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."
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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:

    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:

    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"
  • luis c.

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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.
    • W T

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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.
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    Sep 22 2013: " The reason, basically, is that physicians are enormously expensive to educate." Tom Murphy

    Tom, it sounds like an aspect of finding a resolution to getting more doctors, is to find less expensive ways to achieve top quality education.
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    Sep 21 2013: Reading the scans and test results is precisely what it can do. The advantages over a human come from the ability to compare them to the whole body of literature, with maximum consistency of judgment. Further, the computer can perform these analyses very quickly.

    The specific development in Watson is the program's ability to understand language. The Wikipedia page makes for fascinating reading; it duplicates many of the functions of the human brain with language, and compensates with deep parallel processing, a huge database, and computation.

    It also suggests treatments. 90% of nurses with access heed its recommendation. Revolutionary tool.

    Edit: Apologies, this was supposed to be in response to your comment, Tom.
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      Sep 22 2013: Absolutely fascinating stuff. Is there any price tag on this for the general public to obtain? Can you offer a link to it, you mentioned Wikipedia?

      The cloud aspects and the common language interface of Watson are particularly interesting. I wonder if it REALLY must be a doctor offering the input.. (impact on waiting rooms if say a nurse practitioner or other could do it) .. or.. as some other participants suggest higher self help in the community to lower wait times.. could Watson be offered to the general public as a cell phone app attached to Watsons cloud brain?
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        Sep 22 2013:

        The above is a link to IBM's page on Watson's applications. One of three chief areas is healthcare, with associated video (albeit advertising, so criticism must be found elsewhere). The pricing estimate found in a 2010 NYT article found here: puts it into the millions, as the base cost for the hardware on which the program runs amounts to $1m right out of the gate. Current pricing information is scarce, presumably because it is so variable in terms of newer hardware and the precise nature of services, support, licensing, etc. In either event, the computer would be purchased in the same fashion as any other machine, with appropriate consequences for costs of operation and effectiveness of treatment.

        I have a related thought I will address as a separate topic, however.

        Here is a graphic that explains throws out some current cancer numbers and the flow and function of Watson in that process:
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          Sep 23 2013: Ryan, from an individual standpoint the pricing is staggering. However, more than one participant in this conversation suggested broadening education throughout the community etc to decrease reliance on doctors etc for less than demanding purposes.

          A government could make a purchase of this size with pocket change. What would happen if say a government like Canada purchased this hardware/software offering it in a cloud atmosphere on a "use at your own risk" basis for any citizen of the country to access via computer or cell phone app?

          Would the general accurate access to diagnosis it provide reduce our overall reliance on doctors and medical facilities enough to be worth considering?

          Would it result in a higher standard of health for all citizens overall?
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    Sep 13 2013: Martin,

    You choose to hear what you want to hear. I love how anything I suggest becomes an "extremist viewpoint." Suggesting that too many abuse the health care system means that they have some form of hypochondria is more far reaching rhetoric. Furthermore your reference point of 1-14% is hardly conclusive with a range that goes from 1% all the way up to 14%. In addition you decided to use three examples of a hangnail, a cold sore, and a scratch to further your debate which is really what is preposterous in this entire exchange.

    "The majority of people seek medical attention when they are in need of it.
    I looked it up."

    Thank goodness you looked it up, your credibility is impeccable.

    The difference between you and the one's you debate is that you have decided what your stance is and will do anything, dishonest or not, to prove it. When you see things that may contradict your viewpoint, you throw them out which is not objective. I liken you to a scientist that has a theory that the sky actually isn't blue, so in order to prove that, you'll reject each experiment that proves the sky is in fact blue, and then twist and cherry pick other experiments that might slightly prove your point. In other words facts and objectivity don't interest you in the least bit. Knowing the facts or not knowing the facts never changes your opinion on this subject or any other for that matter.

    Tell you what, you go research the percentage of unemployed doctors in Canada and get back to me, knowing that if you cherry pick, twist, or distort, I'll be calling you out on it.
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      Sep 13 2013: Statistics Canada
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        Sep 13 2013: Really? I just Googled it, and there is one article after another about it, particularly specialists. What your site is saying is that it doesn't have the data. Are you suggesting that has active data on all doctors and residents in real time throughout the entire country? mw
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          Sep 14 2013: If you have information to present, please present it. The more I consider that there are unemployed doctors in Canada, the more I find myself intrigued.

          In fact, one website seems to suggest there are not enough openings in specific fields.
          It does not seem to conclude whether this is due to lack of funding for the services (as one of our fellow contributors suggested) or a lack of people needing the service.

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    Sep 12 2013: "There have to be alot of easier ways for people to make good money than doctoring, not to mention less stressful. I agree doctors can make a great living, but a part of me still feels that something inside them wants to help people, and that something inside them enjoys the power of taking on sickness and death.. and winning."

    Right, Father and Son sit around the table and talk about the merits of helping others before entering pre-med. It is more than the money, I do believe most doctors find great satisfaction in helping others, but this is something that grows over time through experiences. People become doctors for title, money, respect, etc.

    "Frankly privatization does not impress me in the least, and I find it fascinating that anyone but the private company owners are even amused."

    Why? What industry in the world runs better through a bureaucracy vs the government or municipality? The US government spends twice as much as Canada per capita as it is, so pointing to the US as a privatized system is flawed to say the least. Truly privatized medicine will always be a superior model just like it is in every industry. Many point to corruption in Corporate America, but why? Because they are bought and paid for by politicians. Corruption starts and ends with the federal government.

    "Matthew do you see any way we can work together as a country so everyone is looked after, or in your opinion should it just be every man and woman for themselves?"

    No I don't think that you can honestly state I'm looking for a total free for all. I think the flaw is that you believe everyone needs to be "looked after" in the first place. I got back to the idea of social justice. You will NEVER create a place where everybody has a right to equal outcomes. A very reasonable assertion that many like yourself have bought into, but the reality is it doesn't work so we need towards the best system for the greatest number of people.
  • Sep 12 2013: Waiting times would likely go down, but the American experience with more doctors is that overall costs go up. There are a variety of reasons for this, but the biggest is that more doctors see more patients, and therefore order more tests. It is likely that the price of a pure doctor visit would drop, responding to the supply/demand factors, but doctor costs are only a small minority of health care costs.
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      Sep 12 2013: I feel those are very valid points Tom.

      In fact to paraphrase I think you might be saying that if we wanted to increase efficiency while keeping costs down, we'd have to adjust aspects of all the components related to the service and not single out just one. Other wise the one would drive the other up and little would be gained.

      Am I paraphrasing your thought correctly or?

      What then would you recommend?
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    Sep 11 2013: "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?"

    The free market still dominates the equation as it relates to artificially subsidizing doctor education. There are many reasons one wishes to become a doctor, but the one that still dominates is to generate a healthy income. I guess what I'm saying is that the benefits, financially speaking, of being a doctor have to outweigh the cost(and time) of going through the educational process to become one. Minimizing the barrier to entry presumes that this is the biggest factor one might not decide to become a doctor. This is the phenomenon we are seeing already.

