do with the amount of doctors and a lot to do with government interference, red tape requirements, and seeking permission from a bureaucrat on a medical issue. Many Canadians come to the US for procedures they would wait a long time for or have been refused. However, you do have a better program for prescription drugs.

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      Sep 6 2013: Bob,

      I think at the end of the day I am very PRO as to subsidizing doctors education utilizing government funds.

      Frankly, so far in my entire life it hasn't mattered ONE BIT what approach was taken to governing, taxes go up, prices go up, wages go down. Subsidize or dont subsidize doctors makes little difference on that front and I think we both know it.

      However, I read about the vets that were being sent to that hospital where the mold was growing on the walls, and I was appalled.
      The men and women of the armed forces gave all they had protect their country, came back in parts, and were dropped off in conditions I'd not leave my dog in.
      I realize those persons were not rich with great insurance, ok fair enough. But they were and are people who put it all on the line for people who are, along with everyone else.

      Those men, women and children out there on the streets, are our countrymen. Our nations family.

      I think all people in our country deserve the basics that it takes to "pursue happiness" and in my book good health is right there top of the list.

      To think my taxes were ensuring myself my family my community my country had great healthcare? Thats worth something. Its worth alot actually.

      So yes, if getting great healthcare means subsidizing doctors educations so we can make sure we're well looked after is what it takes? DO IT.
      If establishing great healthcare using advanced technology is the answer as it cuts out labor costs? DO IT

      Whatever it takes lets do it, and not sit on our hands and say .. well thats the way its always been, we should just accept it.

      Our nations are first world nations. Top of the line, and our people are not worthy of decent affordable healthcare? Our genius's cannot figure out how to achieve this for us?

      ..a last comment Bob, "Martin, Sounds like Socialist Central Planning" Bob, .. whatever label people come up with that means "working so the the team wins" should never be a bad word. Together we stand, divided we fall.. "
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        Sep 6 2013: Martin, We both want good and affordable health care. This discussion is really about two things: 1) how we arrived at this mess and 2) what methods should we employ to resolve the issues.

        "Most" doctors are good people who want to help ... yeah, there is also some greed mixed in there ... So if we start there what are the problems that got us to where we are. I see a few that could be major players ... lawyers, unions, big government, and social programs that are unfunded and become a millstone around the economy.

        My doctor is also a close friend. He spend much of his time on welfare and pro bono cases just as emergency room do ... the working society pays for those cases. He see many who never take his advice and are their own worst enemy ... they smoke, are "fat", never exercise, eat wrong, and so forth ... unfortunately these are the very people who are looking to make a quick buck and there is always a lawyer lurking in the shadows for a lawsuit. He pays high insurance on his practice, staff, facilities, equipment, and personal policies. He must hire more people to keep up with bureaucrats who tell him how and when to practice medicine.

        So here is my idea to solve the problem: 1) Return to a Constitutional government thus reducing size and cost. 2) Eliminate frivolous lawsuits 3) Eliminate mass social programs that kill the work incentive and inspire generation welfare 4) term limits for "career politicians" thus stopping the elite mentality of congress and 5) insurance is necessary but is out of control ... like unions we need to evaluate and regulate the industry.

        This issue about money and power .... not really medicine or the public. Much like illegals ... it can be stopped but they represent a voting block so ignore the Constitution ... power and money.

        Once again the middle class suffers and foots the bills ... More government is never the answer.

        Lets solve the problem not add to it.

        Regards .. Bob
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          Sep 6 2013: 1 Constitutional government, so pretty much wipe out all government services except by those specifically defined by the constitution. This may not necessarily mean any reduction in cost or taxes, it could for example simply have the remaining government figures having very high salaries.

          2. Eliminate frivolous lawsuits. We may agree here Bob. I think justice would be a lot better served if we removed lawyers from the equation altogether and had individuals present their cases directly to a judge and jury. All to often we see justice degraded to "may the best lawyer win."

          3. Eliminate mass social programs. Very uncool I think. Unemployment is already rampant and as jobs get shipped out globally that number will grow. In the US there is a right to bear arms, and when people get hungry they are going to turn mean and use those guns to survive. Once a person with their bag of money starts spending 24 hours a day hiding from those armed starving people willing to kill or be killed just for something to eat.. you may have some refreshing thoughts about the values of social programs. I can assure you that living on food-stamps as it is is no picnic for anyone there and I'm pretty sure they''d all like to have great high paying jobs. You really sure about this one Bob because people may not return to slavery as quietly as you might hope?

          4. Term limits for career politicians. Last time I checked we're already playing the "the name changes but the game remains the same." Provided the political parties and system remains the same, how does changing the faces any faster actually help the country? I feel unsure how this would benefit.

          5. Insurance is necessary but out of control. like unions we need to regulate .. this statement is contrary to the "constitutional government" yes? As well.. I think the real issue there isn't that insurance is too high, but that people need to earn more money so paying it becomes a non issue. To that end I actually fully support unions.
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        Sep 6 2013: 1. By simple accounting ... less people, facilities, etc would mean less taxes and expenditures. It would also mean that representatives would meet for less time and salary would match work. The original intent (IMO) was for Congress to perform civic duty ... not to become a millionaires club.

        3. This is a difference between you and I as Liberal and Conservative ... I think that we should determine needs on a per issue basis. Mass programs create entitlements ... since these are unearned it develops generational welfare of you owe me. I owe you nothing. I will provide a hand up but not mass social programs of a hand out.

        4. Have to agree with you. This must be done with the return to a Constitutional government and the return of the representatives being civil servants meeting once a year for two month or so. It could be compared to school boards who are unpaid. We need fresh ideas and new views by people who will not be there long enough to manipulate the system or become rich.