    The fundamental problem with the very reasonable idea of "providing health care for all", is that it doesn't equate to "access." In fact it decreases access which is what we've seen in Canada and will soon see here in the U.S. This is the problem that no one ever bothered to figure out and the one that will become the overwhelming issue for those that experience it. The free market typically turns towards alternative forms of privatized competition. The private health care industry is already organizing itself here in the United States because they are well aware that "access" will become the most critical issue we face moving forward.
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      Sep 12 2013: Greed, is the primary reason for becoming a doctor?
      There have to be alot of easier ways for people to make good money than doctoring, not to mention less stressful. I agree doctors can make a great living, but a part of me still feels that something inside them wants to help people, and that something inside them enjoys the power of taking on sickness and death.. and winning. I feel there are other motivators and that lowering the barrier would not result in less interest.

      The fundamental problem with the very reasonable idea of "providing health care for all", is that it doesn't equate to "access."

      I totally agree with you here Matthew. You make alot of sense. The more people eligible for health the more resources it will take to care for them.

      YOu mentioned Canada's healthcare system? Look at it over time. Our health care system ROCKED..until lately. When market forces were manipulated to make "privatizing" look good many Canadians thought ..what more service for less money? AWESOME and took up the cause. What happens? Less service, less cost due to cutting corners until the health system looks like confetti, and the administration soaking up the savings. Frankly privatization does not impress me in the least, and I find it fascinating that anyone but the private company owners are even amused.

      Lastly, you mention the free market system. I don't think there is one frankly in anything but name. To me, a free market system means that cost = demand divided by supply, and that supply is only inhibited by resources.

      In truth on any given market there are likely to be many forces acting on it to control supply and increase demand to drive up prices. So much for free market.

      Matthew do you see any way we can work together as a country so everyone is looked after, or in your opinion should it just be every man and woman for themselves?
      • Sep 12 2013: Martin, I have read several of your posts and complaints about wait times and doctor shortages. I do not believe that the number of doctors available in Canada has anything to do with it. I believe that it is due to the third party payment system that you have there. If it was YOU who paid the doctor, and not someone else, your wait time would approach zero. Doctors, like everyone else, know which side their bread is buttered on. If the doctor's income depended on just your opinion of them, and not a bureaucracy of the government or insurance company, the level of service delivered to you would improve dramatically. That is why Obamacare is being fought against so desperately. While some people will have their insurance subsidized, the majority of Americans will see their insurance rates increase, and will lose some of their control over medical finance decision making.

        So what is to be done? In my best case scenario, insurance companies or the government would simply act as overinsurance, not funding for routine medical care. To make up the difference, each of us would contribute to Health Savings Accounts, a tax sheltered savings vehicle for medical care. Each individual would start contributing to the account as soon as they could in life, but certainly before the time they are forced off parental insurance. Contributing $4000/ year would create a huge pile of money, to be used strictly on medical care. Insurance would cover costs over whatever limit each individual chose. For instance, if one had $50,000 in their account, one could buy insurance for any costs exceeding this amount.
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          Sep 12 2013: Tom, your plan does sound mighty good for those with the money to afford their own, but for those without.. I'd reckon its just too bad to sad eh?

          To answer properly, I'm going to thank Bob Stiglitz for providing what Canada's Greatest Canadian had to say on this matter. please take the time to watch and consider it before passing final judgement.

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          Sep 12 2013: Tom, you are exactly right and I'm a huge fan of HSAs, and they solve many issues including the removal of attorneys in many instances. Like you I believe we help those in need for limited amounts of time, but we don't take compassion and turn into a massive bureaucracy to make everybody equally miserable.

          As I mentioned to Martin, "Social Justice" is to blame for much of this and it isn't getting any better. Success does not equal greed, wealth isn't proof positive of theft, and "rights" need to be about life, liberty, and the pursuit of happiness, not guaranteed outcomes for all.
  • Sep 10 2013: After reading the comments here, let me offer a few of the questions that I know.
    First of all, from several comments about the health manpower problem in Cuba, you should think that when the health care system is operated by the government, the pay or compensation simply couldn't be too high, thus you couldn't attract many physicians to work for the public health care system. As a consequence, the less there are the number of physicians in the public system, there must be less care providers and long waiting time. As in the Cuban system, even if you train more medical graduates, they won't stay long within the public system because of the low monetary rewards. Furthermore, because of the manpower shortage, the physicians in the public system have to work even harder to take care of the patient demand. That is the cause for them to change jobs, or emigrate to greener pastures. To a less extent, that have been the situation in Canada too, if I am not mistaken.
    The situation in the US is even more complicated that the government can't directly control the pay scales of all the health care providers even under the proposed health care system. The government will rely on control of the health care expenses by REDUCING THE PAY RATES AND THE INSURANCE COVERAGE OF MANY DISEASE CONDITIONS in the new "insurance exchange" system. However, that probably won't work too well in the coming years. One evidence is that in preparing for the new health care system, most of the major health insurance companies AND many large hospital groups wouldn't join into the insurance exchange system at all. And, of course, there have been a number of waivers on the original "Affordable Care Act" laws already, before it has ever started.
    Let me just offer one partial solution to this health manpower problem. The government has to train large number of paramedical health providers to complement the work load of the certified medical staff, with work load like other professionals.
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      Sep 11 2013: Hello Bart and welcome to the discussion.

      " The government has to train large number of paramedical health providers to complement the work load of the certified medical staff, with work load like other professionals."

      What you have said here seems to be a common conclusion among many of this discussions participants.

      It's very likely that this will be one possible avenue to success.
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    Sep 9 2013: Fist of all, I hadn't heard there is a shortage of doctors. Is there?

    I suppose a major problem would be, where does the money come from to subsidize more doctors' education?
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      Sep 10 2013: Up to 13 hour waits at emergency rooms along with the difficulty of finding a new doctor would indicate yes there is a shortage of doctors.

      As to where the resources come from to improve this condition, good question. Your thoughts?
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        Sep 11 2013: Well, do you really care if there's a long wait at emergency rooms, I mean, how often does one go to an emergency room, if you have a really intense emergency you will be moved to the front of the line.

        What do you mean "difficulty of finding a new doctor"?
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          Sep 11 2013: In answer to your question a simple yes.

          The last time I needed emerg I had ear trouble. I could not wait for an appointment with my doctor as a good deal of my job is effective listening.

          After ten hours of waiting to be seen I had to give up as it was within 4 hours of my next shift. That's ridiculous. If I were in some remote location ok fair enough, but in a major city, I think not, we're better than that.

          Doctors seeking new patients do not necessarily grow on tree's, or such has been my experience. I recently lucked out and found one however I will not just ignore the issue because now "I" am looked after. A community or a nation is a team and all Canadians have the right to accessible good medical care. In fact I feel people of all nations should have that, it's as basic as breathing.
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        Sep 12 2013: yeah, martin, I'm guessing the hospital actually would like to create a long wait for patients at the emergency room because they don't want scads of people coming to the emergency room, which is what would happen if there weren't a long wait. You know, some people would show up with colds and mild flus, which really aren't emergencies, but I think they would show up at the emergency room if they could see someone without a long wait. I would think in most cases doctors would prefer to see people with an appointment on a non-emergency basis, but I can't think why exactly, why is it that upscale professionals usually prefer people make an appointment?

        I can't tell how major a problem doctors not accepting new patients is, I would think not such a problem because if there are people seeking new doctors, it also means they are leaving doctors, doesn't it?
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          Sep 12 2013: Bit of illogic there to "create long lines" so there won't be long lines so not sure what to make of that.

          I'm thinking they are probably underfunded and understaffed, although how to surmount that difficulty as yet I remain unclear on.
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        Sep 14 2013: well, Martin, my first thought is that if you put enough doctors in an emergency room that people wouldn't have to wait, people will start using it like a walk-in clinic, they'll take almost everything there, even things that most of us wouldn't think are emergencies. So the question arises what's wrong with a walk-in clinic? I think the reason doctors prefer to make an appointment is that they use their time well, in a walk-in clinic, there may be times when there are more doctors available than people coming in, so that some doctors are sitting idle, which it's expensive to pay a doctor when he's just sitting idle. Conversely, in a walk-in clinic, there may be times when there are so many patients that there aren't enough doctors to cover them quickly so that noone has a long time to wait. In a normal doctor's office where they make appointments to see the doctor, they can prevent both these situations, they can schedule so that the doctor's time is always well-spent, no downtime, and they can schedule so that they're not getting more people coming in than the doctor can handle, nor making them wait. So I would say there is a real advantage to seeing doctors by appointment, and thus I believe the hospital purposely makes it hard to see a doctor in the emergency room.

        Here in the states we have something called urgent care, it's midway between a standard doctor's office and an emergency room. Do you have these in Canada, perhaps your ear problem would have been better served by urgent care?
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          Sep 14 2013: Hi Greg,

          I am unfamiliar with "urgent care" or the idea's surrounding it.
          It is easy to agree we'd not want high priced doctors to be sitting around doing nothing, if the emerg rooms were clear. I wonder how we could work around that, and still have them close. Perhaps a rotating on call status?
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        Sep 14 2013: right, martin, I'm sure they do have doctors on-call for major emergencies, like if they suddenly need a surgeon to remove a bullet, and the doctor in the emergency room isn't qualified to do it. But I still say if you turn the emergency room into a walk-in clinic, which is what I think would happen if people didn't have to wait long, you'd get too many people with non-emergencies in the middle of the night, what, you want some on-call doctor to get up in the middle of the night, get dressed, and drive to the hospital to treat a bunch of people with colds and flus? And then he's going to be tired the next day when he has to deal with his regular patients who have made appointments at his office. I'm sorry, I just can't see it working, as best I can see the system is fine as it is. But if you see something wrong with my logic, let me know.

        here is the wikipedia article on urgent care:
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          Sep 14 2013: I like the idea of the Urgent Care Centers Greg.
          Without annual emergency room statistics for the nature of illness by percentage of people who show up cross referenced by season, date and time it would be tricky to really feel comfortable thinking crowded emergency rooms are all about people worried about a cough enough to hang out in emerg for 13 hours to be seen to avoid having to make an apt with their regular doctor but ok crazy as that sounds I guess it "could" be possible.

          Then again, if we could nail down to some level of certainty that say 55-60 percent of persons were hanging out in emerg on a regular basis for things that an RN or otherwise capable staff could handle (coughs, colds, take the temperature of a flu) then perhaps we could staff RN's so there would be enough, and leave the doctors to deal with the 40% that we determine actually do need to see one?

          Where there is demand, there should also be supply to meet it. Sidenote? Another contributor mentioned there are actually "out of work doctors" .. wouldn't they rather be working picking up the slack than sitting around on EI or accruing extra debt they don't need?

          (any time I've found myself in an emerg the folks there really look like they need to be there but I agree that we'd not want staff of any kind sitting idle.)
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        Sep 25 2013: no, martin, the idea isn't that people with coughs currently hang out for 13 hours waiting to see a doctor, the idea is that if you made it too convenient for people with coughs to see a doctor in the emergency room, in other words, they only had to wait, for example, half an hour, then more people with very minor ailments would go to the "emergency room," and it would no longer truly be an emergency room, it would become a walk-in clinic. By making people wait, it weeds out the true emergencies from the lesser stuff. Does this work for you?

        I'm curious, when you had your earache and never got seen by someone, did you go to work and just work despite the pain of the earache, or did you take a sick day? Most jobs you do get a certain number of sick days a year, this might have been a time to take one.
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          Sep 25 2013: Greg?

          No, it doesn't work for me honestly.
          Telling truly sick people its ok to expect them to wait long hours so that more people might be discouraged from using the health system is .. illogical and immoral in my view.

          IF we were talking about lineups at the used tire store? I'm with you all the way.
          But we're not are we. We're talking about ones health and that is about as close to home as it gets, for any and all of us.
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        Sep 26 2013: well, offhand, it works for me, Martin. I think part of it is that few doctors want to work through the middle of the night, I'm sort of guessing that a higher percentage of doctors than the average person have spouses and children and want to work a regular schedule so they're in sync with their family, or really just in sync with the world. But if you want a through-the-night emergency room well-stocked with doctors, they won't be able to do that.

        Maybe psychologically you don't want an emergency room to be too good at what it does because it might encourage lawlessness in the middle of the night, in other words, the gangsters and criminals might get even crazier if they think there's some emergency room with many doctors to deal with all their victims. People might commit more domestic violence if they know there's an emergency room with many doctors to help victims.

        I would guess too that there's some sense that a lot of things do get better if you just sleep on them and see how they feel in the morning. I would think for that reason too the hospital might not want to make it too convenient to go to the emergency room.

        I would slightly guess that doctors like working at the hospital during the day when many of their colleagues are around, in other words they can go to the hospital dining room and talk with many doctors from different fields. Some of that would be lost for doctors working through the middle of the night in the emergency room.

        I still wonder if instead of going to the emergency room, you could have taken a couple of sick days with your earache.
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          Sep 29 2013: Greg, I'm pretty sure over 80% of the entire world, prefers working during daylight hours. It tends to naturally go well with our circadian rhythms. We tend to agree there. I'd also agree that the system as it is doctors pretty much write their own ticket and the public must simply accept it as there really is no other choice provided demand exceeds available doctors.

          I'm not quite so sure that criminals plan their activities around hospital peak service times. I suppose they might but I just can't see that as a primary consideration for them in general.

          To my thinking just like any other business one would look at the demand on a given day hour month based on former years data and then staff accordingly tailoring the schedule as experience updates the data.

          If I needed to put a finger on why the government finds inefficient service acceptable, I'd believe that its because the ones controlling the government do not experience it. Their needs are seen to promptly and efficiently therefore there IS no issue.

          No matter who a voter votes in or out, that individual is subject to "party rule." Faces change and the system remains the same. Which likely means that if a country wants to actually see that what is good for the voters is reflected in their governments choices, they really need to vote directly on the issues such as

          As for the earache Greg. When I'd attended that emerg for multiple hours my earache seemed to be the lowest rung on any triage ladder and with good reason. Several people were sobbing and bent over with abdominal pain. Some had had to be carried in. Some had physical injuries. There was a plethora of valid reasons for people being there.

          I' am not offended in the least by some contributors suggesting that emergs are full only because people there have coughs or colds and are abusing the system, I'm amused.

          The world runs 24 hours a day and does not stop because some persons prefer daytime hours, thats news?
  • Sep 9 2013: supply and demand does not work when there is an oligopoly
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      Sep 10 2013:

      My understanding is that supply and demand are interfered with by an oligopoly. This does not automatically demand or assert that they will interfere to the detraction of society, only that it is possible.
      • Sep 11 2013: if supply and demand worked in the medical profession, check the prices doctors charge. It is highest where there are the most doctors. Also the cost of procedures at hospitals even in the same city are different.

        Basically, the charge at a doctor's office is the total cost of the office, cost of the resources, plus how much they want to earn. That is the basis for the charges, less patients mean higher charges.