        5. Unions are a Marxist invention where the the ideas was that the value of the product lies the the craftsmen and therefore owners and managers were unnecessary. Lately people have come to realize that unions have lost sight of their original purpose and have voted them out. As for your statement of insurance isn't to high but people need to make more to afford it .... when wages go up costs go up .... I have yet to understand the mentality of .... if you don't give me more money we will shut you down and not have any money. Who sold workers that idea .... Hi honey we didn't get a raise so we are going to shut the whole company down. We will lose the house, the car and go hungry. Boy did we show them.

        Thanks for the reply ..... Bob.
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          Sep 7 2013: 1. Politicians decisions and math are not interchangeable. There is absolutely no guarantee that less government equals less cost, only in our dreams.

          3. Want to stand alone? I'm sure there are islands in international waters where a person can set up camp and owe no one anything. As for being a part of a society protected by an army, transportation and goods provided at reasonable rates due to mass production/consumption, jobs available because there is a society to purchase them, medical aid available because the masses require it.. to stand there and say I owe society nothing.. yes you can say it.. but don't you ever expect any reasonable person to believe it. Without society backing you, chances are good we'd have nothing backing us but trouble.

          5. When the average person becomes rich, a good deal of their money is saved, or spent offshore. Most people who are not rich, spend most of their money locally to themselves to improve their condition. That means the money goes back into their communities and nation. That means that unions, getting good wages for their people, are actually STIMULATING the local economy, not some nations economy abroad. Did you consider this before downing unions? With more and more jobs going to "minimum wage" faster and faster.. that downs the local economy and weakens our nation. Myself, I'd like our nation to be strong and prosperous from the ground up.
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        Sep 7 2013: 1) I never discussed politicians decisions ... I am against big government. If I reduce it then taxes must come down or someone needs to go to jail.

        3) No man is a island. I do not advocate total abandonment of government. I suggest a return to a Constitutional government. The federal has specif responsibilities and the power in invested in the states. You may have misunderstood what a return to a Constitutional government implies.

        5) My argument against unions stands .. on this we disagree and will not likely change views. On money going offshore etc ... many US citizens are giving up their citizenship because the IRS wants a share of all money sent / earned / deposited / invested / ect ... overseas. Jobs are going to minimum wage because Obamacare has determined the work week to be 30 hours. Because employers would be forced to spend millions to maintain the current level of employees they have reduced the work week to 25 hours to keep the business operating. The socialist hate for the wealthy is nothing new ... however, a look into the amount of taxes the rich contribute would defeat most arguments ... don't believe all the propaganda.
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          Sep 7 2013: I've erased my comment. We are moving away from the subject of how to improve our nations healthcare and digressing into a place that can bring us no good.

          Bob, if you really feel the rich have no obligation to their country or fellow man only to themselves, so be it. That will have to be between you and God, within the context of this debate that is not an issue for me to undertake.

          I will thank you however for your input, you have provided some interesting thoughts.
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        Sep 7 2013: The "rich" (1%) paid 39% of all taxes last year .... the top 20% paid 94.1% of all taxes. The charts show that all of taxes are paid by 25% of the people.

        As you say it is off topic. Perhaps we should cover that in a separate conversation.

        Thanks for a respectful conversation. I wish you well. Bob.
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          Sep 8 2013: Bob, I will always enjoy our debates as I keep in mind the person is separate from the action.

          Perhaps the day will come you will change my mind, or perhaps the day will come that I change yours, or some combination thereof.

          I feel it is more important to focus on what is right or wrong, than who.

          Cheers Bob!
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    Oct 4 2013: As our talk on this subject draws to a close, I would like to take the opportunity to thank everyone who participated.

    Opinions vary, at times we were very passionate about our positions but these are the very things that make a debate interesting and productive.

    As a result while originally it seemed like increasing the amount of doctors was a solution it came to light that there are not one but many contributing factors we as a society can adjust to address this issue.

    Again thank you all for sharing your thoughts on this matter it is much appreciated. I feel I come away from this talk more enlightened and filled with hope that one day every person will receive timely efficient reasonable access to quality medical care.

    God bless, and good fortune.

    warm regards,

    Martin Odber
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    Sep 23 2013: Quite correct, this is not a feasible purchase for an individual. It is presently being purchased by hospitals or universities, and is likely to remain that way.

    Martin, I suggest that personal ownership of such a device would be wasteful in the extreme, however. The set-up for the supercomputer permits many thousands of analyses a second; the current model involves renting time on Watson for diagnoses in the same fashion universities and government agencies rent time on supercomputers to run calculations.

    I do, however, believe that we are headed precisely where you project in the same fashion that physics computation on the Apollo missions was eventually superseded by smartphones with GPS. It is important to keep in mind this is the very first iteration of the use for the technology, which is composed of nothing but fields that advance at an exponential pace. The specific development you are interested in is being pushed from here: http://www.qualcommtricorderxprize.org/.

    As far as reducing costs, there are questions that could be asked. For example, how much computing power could be expected to handle an individual's annual needs for diagnosis? How streamlined could a program be made that focuses exclusively on medical purposes? Could similar software that is more efficient be written? Whatever the answer regarding computing power and software efficiency, how do the present demands relate to devices and resources available to civilians? Once the threshold for a cellphone is crossed, this solution will break like a wave over Africa, where almost all processing power in private hands is mobile devices. Would we be willing to wait longer for an answer if it meant skipping the doctor? Running a program that takes days to complete is conventionally regarded as a thing of the past, but if it is waiting for a doctor's phone call after forking over a lot of money, or forking over little and waiting on your phone, I'd pick the latter.
  • Sep 17 2013: In Australia the entry score for studying medicine is something like 97%. I believe that is too high a score and we miss many studying. Something a bit lower like 94%.