        Doctors know what others charge and they discuss this and the AMA makes it possible.
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          Sep 12 2013: I'm thinking that if you had a pride of lions, they might all get along at taking down the game. But if you increased the amount of lions, there would be less game per lion to share. Sooner or later would come the tipping point and the lions would stop cooperating and act competitively to protect what they saw as their share of game.

          Self interest is a strong motivator and increasing the amount of doctors would increase the competitive edge thus jeopardizing the security of any oligarchy.

          My bet is on human nature.
      • Sep 12 2013: not if the assumption is the game animals have additional meat as the number of lions increase. and the analogy points out the weakness of supply and demand if there are monopolistic activity behind. if you need a better example, check out what standard oil and gm did to the public trolley system.
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          Sep 12 2013: I agree with you. Private interests will act to protect the same even to the detriment of the people of the country themselves unless their government intervenes.

          Check out what Tommy Douglas did to privatized Health Care in Canada.

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    Sep 9 2013: India is a great example supporting your thoughts. Healthcare in the States may have put that idea on hold until the end of the month. I hope we get there.
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      Sep 9 2013: I hope we can all achieve reliable, affordable,timely, quality health care too.

      Welcome to the conversation.

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    Sep 9 2013: Do we actually need doctors or but we need more para professionals, as well as more individuals taking responsibility for monitoring their own health. Health has a trajectory that, to an extent, is predictable, barring unexpected events.

    There is a TEDTalk about the growing need for mental health workers in India. It report the following:

    "To give you a perspective, if I had to translate the proportion of psychiatrists in the population that one might see in Britain to India, one might expect roughly 150,000 psychiatrists in India. In reality, take a guess. The actual number is about 3,000, about two percent of that number.

    It became quickly apparent to me that I couldn't follow the sorts of mental health care models that I had been trained in, one that relied heavily on specialized, expensive mental health professionals to provide mental health care in countries like India and Zimbabwe. I had to think out of the box about some other model of care.

    It was then that I came across these books, and in these books I discovered the idea of task shifting in global health. The idea is actually quite simple. The idea is, when you're short of specialized health care professionals, use whoever is available in the community, train them to provide a range of health care interventions, and in these books I read inspiring examples, for example of how ordinary people had been trained to deliver babies, diagnose and treat early pneumonia, to great effect. And it struck me that if you could train ordinary people to deliver such complex health care interventions, then perhaps they could also do the same with mental health care."
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      Sep 9 2013: Welcome to the conversation Theodore,

      What you suggest and what the article seems to suggest has a great deal of merit I feel.

      Compartmentalizing services so that any that can be delivered by lessor trained (paid) staff while reserving the most complex for actual doctors thusly decreasing the workload and financial burden while increasing speed of service makes alot of sense.

      A cornerstone in this area might be a very well trained triage staff to efficiently and accurately determine which patients required which level of service.

      For insurance purposes and public responsibility predetermined levels of competence of para-staff for the diagnosis and or treatments assigned to them would be a must of course.

      In your estimation how much of the average emerg room workload could such a system remove from doctors?
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        Sep 9 2013: I really cannot estimate the reduction in emergency room visits but in Vermont where I live we are heading toward a single payer universal care system, and it has been identified that that will be a huge saving in having the uninsured receive primary care and early detection.
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      Sep 9 2013: This echoes to some degree Paul Farmer's work on training community members in remote regions to provide informed health care delivery. One issue in India is that there are a great many lay practitioners who are not well informed of or well equipped to offer effective health care services.
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        Sep 10 2013: Standardized training and equipment would then be an advised remedy if this system were applied?
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          Sep 10 2013: It may well be easier for whoever is doing the training to do something standardized, though that is not necessarily true. As an example, when in schools student teachers have staff mentors, the guiding teachers mentor based on their own successful experience rather than a standardized rule book.

          If you are asking about the lay practitioners in India, there is a different challenge in that. They are traditional healers who may not be interested in any such training.
  • Sep 9 2013: Then what? Do that with all professions? This sounds familiar.
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      Sep 9 2013: At the moment the focus is on finding a way to improve delivery of medical services however I agree with you that most or many aspects of society can always benefit from improvement.

      Welcome to the conversation Taylor. How would you improve today's medical system delivery?
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    Sep 8 2013: I sort have alluded to what I thought what would help people access primary health care. I think that all people should have "access" to health care. And currently they do. The "problem" has been stated that poor people go to emergency rooms for primary health care situations and that is extremely costly. OK,, then free or low cost primary health clinics would relieve that situation.

    The phrase "reasonable and affordable medical care" means what? There are medical conditions that treatments can reach into the millions... is that reasonable and affordable? How does one draw a line and say what's reasonable. I don't want into that conversation. A number of primary care clinics would have done so much more with so much less political bickering. Too late.

    What I see in the new health law is a Federal Grant for health insurance companies to steal. Stock investors have already boarded that bus and are going to make a fortune.
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      Sep 8 2013: I feel "reasonable and affordable" health care would cover anything that was not optional or vanity. This would mean that operations such as face lifts would not be covered, while cosmetic surgery for major burn victims would. I feel the reasonable dividing line would be found between need and want.

      As for the business world, someone better qualified than I will have to answer as to how to keep them on the strait and narrow. If the federal government allowed Enron, how can we prevent misuse of funding loopholes in medicine?
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        Sep 8 2013: Good points,
        Needs and wants. That has always be an individual determination.
        There is a current case where an incarcerated transgendered person wants the state to pay for his/her surgery. It is really needed and really expensive. This is the kind of decisions that someone will have to make.

        As far as the misuse of funding loopholes in the new laws.... It will be bigger then the save of the large financial institutions, (paid by a trillion dollars of taxpayer funds), bigger then the save of academic institutions (paid for by a trillion dollars of student loans) oh yes, this is going to be stupendous. .
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    Sep 7 2013: When I first heard of a national health care system proposed a few years ago, I envisioned primary health clinics all over the country to address health concerns, The country is short tens of thousands of primary care doctors as reported and in my imagination, the government would provide scholarships to doctors and PAs and nurses in exchange for service in all the new public clinics. It seemed like a great idea to provide basic medical care to the poor.
    Well, the program instead became a windfall for health insurance companies and a great disappointment to me.

    I am not familiar with the Cuban medical situation. I have heard they have well trained doctors but are sorely lacking in the technology we have here in America. I am familiar with medical services in European countries and
    again, the US has an technological advantage. A German doctor confided that the big MRI machines made by the Siemans Company in Germany are sold to the US. They are too expensive for the government medical budgets in his country. There are constraints in public funded medical care. But, they have other techniques and tools in their practices that our doctors can't use.

    I am disappoint the USA health care program became about insurance and not about assuring the poor had basic health care opportunities.
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      Sep 7 2013: Mike how would you suggest we resolve the medical situation so that all citizens have reasonable and affordable medical care?
      • Sep 13 2013: Please define "reasonable".

        It appears that waiting 2,3 hours in an air conditioned office / room for a non emergency / trauma visit is considered inhumane and draconian.
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    Sep 7 2013: Let me try to bring here the other side.

    Medical doctors are not merchandizing products.
    People may realize that we are humans as other. The difference is quite simple. The profile of a good doctor is rare, and becoming scarcer with the implemented western/capitalist culture.