    I believe it is not just the academic score that makes a good doctor, other things like not believing the drug companies, not taking their gifts or research overseas trips etc. commonsense and experience maketh a doctor.

    The fact it takes something like 6 years is a long time to survive without pay, so are we excluding those brilliant people with 97% but not the wealthy parents to support them thru study ? Definitely a percentage of students should be subsidized.

    Often when I go to the doctor I do not need a doctor, and could well do with a Practice nurse. My doctor's regular nurse (she is not a Nurse Practitioner which is extra study on a nurse) is often better advised than my doctor and I often seek her input too.
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    Sep 17 2013: I return with some current events concerning the developments I mentioned:

    Regarding the efficiency and accuracy of tests: http://online.wsj.com/article/SB10001424127887324123004579055003869574012.html

    Regarding diagnoses:

    Digital tests and digital diagnosis seems, at the basic level, like problem solved.
    • Sep 21 2013: I read your article regarding Watson, and found it puzzling. It is not clear what Watson offers in diagnosing, say lung cancer. The intellectual track in lung cancer diagnosis is simple: Pt. presents with a symptom such as cough, and gets a chest X-ray. The xray is abnormal, and a CT is performed. The CT shows an abnormality, and a biopsy is performed. That's it. Where would a computer fit in? It cannot read the chest X-ray, nor the CT, nor can it perform the biopsy. It may help in deciding when to order the chest X-ray, but that is mostly a human question wherein the physician has to figure out what the patient really means in their complaint. My experience with computer assistance is that it simply slows one down by adding another layer of things to check.
  • Sep 12 2013: There is no system that is perfect, including and especially my desire that people have Health Savings Accounts with overinsurance, rather than government insurance or government healthcare. In the US we have Medicaid for the poor and disabled. These are state run, rather than federal systems. I do not believe we could or should change this system. However, Medicaid is really charity care, and most physicians lose money seeing these patients. We still see them, usually out of a sense of duty or Christian charity, but most practices have strict limits.

    The basic problem with any discussion of healthcare and healthcare funding is that people do not wish to see medical care as an economic service, like any other part of our economy. We have government safety nets for people who cannot afford food or housing, but we would never dream of creating a government bureaucracy to distribute food in some third party payment scheme to everyone in the country, regardless of income. Why should healthcare be any different? We definitely do have socialized education, but that too has dramatic flaws which are publicized daily.

    Like any other economic entity, medical care obeys laws of supply and demand, even if the response is dramatically distorted by government interference. More to the point, medical care must respond to the first problem of economics: how to most effectively distribute finite amounts of goods and services. ALL economic systems must make this decision. I do not believe that bureaucracies, either government or insurance companies, should be making this decision for us. Bureaucracies IMHO behave in ways to make their existence better, with any production being only a lucky side benefit. I would put us in charge of our own lives, and making our own decisions about our own medical care. The system of HSAs with overinsurance is the best I have seen toward achieving this goal.
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      Sep 12 2013: Tom,
      You have made some good points. Because of my inappropriate lifestyle, I find my self with seeing several medical specialists. I have already lost my internist, who told me that he could not sustain his practice on an economical basis so he left to join a new Medical Company that has opened small offices in strip malls all over town. My cardiologist dropped his patients, to work in a hospital as a surgical second??
      Medical Care is a business. I had said before that when I heard of the AHA, I imagined a series of
      public health offices to provide basic care to poor and uninsured instead of short changing established practices with low ball medicare payments. I know that thought was full of holes, but it was my imagination.

      What we got was a complex insurance scheme that I am sure will benefit health care insurance companies in spite of the fact some politicians gleefully imagined that it would lead to the end of private insurance companies and the establishment of a government single payer program... medicare on steroids. With some experience in this area, I am sure the private insurance companies are just a gleefully imagining a windfall profit from all the new customers AHA is forcing into the system.

      Two views.... I am betting on the business side.
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    Sep 12 2013: Which soldiers Martin, and what percentage did this happen to, and what were the circumstances involved objectively speaking? You made the assertion, you prove it.

    Yes success is dependent on a lot of things and some aren't fair in the cosmic sense, but such is life.

    "I do believe in social justice. You are absolutely right."

    I don't believe social justice is an objective philosophy Martin. It is riddled with the perpetuation of the very outcomes that it intends to improve upon. I don't mean every once in awhile, I mean quite literally every time. The level of forced social justice is directly related to the outcome of those it intends to help. It is inherently flawed because it's intent is to punish the good, right, and successful. That isn't 180 degrees from true justice. Once you subscribe to social justice then you are literally unable to remain objective, which means your compass no longer points north.

    What I will say is that being objective is very hard. You have to be willing to use objective truth which the social justice crowd finds offensive. It is in fact a "hate crime" to suggest that not all persons of the wealthiest countries on earth shouldn't be entitled to free health care. I get that, it sounds reasonable, but it is far from feasible.
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      Sep 12 2013: About the soldiers Matthew, I really don't think a single one is likely to say they do not care about health care when the chances of them having to rely on it are extremely high.

      In the past I have had the opportunity to speak to some of our soldiers, some of them from the world wars, some of them from recent wars. One soldier from one of our latest wars whom I met took his own life here in my city not long ago. He was suffering from ptsd and it overcame him. Better access to quality health care may have prevented that. All people are worthy of health care IMHO, even and especially him.

      I am well aware of the philosophy "here's to me and to heck with you."

      I will always respect a persons right to hold and speak such a thing. I believe in free speech, our nation would be less without it.

      Far from feasible you say? In Canada until recently when people were sucked into believing privatized health care meant better health care at lower costs, we had largely achieved that goal. Tommy Douglas achieved it for all Canadians.