    When in need (in primary care not only needed) everyone wants to be checked by a professional with the right skills and preparation. But not only, we also expect some one with sensibility enough to understand our fragility and the concerns and doubts our nearest and dearest have. Someone who can deal with a huge amount of different stress factors: the harm that a simple "mistake" can bring to the patient's health, then and consequently to our carrier, the administrative and bureaucratic pressures, carrier progression, exams, congresses, publications. Then as said before, we are all humans with our own problems and families (mother and grandmothers in law and all), things we must fully leave behind from the moment we are on duty.

    So the society demands/needs a person willing to dedicate most of our time to learning, practicing and innovating and at the same time being focused, respectful, ethic, compassionate, patient, tolerant, resilient.
    At the same time and because we "only need" them when sick, we generally "think" they should be payed less and less.

    In a profoundly damaged society (value and education wise) these thoughts don't come as a surprise.
    It's even less surprising bringing this question. More so when most of you must already have replies prepared in your mind. Replies with statements that only reinforce my point of view.

    Yes there are obnoxious, arrogant, insensitive, distant, cold, incompetent doctors already. That's a problem. Increasing the offer, means increasing this people in medicine and thus worsening the health care.
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      Sep 7 2013: Medical boards see patients as statistics when making determinations and doctors follow the dictates of medical boards such as I noted when 2 weeks after a major injury to my leg at work my doctor told me that while it was winter, and he knew to get to work I'd have to walk just under 2 miles to get there, it was his job to send me back to work because the medical board had negotiated a deal with employers for a new "early return to work" policy.

      Bottom line the business world see's doctors and patients alike as products and statistics as much as both parties are and want to be seen as human beings.

      However that aspect of things aside, a good deal of strain on aspiring and new doctors is financial, and of course an overwhelming neverending workload. Would it not be advantageous to have a lighter workload and less financial strain? Would that not allow doctors to have more time for higher quality assessments under less pressure, thus benefiting both doctor and patient?
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        Sep 7 2013: Hi Martin,

        Yes they see only numbers, worst, when you offer a medical doctor a position of director and push him around with numbers and stats and on top of that you offer a bonus if his department achieves certain goals they too become blind. I face this in a daily routine. Once you are not just another regular patient or the medical doctor held responsible for the patient health, you become easily blind.

        Medical boards and insurance companies apart (yes these are parts of the capitalism face of health care now a days), I keep seeing a big issue, in the actual state of things (culture, economic, social and political wise) even if you manage to trick few more to believe in great wealth and quality of life by being medical doctors there will not be a number enough willing to endure in this carrier for the sake of altruism. Thus you will end with worse health care.

        I understand your points, but I happen to know things from the other side. It might not seem (?) but just the amount of knowledge (ever increasingly) demanded, all the responsibility and pressure involved is not something the society/governments have motivated/directed schools and homes to implement so a lot people would be willing to endure and be capable. It's not.

        Medical doctors can not be "produced" in a massive scale, you or your close ones will fill it the day it happens.Though you may pick doctors from other countries. But believe me that the amount of money we have to spend so you can certify/believe we are skilled is not worth for most foreigner doctors (the worth one's having there at least) to go there.
        I wouldn't mind living in Canada, but the bureaucracy and expenses are tremendous.
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          Sep 7 2013: Joao,

          You too make some really good points.
          "but just the amount of knowledge (ever increasingly) demanded, all the responsibility and pressure involved is not something the society/governments have motivated/directed schools and homes to implement so a lot people would be willing to endure and be capable. It's not."

          Joao, what if we compartmentalized more? Less education required. We already do this with "specialists" to a degree yes?

          What if we had a sub group of doctors specialized with colds, with injuries, etc.

          Could we not mass produce these?

          What if we were to move some of a doctors skillset to be handled by RN's? Many RN's are exceptionally capable people and can handle more than they are currently allowed.?

          I don't believe in throwing in the towel and saying oh well. I believe in saying ..what will it take to get this job done?

          So.. in your opinion, what will it take to lower the wait times in emerg units without sacrificing quality?
  • Sep 6 2013: Except there is no lower equilibrium price in medicine in the USA. Instead, the market is so severely meddled with that no equilibrium price is permitted to exist.
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    Sep 6 2013: I'm not sure of the technical economics of it all but there may be a few issues.

    1. Any/All mechanisms you mention and any I can think of would require investment. How would that be financed?

    2. Medicine is an intellectually challenging discipline, are there enough capable people in the population who want to pursue a career in medicine.

    3. There would always be an opportunity-cost for someone choosing medicine as a career. This is often offset by the promise of higher incomes in the future, which I'm assuming would be negated somewhat by the action of your pricing mechanism.

    I agree that access to education is a barrier to entry, but I'm not convinced that you'd reach a point where increased supply resulted in less cost in this case. If for no other reason than increased supply and ease of access to healthcare may result in increased demand.

    My feeling is that reducing demand for qualified doctors by means of triage mechanisms and better health/fitness among the population would provide better and more dependable results.
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      Sep 7 2013: : 1. Any choice including none is going to require investment. Financing will either come from the private or government sector or a combination thereof.

      2. Medicine IS an intellectualy challenging profession. Agreed. It is certain Canada has individuals who are capable and willing or can aquire them if the opportunity is there.

      3. The current system of doing things leaves us with a shortage of doctors. In order to circumvent that shortage we would have to change the current way of doing things to be more conducive to that end.

      Stephen, I have to agree with you. There remains the as yet unspoken possibility that as we generate more doctors into the system and costs go down, that the rate of bleeding existing doctors from Canada to other nations willing to pay more may not become a factor that negates the benefit of subsidy.

      However of course in the past it was done successfully I believe when Canada subsidized doctors on the proviso that when they completed they would work for x period in x location to help ensure doctors were where they were needed most.

      Stephen how would someone being more fit or having better triage reduce wait times dependably in say an emerg with 13 hour wait times?
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        Sep 13 2013: What if I proposed there wasn't a shortage of doctors, but rather an increase in the usage of the health care system? If you give someone a $100 gift card to a store, they usually spend it right? If they have to cough up that $100 themselves the barrier suddenly becomes significant and they might think twice before making a purchase. This isn't to say that someone shouldn't seek medical help when necessary, but that they might seek help when it is not necessary which is frequently the case.
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          Sep 13 2013: Matthew then I would have to propose that you were yanking our chain.

          I can think of a great deal many things to do with my day off than hang out in a hospital waiting room waiting among a group of suffering people to ask the doctor about a hang nail.


          Would your own mother hang out in a hospital waiting room over a hangnail? Would your brother give up his golf day to spend it among sick people to see if his cold sore could get some prescription balm? Would your sister give up her day off to hang out at the doctors to ask if they'd prescribe antibiotics for a scratch? Your father spend his only day off in a room full of agonizing sick people because there was nothing better to do? I don't think so.

          The majority of people seek medical attention when they are in need of it.
          I looked it up.

          "1% to 14% of patients examined for health problems, suffer from Hypochondria"

          So we should have privatized health care where only those that can afford it can get access, because while 84% of people would use a subsidized health care responsibly, 1-14 % of persons might unintentionally misuse it? Is that what I'm hearing?
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    Sep 6 2013: Hi Martin,

    I think your approach would work, but there are a lot of assumptions:
    1. the supply/demand paradigm assumes rational actors - we try to be rational, but it doesn't always work out.
    2. you are dealing in a market that has significant demand manipulations - promoted demand distorts natural demand.
    3. you have supply-side constraints. Some of which are irrationally driven (prestige, in-fighting)
    4. deep seasonality.
    5. Frequent outliers (disasters - natural and man-made. epidemics)

    With all the noise in the healthcare "market", I think one needs to concentrate on versatility/adaptivity before manipulating supply-side.
    One major advance to the solution might be to stop constraining the issue in market terms.. perhaps more emphasis on social capital would help increase scalable response-times? For instance, an increased level of nursing education in the general community might establish a reserve resource to address the variability and increase service levels without increasing narrow cost constraints. Having a higher healthcare ambience in the community might result in higher take-up rates for specialised professions?
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      Sep 6 2013: Hi Mitch!