      I am a "no man left behind" sort of person. To me we all win or no one does. Perhaps that is simply hardwired in.

      None the less, to any person who may suggest that evolution means it is the duty of the strong (or pampered) to leave behind anyone who is not, I suggest that it takes a stronger person to ensure the team makes it rather than to just look after yourself.

      So in an evolutionary sense, rugged individualists are not the strong they are the weakest members in the evolution of a society. Tommy Douglas was not named the Greatest Canadian because he stood proudly and alone at the top. But instead because he brought medicare to ALL Canadians at less cost in terms of GDP percentage than it cost the US to provide privatized care, to the select few.


      I do respect your preference for a two tiered health system Matthew, but I'll never share it.
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        Sep 12 2013: "I am well aware of the philosophy "here's to me and to heck with you.""

        You'll never agree with me because you are objectively dishonest. This statement is a clever play on words that all progressives use. "Matt believes that making health care a right to all is not feasible, therefore he has the philosophy of here's to me and to heck with you." Not only did you put words in my mouth, then you did me a favor by saying you respect free speech? What a pile of steaming ****. The entire premise is based on your total rejection rational thought.

        "Tommy Douglas achieved it for all Canadians."

        What Tommy Douglas introduced is a system whereby diagnosis is a walk in the park, but treatment is a total failure. It is not a free system, you are taxed to the hilt to cover it, and on top of that you pay a premium each month on top of that, which is really just another cleverly disguised tax. Operations are capped, which means many Canadians die because of your system. The one's that refuse to accept that, go elsewhere, primarily here to the U.S.

        Martin, when are you going to be willing to become an objective thinker and cast aside the colored lenses that distort your views? Compassion doesn't mean that we enact legislation that allows one to gain at the expense of another. Compassion doesn't mean we attempt to punish the good, right, and successful, and reward the evil, failed, and wrong. Compassion IS creating an opportunity for all citizens of any country to pursue happiness, however they may define it.
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          Sep 13 2013: Mirriam Webster: Compassion
          noun kəm-ˈpa-shən

          : a feeling of wanting to help someone who is sick, hungry, in trouble, etc.
          Full Definition of COMPASSION
          : sympathetic consciousness of others' distress together with a desire to alleviate it

          Matthew we are losing the focus of our topic, due to our differences in opinion.

          I do respect a persons right to hold any opinion they want and I respect my own right to the same.

          I hope you are willing to agree to disagree because you will never convince me that anyone who is not successful is evil failed and wrong, and those who successfully profited from scandals such as Enron as "good right and successful."

          Even so, thank you for your thoughts as they certainly do provide food for thought.
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    Sep 12 2013: "Quite frankly? I feel it became a right when our fathers, mothers, sons, brothers, family and friends gave their lives defending our nation in all the wars since our country began. A person would think that should be worth something."

    According to whom? We went to war to defend our right to health care? Did you really make that jump? Our brave soldiers fought for freedom from tyranny and aggression certainly not for health care.

    "History has proved no such thing Matthew. All history has proven is that greed and selfishness on the part of a few gets in the way of the good of all."

    Like Kindergarten? Who are the greedy in your mind Martin? Is there such a thing as someone achieving success, whatever they feel success is, without them having stolen it from someone else?

    "Justice stands for the same thing it has stood for from the dawn of time.
    People may claim different depending on what is convenient to their cause at a given moment but let each person look to their heart to know the truth of it.

    Your heart knows justice no matter how another may try to twist its meaning."

    Martin, you don't believe in justice as it once was, you believe in social justice. There is no twisting that is inherent in the idea of justice. Social justice is all about twisting. It is the opposite of objective truth Martin.
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      Sep 12 2013: "Our brave soldiers fought for freedom from tyranny and aggression certainly not for health care."

      Really? Ask a soldier just how they feel to fight to defend a nation that when they come home in pieces refuses them medical treatment if they don't have the coin in their pocket. I believe that yes they feel that having medicare is worth defending. Get back to me with their answer I'd be pleased to hear if they tell you otherwise.

      " Is there such a thing as someone achieving success, whatever they feel success is, without them having stolen it from someone else? "
      Success is partially derived from ones personal ability, but life chances figures into it. The most brilliant capable person in any field is likely to amount to little if he or she exists alone on an island. Being a part of a society makes a tremendous difference, and being part of one of the greatest societies on earth an even bigger one. So yes, individuals by law can use a society for benefit and then turn their backs on it to their own design. Some might even say its been a time honored tradition. But that wouldn't be me, is it you?

      Martin, you don't believe in justice as it once was, you believe in social justice"
      I do believe in social justice. You are absolutely right.
      On the other hand that does not mean I do not understand justice Matthew.

      A person recently told me, that they felt justice was found in a judges judgement based on admissible evidence and testimony, even if it was clearly in conflict with what ones heart knew to be true and just(for example a murderer is set free due to a slight technicality in procedure)

      That was not justice. That was law and may the best lawyer win. That was an offense against justice.

      I do understand justice Matthew and I believe that in your heart, you do too, we all do.
  • Sep 10 2013: Hello, Martin. I am not quite interested in economy but your idea sounds resonable. Increasing in supply is great thought to solve problems related to the shortage of doctors. But one which should be preceded before increasing the number of the doctors is some kind of systems supported by the government. No problems could be solved by one party's effort. Every society participants have to pay attentions to social issues, I think. Thanks you for sharing your deep insight! :)
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    Sep 9 2013: Are there those that think the new health insurance laws in the US will provide the care not really promised but intimated by the proponents or....
    Are there those like me who are investing every dime into health insurance companies with the hope that our ROI will cover medical expenses or the insurance rates that are coming?
    Those 2000 pages of healthcare law was not written by our intellectually challenged congress or reviewed by a charismatic community organizer at 1600 Pennsylvania Ave...
    It was written by health insurance lobbyists who had a profit motive in mind.
    Am I wrong? Check out the market on healthcare insurance stock prices....
    like they said "follow the money"
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    Sep 7 2013: Martin

    The mass production of doctors, with government subsidizing their education and training simply does not work. Cuba has been working on this experiment for 50 years with catastrophic results. Today, you can find hundreds of doctors driving taxis and waiting tables in many Cuban cities...
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      Sep 7 2013: Interesting.
      How long are the wait times for doctors in Cuba?
      • Sep 7 2013: Wait time? Well, it depends on what segment of society one falls.

        1. If the individual is a senior member of the ruling party "the new elite", then these few have access to doctors, but more importantly, they have access to the exclusive hospitals and access to basic medical supplies and treatments.
        2. Foreigners with dollars seeking special treatments... the wait for this group is relatively short, if any.
        3. All others (overwhelming part of society). Here too there are two categories:

        a- Those who access to basic resources, primarily food. The wait for this group may be relatively short if the individual can offer a "gift" to the doctor. Example 10 pounds of meat, (typically pork since it is illegal to buy beef) rice, cheese, or some money. Yes.. service for food.
        The salary for a surgeon is approximately 600 (six hundred) pesos per month, that equates to US$24.00 (twenty four US dollars). The price for meat (if available) is approximately 25 cuban pesos per pound... do the math... The income of a taxi driver in Havana or Varadero is much higher than that of a doctor. Many doctors have to accept the "gift" just to survive.

        b- Those with no resources ( the great majority) it is hard to quantify the waiting time.

        For the majority of the Cuban people "wait time" is the least of their problems. The real challenge is procurement of basic medicines, medical supplies and treatment after they get to see the doctor.
        Bartering plays an important role in the procurement of basic medical supplies. Some lucky ones with family in the diaspora may receive basic supplies. However, there are strict government restrictions on quantity / weight of parcels allowed into the country.

        Patients in hospitals (those in the a and b group) are expected to take their own sheets and pillow to the hospital. Family members take a chair if they plan to stay the night with the patient.
        Unfortunately, this is reality for some 12 million people.

        "Wait time" is a relative term.
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          Sep 8 2013: So.. in Cuba there are so many doctors that they are out driving cabs rather than practicing their profession, yet so few doctors practicing that wait times for the general populace are through the roof.

          Why does this seem out of context?

          All the funding goes into teaching people how to be doctors with no funding in the service infrastructure to allow them to provide service to the public?
      • Sep 8 2013: It seems out of context for one reason.

        Panned societies where the government plans all allocation / use of resources including human capital by training X number of doctors, X of teaches, X of scientists is wonderful in theory, but this model has failed time and time again. Among many things, the model ignores the natural forces of labor markets. More importantly the model fails to recognize the fact that individuals have different values, perspectives, character, goals and objectives. It assumes that all members of society have the same dreams and ethical imperatives.

        If we decide to fund the education of doctors to increase supply, who determines the equilibrium point? The government ?

        If we use tax dollars to fund / help those who study medicine, will we also help scientist, accountant, dentist, teachers ? Will the government decide which disciplines are important and which are not ? which disciplines get funded and those that will not ?
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          Sep 8 2013: Whether we fund the educations of doctors or not " individuals have different values, perspectives, character, goals and objectives." is true. Funded or not funded does would not likely impact this I feel so I am not sure why we include it.

          The tipping point might become when wait times were down on average to say 2 hours maximum? That seem reasonable?

          AS for funding other professions, as a people we might look at that and ask where do our values lay on a situation by situation basis, however a persons health usually ranks at the top of concerns.
      • Sep 9 2013: Doctors in Cuba drive taxis because, if they do not get into the service of the elite, they can make as good a living driving taxis with less headache than a doctor has. This is the inevitable end result of any planned economy. Only the planners benefit in the long run.
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      Sep 7 2013: And many are working menial jobs when they immigrate to the US as well.
      • Sep 7 2013: Correct.

        Like all immigrant groups, Cuban doctors have to work in low paying jobs while they study to regain their MD license in the US. Since the early 60s Cuban doctors, and many other professionals have migrated to the U.S. in search for freedom and a better life. They worked in what you refer to as "menial jobs" to support their families. However, with perseverance and hard work hundreds have regained their accreditations and have built successful practices in the U.S... Yes, it takes hard work and sacrifice, but for the overwhelming majority of immigrants, the tradeoff is very worth it.
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          Sep 8 2013: Yes, I agree that the trade off for hard work is well worth it.

          The South Florida community has a lot of doctors from many Spanish speaking countries.
          Many doctors from Cuba have established their medical offices there.
          Others work for clinics, or hospitals.

          The most prosperous ones are the ones who speak English and are up-to-date with the latest medical advances. Many times their sons and daughters choose to pursue a medical career as well.

          Are you yourself Cuban?
      • Sep 8 2013: Yes, I am Cuban.

        To practice medicine in the U.S. all foreign doctors must pass board exams, the same as an MD who studies in the U.S. All exams are in english. If they practice medicine in the U.S., they must be well versed in the language and be up to date with medical advances.
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          Sep 8 2013: I am wondering, since there are so many Spanish speaking medical personnel from Cuba in S Florida, if all of them have passed board examination to practice medicine.

          I wonder, for example, if those that are working for clinics, are certified?
          Some listings (doctor's names) in the medical directory of various HMO's will say 'board certified'............others do not.

          Do you happen to know the answer to my question?

          Is board certification different from the exam foreign doctors have to take to practice medicine here?

          I do appreciate your replies to me.......thank you.
      • Sep 8 2013: i am not in the medical field and i am not familiar with the board process / requirements.
        Many who are not board certified may work as nurses or technicians in the medical field.