      Great to hear from you again.

      Mitch, please forgive me but some of that went right over my head.

      To paraphrase I think you might be saying rather than focus subsidies on introducing more doctors into the system, increase medical spending towards employing more staff in key area's below doctors so the money would go further and the services end would expand more readily.

      Is that correct?
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        Sep 6 2013: Hi Martin,

        Sorry for the jargon! I spent about 16 years working on supply/demand systems with a focus on demand forecasting.

        What I'm saying is that there are 2 economies - the exchange economy and the social economy.
        In the exchange economy, there is no value residue after a transaction beyond interest/usury.
        In the social economy there is a large value residue that is generated as a commons. This is equivalent to surplus from human labour.

        If you increase the commons component of value, it serves as a "buffer" and allows the economy a larger margin to absorb shocks.

        So the suggestion is to have nursing and healthcare skill educated throughout the community as a social investment. That way, healthcare shocks can be absorbed by having a "reserve army" of volunteers plus a greatly enhanced first-aid capacity. The secondary affect is that the increased awareness of healthcare issues would induce greater uptake of people entering medical professions. This would induce your supply-side balance without directly manipulating funding arrangements.
        The danger of directly funding supply-side is that it creates a pool of money - that attracts exploiters before it attracts the truly "called". It results in a quality downgrade in medical professions.
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          Sep 7 2013: Mitch,

          I can see some good logic there, but ..there's always a but isn't there? I have to question how many steelworkers, waiters, and people from all walks of life already stressing from trying to get through their busy days, would be eager to sign up to take night courses in nursing/healthcare .. so they can volunteer them to the community. Alot of people that finish slaving all day just want to get home to their families and enjoy some downtime, don't you?

          On the other hand, what specific skills do you see in those area's that could alleviate the reasons people commonly see doctors enough to significantly reduce wait times?

          After all, we could always include a new "mandatory" class in schools that would see every citizen learn a reduced set of medical skills if it would benefit them strongly enough to be worth the cost and effort.
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        Sep 8 2013: Hi Martin,

        "but"? yes, nothing is simple. Or rather - things may have simple roots, BUT become complex very quickly.

        The situation with people not having any time is another subject .. I could go on at length about that, but I'd better not .. personally, I have tons of time .. that took a lot of strategy to achieve. Most who can engage with TED conversations have a lot of time, for one reason or another.

        I'd see the raising of healthcare skills best served by getting first-aid taught at the youngest age possible. At the moment, that means schools, but it could be done other ways. Whichever way, it doesn't matter. By getting to the youngest, it propagates to their parents and spreads-out. From there you might see some reform to the liability laws that currently hamper a lot of civilian intervention - as is seen in things like road-accident cases where everyone slows-down to look, no one stops.
        It's an awareness thing.

        If you follow modern neuro-science, you will see that "framing/priming" has powerful affects on the way people perceive and react to things. That's where "ambience" becomes important.

        Specific skills? .. common diagnosis would help .. how to take a pulse, get a blood pressure, check common signs, and how to recognise the need for specialised help. THis is already a factor - things like CPR, the Heimlich manoeuvre etc already have some degree of traction - these, as a start, could begin the process if they were formalised for the whole community. You could go on with some of the more common nursing practices. There might also be some relaxation of the prescription laws - if a person holds a certificate of diagnostic skill, they might be granted a small range of prescription - so the operation of basic drugs could be educated - simple things that work, like anti-biotics, analgesics .. dressings .. basic stuff.
        My sister is a chief nurse-educator in my state's healthcare system, my brother in-law is the nurses' union leader. Perhaps I could ask them?
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          Sep 8 2013: "My sister is a chief nurse-educator in my state's healthcare system, my brother in-law is the nurses' union leader. Perhaps I could ask them?"

          If you would include them yes that might give us some valuable insight. With responsibility comes accountability and if any wrong decisions were made it could cost lives. One would always want to err on the side of safety yes?
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        Sep 9 2013: Risk is a very interesting concept.
        If you take too much, you fail, if you take none, you fail.

        With policy comes discretion. Unfortunately, lawyers do not like discretion. And discretion is the birthplace of corruption.

        Wrong decisions will always be made. It is the nature of risk. Accountability is determined by winning more than you lose.

        This is where "ambience" becomes so critical - our culture has drifted into an ambience of unreasonable intolerance.

        Healthcare begins with empathy - empathy leads to compassion. All that is needed is to emphasise the critical role of compassion - and give it some tools. This is a cultural task - customs of compassion will certainly find the tools for expression if they are allowed to.

        There is evidence that a compassionate culture has less health problems. So perhaps your supply/demand question could be solved by abandoning the supply/demand ideology?

        I will ask my sister what she thinks. My Brother in law will be un-reachable right now, the fascists just took power in Australia - and the unions will be very busy planning their survival.
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          Sep 10 2013: I do not know that abandoning the supply demand ideology is a valid option that we can reasonably achieve at this point in politics?
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        Sep 11 2013: Hi Martin,

        In the realm of "serial binary transaction" supply/demand is solid (give or take the inherent instabilities of scarcity/distribution). However, when you are dealing at the tribal/community level, it stops being binary. It becomes massively parallel and networked.

        I'm not talking about abandoning the supply/demand "market" *method* .. I'm talking about the supply/demand *paradigm* .

        When blank "market forces" are the total definition of the paradigm, the solutions you are looking for cannot be found.

        I am suggesting that the paradigm be widened to include the type-2 social economy.

        For instance, we use the "insurance" concept to comprehend healthcare outcomes.
        It's a reasonable good concept. But it has a flaw - insurance, at its base is risk-shifting when applied to market forces, but when it is applied to the social economy, it is risk-sharing. Healthcare is a social investment - and insurance applied to it is risk-sharing.
        When you indulge in risk-shifting, you export your risk to "dupes" - this is what the commercial insurance industry does .. it's rarely presented that way .. but a wink-and-a-nod can make someone else suffer your risks for a small fee.
        When applied as social insurance, it is an investment in social strength and productive potential.
        This is the basis of the "welfare state" which is currently being demonised as a prelude to pillaging the latent social value stored within it. That's our lifeboats being sold as firewood.

        No, don't abandon the "market" method - simply subsume it into a more honest framework. To do that, you need to have a serial+parallel paradigm - and know which side of it is appropriate.
        I use insurance as one example - there are others.

        (I note that that insurance began as a confidence trick - Having worked in the insurance industry, this is well known in those circles)
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          Sep 11 2013: Hi Mitch,

          In general I believe you feel we can apply risk shifting to various factors of the financial (and or logistical) requirements of an enhanced health care system to downgrade costs and upgrade efficiency if I understand you correctly.

          More than one of our other contributors suggested shifting the risk with regard to logistics by training and empowering people to perform a doctors more mundane functions, freeing the doctors up to focus on the more complex aspects of care.