        • Sep 12 2013: In the United States, there are several levels of certification for doctors. To call oneself an MD or DO, one must take a four year post graduate medical school course, and pass "the Boards", which are a three part test, each test taken two years apart. One must then take at least one year of internship. At that point, one may get a medical license, but the doctor is NOT board certified. To become "board certified", one must take an additional residency of three to up to ten years, then take a certification test. Each specialty sets its own requirements for the certification. One may only say they are "board certified" in that specialty once they have met the requirements set down by that specialty. For instance, any doctor may call himself a cardiologist, so long as he has a medical license. He may NOT call himself board certified unless he has met the requirements of the American College of Cardiologists. A foreign trained physician may become a US physician simply by passing the USMLE test, and satisfying the individual state's requirements for internship. However, "board certification" has the exact same requirements for a foreign trained or US trained physician.

          BTW, I am a US trained radiologist.
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    Sep 6 2013: Mitch,

    Regarding the access to technology issue: I think the logical consequence of the developments I pointed out earlier is a lower threshold to access. At present, the third party payer/employer provided health plan which is administratively imposed has the effects you describe, but a radical reduction in cost for services will bring healthcare within reach for people without insurance. Consider the following possible impacts on the system of a handheld automated diagnosis device:

    1) Almost complete elimination of overhead; no need for routine triage, collecting the patient's data, nurses to take measurements or a doctor for diagnosis.

    2) Near-instant feedback. No need to wait in long lines, sign up for an appointment ahead of time, take time off work, or avoid treatment for any of those reasons.

    3) Reliability. As much as 40% of diagnoses are in error, and there are a great many complications that develop from delayed or improper treatment. Fixing those problems will lead to:

    4) A drop in demand for healthcare. Timely provision of quality care will reduce or eliminate: seeking care again for issues missed in diagnosis; seeking care for damage resulting from incorrect treatment; requiring more intensive care as a consequence of delaying or refusing to seek treatment.

    Adding to that is the increasing opportunity to apply preventive care that will abrogate any specific care requirement at all, for example through getting a detailed genetic work up to learn of disease susceptibilities.

    Information is the tool of choice in solving this problem, I suggest, rather than regulatory action or government financing.
  • Sep 6 2013: My Two Cents...

    Short Term Solutions are generally designed to save money. No probelmo. It's the right thing for today's general mentality.

    However, if we do not wipe ourselves off of the planet, future generations will look at our "Profit-Model-Of-Health" to be primitive at best and Insane at worst. SO.......we actually might benefit in the Long Run if Health Care Costs AND Profits continue to skyrocket and cause mucho suffering. Sad for us in the short term for sure. But it does tend to push to us toward greater awareness and collective conclusions at a faster rate. (We must clearly see insanity to know sanity)

    We are not able to see other models of Health Care because Our Current Model is based in Fear OF and Profit ON Human Suffering. Fear smothers Perception. It will come. Slowly
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      Sep 6 2013: Scott, your message originally appears to be pessimistic but its actually layered with optimism I feel. Kind of we will survive/adapt/overcome sort of message pointing to light at the end of a long dark tunnel.

      What so you feel would happen if we suddenly tripled or quadrupled the number of doctors in our present system, and why?
      • Sep 6 2013: I'm extremely optimistic. Everything is as it should be. We are waking slowly.

        Regarding your idea of increasing Supply.......we will eventually reach a stage of Replacement rather than Reform of the current health system. Many institutions are failing for it is their nature. Many are focused on Reform. Your idea is a kick of the can and perhaps a delay of game in the necessary cycle. The tension and stress and even the suffering is Necessary for evolution. It only seems crazy when you have a view of the world where we are all Separate. We're not separate. It's a Collective thang. To Profit on Dis-Ease is silly. Perhaps crazy.

        I'm more in favor of disruptive models.

        YET, I admire and appreciate you for placing the idea out there. It's vital.
  • Sep 30 2013: Is there a shortage of doctors????
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    Sep 30 2013: Martin in my country India, where population is around 125+ crore. The Doctor population ratio is 1:2000 and this is as per Government records. Which I don't believe as the real Scenario is Much worse I am adding link to justify my self.


    In my country Corruption is big problem, where medical seats are sold to students. another link


    The parents want their Children to be doctor and are force to do medical (not all but most of them) for that Parents are willing to pay any amount. But the child who have no interest in Medical opt for it, but latter after some time they either leave it or Medical is compromised.

    while there are students who are very much interested in doing medical, but is thrown out of system of reservation, quota, corruption, cannot afford it, or not allowed to study further etc

    I hope the students who are becoming new doctors, understand their role and importance in society, merely for money if the interest is the society will suffer.

    another link where medical student protest against mandatory year long rural protest


    So Answer to your question is Only "Interest in learning Medical and Good will of Government matters"
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      Oct 1 2013: Kuldeep thank you for providing this provocative perspective on alternative approach to medicine.

      It's stunning to say the least and a superb example of WHY government intervention and oversight should never be taken lightly.

      People getting seats in med school without having to show they are competent or even interested can only lead in far larger numbers being incompetent.

      I like the idea of subsidizing "competent aspiring medical students" to become doctors and having them in part repay the favor by a per-determined stint in rural area's that might not otherwise ever have a doctor.