          Others have suggested educating the public itself in prevention methods and first response techniques to lower the amount of professional health care required.

          Yet others have suggested creating private foundations to offset new doctors educational costs.

          Are these some of the specific approaches your serial+parallel paradigm might embrace?
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        Sep 12 2013: Hi Martin,

        Yes, these are good examples of what an expanded social paradigm might do.

        I particularly enjoyed reading the Cuban perspective (below).

        With the expanded social capacity enabled by the internet, There is a growing pressure for institutions to move towards a serial+parallel paradigm. The incumbent interests all reside in the serial economy. Most governments (states) understand the need for social investment, but are fighting a losing battle because they do not understand the world in these serial/parallel terms.

        I have been examining the divide between social and financial capital for many years now and am now beginning to identify the conceptual tools required to comprehend the issue. It's early days, but I think these tools can evolve such that they will spread globally.

        1. There are 2 economies. The financial economy cannot be successfully applied to collectives such as tribes or states - tribes/state must operate in the social economy.
        2. Secondly, the 2 economies can be clarified by separating financial/social, serial/parallel, binary/analogue etc.
        3. It must be understood that the serial financial economy is not intended to yield a transaction residue - any residue imposed on it is usury and will increase wealth imbalances. On the other side: a social economy is intended to yield transaction residue - this residue passes into the commons.
        4. Insurance is a criminal act when applied to the financial economy, but is an important factor of the social economy.

        By using these tools, you can understand the root-causes of social issues.

        Underneath all of that is the notion of "property" - the only thing a human "owns" is their agency. If the principle of property was understood this way, there would be no crimes of dispossession or liberty.

        These things can evolve politically - but only if the basic principles are understood by all.

        I have learned a lot from this conversation - many thanks!
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          Sep 12 2013: You know Mitch, I really enjoyed the read too. I'd not hazard to think I understand the nuances as well as you, but none the less I feel it has advanced my perception somewhat. Especially the comparison between serial/financial and social economy.

          Honestly though when I thought of financial economy I thought of China with its state owned enterprises vs social economy such as perhaps the US where privatization of social services provides services at a price feeding private enterprise from the social teat.

          I won't say however that I feel understanding those will explain to my satisfaction the root causes of social issues. I feel the root causes of social issues are "to heck with you and here's to me!"

          I'm believing by agency you mean "the capacity of an agent (a person or other entity, human or any living being in general, or soul-consciousness in religion) to act in a world."(wiki) but frankly then I'd have to disagree. A person is not always their own master in this world as forces, or poor health can take even that away. So we don't really own our agency, we rent or lease it. *winks*
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        Sep 12 2013: HI Martin, sorry to go on and on, but it seems productive.

        To me, agency is what an organism does to maintain its existence.
        it's a loop: reality-->senses-->perception-->information-->evaluation-->potential-agency-->decision-->action(agency)-->changed reality (repeat until death). All organisms do this.

        "Heck with you" is a statement of property. It is what happens in a serial economy over time when the parallel economy is downgraded. For instance, it is harder to say "heck with you" to your own mother or your best friend.
        Property relates to the evaluation of potential agency - it arises in competition for scarce resources when evaluation exceeds social options. For instance it is useful to view morality as being the zone where both personal and mutual advantage is served by agency. To act outside this zone is to be "immoral".
        "heck with you" is also what financial economists call "externalities". In the corporate world, it is actually illegal to consider externalities .. but it also fails to recognise that a corporation is a feudal community.

        When I look around, I see no scarcity - I only see a political/economic paradigm that has obsoleted itself.
        In game-theory, the selfish tit-for-tat strategy initially wins-out, but the moralistic forgiving-tit-for-tat strategy overwhelms the selfish paradigm. I am looking to observe how the tribal limits of humans affect the game theory.
        When you apply tribal limits, it seems that large collectives are inherently unstable .. this renders large-scale policy ineffective.
        It seems that a stable tribe has no need of financial economy - but inter-tribal relations certainly do require it.
        Atomising the community into individuals conducting serial transactions is a method of de-tribalizing humanity, but the limits are physical - a human cannot comprehend more than 200 other humans - and this is the stable collective tribal size. Beyond that is instability, and humans will form tribes regardless.
        Tribal stability is the end-game.
  • Sep 6 2013: There are solutions but whether human beings are intelligent enough to implement them is another thing entirely.
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      Sep 6 2013: Bob, please allow me to pick your brain some.

      You mention there are solutions that would resolve medical service shortcomings in our countries if we were intelligent enough to implement them.

      Would you please expand on this idea in more specific terms?

      What do you have in mind? (and thank you for being kind enough to share I appreciate it as we sure need all the help we can get and I realize your time is valuable)
      • Sep 9 2013: Unfortunately canadian voters are too uneducated. The real problem is that the canadian electorate is out of touch with reality, pretty much the entire country is not smart enough to be even voting in elections. The whole country is being taken for a ride by the corporate media and politicians.

        Both the conservative and liberal parties are on the war path to privatize healthcare. They have been intentionally under funding it for the last 20-30 years. As well as underhandedly attacking social programs and our media has been complicit in not reporting anything about these attacks.

        Tommy douglas:

        Mel From TV ontario

        A talk he gave

        Books you need to read:

        Health coalition
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          Sep 12 2013: Thank you Bob.

          I apologize for taking so long to reply, however I wanted to ensure I had time to visit each of the links that you have graciously provided.

          I have to say the ones with Tommy Douglas and Keifer Sutherland are my favorites. I have been an admirer of Tommy Douglas's views on many social issues for a long time. I'm not one bit surprised that a CBC poll once named him Canada's Greatest Canadian.

          I have alot of faith in our fellow Canadians however. I feel while we may not be all experts on what is going on in the intricacies and Machiavellian undercurrents of politics, we are experts on ourselves, and how we feel about things concerning ourselves. I've always felt if we gave ourselves the issues and let us vote our conscience with the government of Canada carrying out our majority will, we'd all be a lot better off. All Canadians share a good deal more in common than many might suspect.

          Thank you again for this valuable contribution.

          all the best Bob
      • Sep 12 2013: @martin

        I'm sorry but if canada keeps electing liberals/conservatives, you can kiss goodbye to healthcare quality. I don't think you grasp what has been discovered about the human mind. Also you are one of the ignorant people I'm talking about. It's obvious you are clueless.

        Learn more about harper
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          Sep 12 2013: Hi Bob,

          I can understand the pessimism. After all if you do a thing a million times and get the same results, whats the point in expecting different results!!

 stop doing the same thing if you want different results.

          Last thing Bob? Respectfully .. you've made some good points towards health care. Do not demean yourself or this conversation please with personal attacks. I hope you are better than that.

          Please have a wonderful day and thank you for your contributions.
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    Sep 6 2013: It is possible only if the demand remains constant. But where will that happen? Population is growing rather quickly,
    Medicine has been compartmentalized to a greater and greater extent. Doctors are finding that certain practices are more rewarding then others including the financial rewards. It maybe theoretically possible, but I am not sure it would really happen.
    Modern technology could inject some manhour savings, but I think we are centuries away from robotic doctoring.
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      Sep 6 2013: Ryan Blough has some really interesting comments on the technology end of things including some excellent pointers to existing TED material by Ray Kurzweil I plan to look up.

      Ryan feels we may be seeing it sooner than we'd think.
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    Sep 5 2013: I think you are correct in the economic mechanism, but are looking in the wrong direction for the method.