      I will say that if subsidizing doctors educations, would result in lowering wages, then it may be likely that less of the money hungry and more of the "called to be" doctors would be found in our system. Money, is by far not the only motivator for being a doctor.
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        Oct 1 2013: Martin Thank you for your point of view, but tell these to those parents who are motivated with the status and money attached with Doctor. No one says Lower the wages because, I Think real Passionate Doctors never count their time how much they have worked today, They only Looked how many have they cured today and continue this task irrespective of any time, place and other motivation. These Doctors should be paid well so that more doctors with similar interest and passion feel rewarded.
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          Oct 1 2013: I'd suggest that we motivate doctors by putting their services on commission to encourage them to make more by seeing more patients but I fear this would only degrade quality of service.
  • Sep 30 2013: Martin, it is easy to debate on this but would it serve our purpose? Choices made in a nation's development sometimes return as problems. The medical problem is no exception. If there were a perfect solution then it'd probably be passed on between nations and we' have no problems.

    Instead, we have to find new eyes to see beyond the only visibly options and find something that'll work. That is much easier said than done though. Do you know what has led to the rise in costs within your nation?
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      Sep 30 2013: "..we have to find new eyes to see beyond the only visibly options and find something that'll work. "

      Kent I commend you on your insightfulness and feel on this note you are blindingly correct. If what we are doing is not achieving what we set forth to do, then repeating it will only create ruts in the road and not advancement. We need to find and try new approaches to resolving our issues.

      One key thing I feel lends hope, is that we recognize there is an issue and consider solutions because if we seek them, eventually we will find them. Someone once told me that "everyone has a bias and that by recognizing we have one we take the first step in gaining the control needed to change it."
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    Sep 26 2013: Is there a shortage?
    In Belgium we have a surplus in specialists.
    But most of their income is paid by the government...
    We cannot detect supply-induced demand, due to lack of specifications and restriction of range in the data.

    There can always be more doctors or other health-care workers... though the total price of all the health care needs to be paid, which means there is a (democratic) decision to be made as how much one wants to pay for it... how it is divided between private and government and insurance... but even so, there is a limit in care we can afford.
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      Sep 29 2013: That makes some pretty good sense.
      Several times the key consideration seems to come back to price and affordability.
      Factors that are influenced from any number of angles as you point out.

      When considering the limit it might be prudent to aim for "what it takes to accomplish the goal" and then work backwards from there as to how to achieve the affordably.

      What is the goal and why?
      How can we influence the current system to attain the goal?
      How can we influence the system to attain the goal with the highest level of efficiency and lowest level of cost?

      With all the various suggestions our fellow participants have came up with, subsidizing education of doctors or medical workers, implementing high tech diagnostic equipment (no one really suggested high tech surgical machines geared to perform specific surgeries but why not? They would work around the clock for the price of electricity), encouraging greater immune systems in the populace through diet/exercise, and a host of other worthwhile considerations.

      The one constant seems to be "we can do better."
  • Sep 25 2013: Martin, i realize we are talking of two different systems. We do not operate on a country-wide health care system. As such we have No such waiting times whether with a doctors clinic or in an ER. You get seen/treated on very hour you step on an ER. You get seen in a clinic on a scheduled date of appointment or even immediately.

    Now on the bases of health care cost:
    Educating doctors takes a very long time and a lot of money. Training doctors for specialization also takes a long time. Doctors also need hospitals/clinics. Doctors need special equiptments/operating theaters... if you are referring to a government subsidizing health care then don't expect the true cost of health care to go down.. it will always go up. More people means more diseases, better life expectancy of the population also means more
    age related diseases. I just don't think adding more doctors to the mix will drive cost down.
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      Sep 25 2013: Jeff,

      I don't think the object is to drive health care costs down. Instead its to drive wait times down.

      Driving costs down?
      *Compartmentalize medical services so doctors are reserved for the most complex care, and more lower paid staff for other area's of concern not requiring complex solutions.
      *government funding for doctors education so their real investment is time to learn, and more openings for more doctors to enter the system to create competition
      *invest in diagnostic software that can replace medical personnel in all but the most complex situations (labor is the most expensive part of most business transactions?)
      *encourage healthier lifestyles so people have more robust immune systems
      our participants have came up with many great idea's and the ones I stated are only a few
  • Sep 25 2013: Good question. Do realise that there are other underlying factors to consider: ask if 1) doctors would be willing to get lesser pay after putting in so much towards their course of education; 2) whether the medical boards and health ministry would approve training of more doctors? (If so, how many) 3) what chance is there all those trained will remain within that nation given possible economic brain drain. and Lastly, consider impact of available impact of accessible healthcare systems across borders and in touring destinations like Thailand etc.
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      Sep 26 2013: Superb points Kent.

      1. Doctors are not infallible mythological gods with omnipotent powers. They are (in most cases)intelligent highly trained human beings performing a function. The laws of supply and demand impact on their logic just as surely as it does that of the rest of civilization. At the moment, their field is largely exempt from laissez faire forces however if that were NOT the case, I feel confident that very few doctors would decide to trade in their white coats for a job in a retail store.

      2. As to would medical boards and the health ministry approve training of more doctors that would depend on if the government deregulated that area now wouldn't it? If government were to remove or adjust the caps then the rest of the system would follow. So this question is really does society want the government to do this enough to pressure their representatives to make it so. As to how many that is likely a question for another discussion as many related questions would need be answered and factors should be taken into account before a wise choice could be made.

      3. Brain drain. This is a very valid concern. Even so I feel the answer seems obvious. Doctors motivated to leave Canada, and there are/will be are ambassadors of our country, culture and tolerance spreading goodwill and good health in the world where-ever they land. Can we keep enough doctors to make it worthwhile? Absolutely. Canada is one of the best places to live in the entire world. Not everyone is willing to live in an electrictyless dusty village for "a few dollars more." We have one of the most stable governments, economies, and are an incredibly safe place to live, not to mention one of the cleanest environments. That is something worth coming home to. Further incentives could be created as conditions of serving in Canada such as but not limited to vastly enhanced educational funding for those with the intellect and drive to become doctors. Money is not the only motivator for doctors I feel.
      • Sep 26 2013: Yes, hence after understanding the above, consider this:

        Assuming the medical board agrees to train 5000 new doctors in the new year, the decision would see an increase in the supply of doctors within the industry in 7 years. If the projected supply meets with currently increasing demand, the wage levels of doctors will remain the same. If it is above anticipated demand and medical faculties available, it'll trigger issues given there may not be enough work spaces for 5000 doctors then resulting in unemployment or if the increased supply reduce wages of doctors leading to some brain drain. Both of which can become economic burden to the nation.

        We assume that the level of wages will decrease with the increase in supply... However, in the real world, there can be resistance to this. Factoring in other factors I highlighted earlier and it can be quite complex.. the cost to hospitals will make it harder to hire all the trained doctors if they refuse a lower wage. The building of new hospitals to allocate the new work spaces also incur costs. That is a big cost to any government. Do consider this.
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          Sep 29 2013: Kent you are absolutely right. A chain is only as strong as its weakest link.

          Yourself and many of our contributors all agree that having more doctors is not enough to resolve the issue of efficient timely care. Instead the common consensus seems to be that if we really want to improve cost and efficiency we need to examine EVERY link in the chain for ways to improve it and decrease costs across the board.

          Do we really need doctors for all the functions they currently perform?
          Precisely which services can lower paid staff perform?
          Would it be possible to relegate doctors to a supervisory position?
          Would introducing highly advanced diagnostic equipment be able to perform many or most of doctors most common diagnostic responsibilities?
          Which surgeries could be managed by technical staff and machines and which could not?
          Can triage be handled more effectively.

          In my mind Kent, our discussions do not lead so much to answers, as to a great deal more questions.

          How can we attain the most widespread efficient round the clock medical service at a fraction of todays cost?
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      Sep 24 2013: I'm multi-cultural, if it can't escape it's not really considered fast food whatever culture it originated in
  • Sep 23 2013: Maybe not all procedures need to be done by a doctor at a medical facility, for example a local wart removal business could probably be inexpensively operated by someone licensed and tested by the State with only minimal training.
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      Sep 23 2013: Agreed. Compartmentalizing some procedures in a Fordism way (assembly line to health care?) could alleviate some persons from waiting in line with persons requiring more complex diagnosis and care.
  • Sep 23 2013: Martin, I don't completely agree the cost of health care will go down accordingly as you may predict.
    If you take a look at the real cost of medical bills you might be surprised. There is something odd about the cost o health care and people's perception regarding why it is very expensive and doctors seem to get the blame most of the time. I will try to change your mind about this concept... and its not about the law of supply and demand of doctors.

    Lets take a look at it this way.. if you were a private doctor, how much would you charge your patient?... lets say standard fee is $50.. fine.. expensive BUT.. you can always charge less as a doctor. This is a professional fee.. its NOT fixed for a private doctor. In fact you can even NOT CHARGe the patient at all.
    So why is health care sooooo expensive? its NOT the doctors. Its the medicines, the lab workups, the xrays/ct scans/mri, its the hospital bills!!!
    A doctor may charge you anywhere from $0 to $1000, but that is miniscule compared to the other costs of health care.
    Don't think about the doctors as the reason for expensive fees..... think of the health care beyond the doctors.
    Doctors are the drivers of health care, so they get most of the blame. BUT the actual money that pays these physicians while is seemingly very large as an income... is actually less than the rest of the medical bills combined.
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      Sep 24 2013: Jeff, I agree that in calculating cost or any factor really we should take into account all aspects of a system to get a more complete and valid picture.

      Yet the coin we sought to decrease is not money but time. Wait times to be specific. Getting an appointment with a doctor can take days or weeks. Wait times in hospital ER's can take 10s of hours.
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      Sep 23 2013: Personally I agree with you that we should not "bully doctors" or anyone else for that matter.

      On the other hand I disagree with suggesting that the solution lies in removing any responsibility from society based health care, and placing it on diet and vitamins. To me, that seems illogical.

      Not every person is willing to become a vegan for one thing, or wants to use food as medicine, or should be forced to.

      However I agree with you that eating healthier (for those that have that opportunity and can afford it) is a very beneficial health aid to have in ones corner. A persons body needs a good variety and base to draw from to stay healthy.

      Even so, .. to go that road we now have to talk about organic foods right? Of which there is low quantity and high price. Eating a whack of pesticide coated, steroid enhanced veggies is not a proven good health aid? In addition cooking habits also come into play don't they? Fried foods bad, boiled foods lose their vitamins, ruffage good, steaming good? It can be complex..

      My feeling on this is that eating right, vitamins, exercise, sleeping right, controlling stress, as immune system enhancements are very good steps in the right direction, but not a complete solution.

      Carolyn, along the lines of getting people to eat healthy to improve our immune systems, how would you advise we as a society get people interested in doing this? Any suggestions?
  • Sep 23 2013: I still believe that the supply is there; tuition plays little role in it. No one going into medicine expects it to be cheap. To be trained in state-of-the-art facility cost money and that has to come from somewhere. But perhaps a huge debt coming out of med school provides the incentive to make as much money as one can. In Canada, doctors are billed for their services; perhaps this is why doctors are working as hard as they can to keep their living, taking up the money that could otherwise be used to hire a new doctor (this is pure speculation). Perhaps more daunting, at least in Canada, is the fact that resources are limiting. Even if a doctor, say a specialist, wants to perform a procedure. He needs the hospital facility and resources (say an operation room) to do so. It costs money to run an OR. When hospitals are on budget, physicians fight over opportunities to utilize the resources. The incentive has to come from a government funding or an external funding such that hospitals have enough funds to provide those resources for physicians.