    I suggest that the problem be broken down further than a shortage of supply of doctors to a question of demand for medical products and services.

    At present, IBM is programming new generations of their Watson supercomputer to have access to all medical literature and research, and be able to compare symptoms and demographic data to provide diagnoses. The X Prize Foundation is offering a prize for a handheld device that can record symptoms and perform basic tests for remote (or instant) diagnosis. In the US, public pressure is directing the medical research establishment towards questions of efficiency. Robotically aided surgery enables expertise to be applied anywhere in the world.

    We haven't elected to produce more doctors, but to provide alternative means of testing, diagnosis, and treatment delivery that don't require as many. The new family physician will be a small box with probes and access ports for disposable testing materials. Medicine at the pharmacy or by mail.

    These solutions can all be mass-produced.
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      Sep 6 2013: Ryan that is fantastic news!

      I was not aware of progress in this direction.
      With regard to the diagnosis end of things how far out is their timeline to deployment at a facility near you would you think?

      20 years, 50?
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        Sep 6 2013: Much sooner than that. Imagine how long it took for a brick portable phone to turn into the modern multimedia device, and then consider that both the need is greater and that technological growth is accelerating. Ray Kurzweil has several videos on Ted that should explain the mechanism.

        As far as a facility near you or I, there are large industrial interests that might succeed I regulating against such devices in the near term. But they will develop anyway, and deploy widely in Africa and Asia, where they are most sorely needed and where the component concepts were largely field-tested. NGOs there already are trying systems of remote diagnosis by describing symptoms over a cell phone text message, and there is a blood test designed that checks for a half-dozen diseases via a drop of blood through paper filtration for some absurdly cheap price - less than a buck apiece, I think, once economies of scale are applied. Also on Ted, under the Mobile and Healthcare headings respectively, I think.

        Full steam testing in 5. On Amazon in 10 or less.
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          Sep 6 2013: The trick with technology is to get it deployed for the whole community.

          It would be brilliant if that could be done.

          But there's a hitch:

          You need to be in the economy to gain access to the technology - i.e. you need money.

          Technology displaces humans in the economy - in the USA, it is shown that 60% of unemployment is due to "productivity" increases due to technological efficiency . the remaining 40% can be traced to off-shoring.
          Unemployment in an economy is equivalent to exile from the economy. This leaves only Keynesian intervention to re-admit those exiles - through "make work" programs or welfare. These are not popular at the moment - I assume that the unsaid alternative is "just let them die".
          Those who have been left to die might not agree. Indeed, many of the non-exiled community would also not agree.
          Market economy moderated by money, including the means of efficiency (technology) seems a potentially destructive approach if the corresponding issues are not also solved.
  • Sep 5 2013: Replying here Martin since there is no room below.

    I never said that Doctors doing what is in their best interests wasn't a problem. I just said that adding more government, which is what helped create the problem to begin with, won't solve it.

    We need more creative ways for people to become doctors which requires more, not less, freedom to experiment. Government only functions by telling people what they can't do.
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      Sep 5 2013: Robert, I think perhaps you and I can work towards an agreement. You see, it is not my goal to achieve better medical service through governance, it is my goal to achieve better medical service through the most expedient means possible.

      In my mind, I am thinking that the more doctors there are in the system, the more access there will be to them. In the legal profession one way they achieved a similar goal was through paralegals.

      It is my greatest hope that together we can all find a solution that will result in our fellow citizens having superb accessible health care at a reasonable price.

      After all, if the greatest countries in the world cannot achieve this, what hope is there for the rest of the world.

      We CAN achieve this, the question is what is the best way, and do we have the will to make it so.
      • Sep 5 2013: You may be correct that we can find agreement. Your topic paragraph mentioned subsidies for med students. Subsidies are handed out by governments and, as such, depend on people having their wealth removed involuntarily so that others may benefit. I am Libertarian so I'm fundamentally opposed to all types of theft.

        If you really want to help med students then get to know a few. The only real and moral way to help them is to get directly involved. Maybe start a foundation to help with their education expenses.

        On a related note, a Chinese friend of mine is the chief of surgery in a major Chinese hospital. He only had four years of training post high school. The rest of his talent was developed with on the job training. He worked directly in the hospital under the tutelage of more experienced doctors for several years before he started doing solo surgeries.
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          Sep 6 2013: I'm a strong believer in government.
          However I believe in government directly controlled by and responsible to the people.
          My thought is we are a team and need each other.
          No man is an island so they say.

          I like the idea of on the job training. I like the idea of subsidizing. I like the idea of advanced technology ,and I like the idea of compartmentalizing so that existing doctors have more of their functions done by staff that require less education.

          At the end of the day I think its more important that we find a way(s) to improve our medical system access/quality/cost wise, than it is to insist on any single path of achievement.
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        Sep 11 2013: Martin,

        I agree with a lot of what you say, but not all. Health care, as it currently stands, is profit driven and extremely reactive in it's nature. For example, how much cheaper would it be to provide every man, woman, and child a multi-vitamin, as compared to all the illnesses associated with the lack thereof? I'm not suggesting a multi-vitamin cures all problems, but there are numerous clinical studies that show just how valuable they are to one's health and immune system. Taking the practical approach isn't done when you have privatized health care. Socialized health care, by default, is not the solution.
        It is a very reasonable sounding idea that the "the richest countries in the world should be able provide health care for all it's citizens" but not a practical one. We hold health care, understandably so, to a different standard since it deals with life or death, sickness or health. I get that. When did it become a "right" however? When we attempt to control outcomes of all peoples through wages or even health care we no longer are a free society. The problem is that our perception of "justice" has been tweaked an manipulated over time. Justice used to stand for "a fair shot" but now it stands for "a fair outcome." I think you would agree that mandating "fair outcomes" through government channels" is impossible, and history has proven this repeatedly.
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          Sep 12 2013: "We hold health care, understandably so, to a different standard since it deals with life or death, sickness or health. I get that. When did it become a "right" however?"

          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.

          " I think you would agree that mandating "fair outcomes" through government channels" is impossible, and history has proven this repeatedly."

          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.

          " Justice used to stand for "a fair shot" but now it stands for "a fair outcome."

          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.
  • Sep 5 2013: Not sure about Canada,but in the US the areas with the most number of doctors have the highest rates. the areas with the least number of doctors,the rates are usually very low.

    Also,the question is the number of people with the aptitude to become doctors - not those that wish to be doctors but have the personality and ability to do it.
  • Sep 5 2013: The beauty of the laws of free market economics is that freely and independently set prices help determine what and how much is produced. Things that are hard to produce/procure are automatically rationed since their prices will tend to be higher. The higher prices give people the incentive to find ways to produce more. These laws work tremendously well to produce enough of what is needed. It is usually when someone thinks they are smart enough to tweak these laws that things start to fall apart. What you are proposing is nothing more than the same socialist central planning that has brought the world economy to its current sorry state.
    • Sep 5 2013: Not exactly. The medical industry is already tweaking the situation to keep prices high.

      In any event, the medical industry is unusual in that its customers are sick, and often cannot or are unwilling to consider the competitive situation. The medical industry takes full advantage of this to increase revenue and profit.

      Socialist central planning will not result in the optimal solution, but if no action is taken, we have every reason to believe that current trends will continue. Doctors, drug companies, hospital corporations, medical supply corporations, etc. will all continue to increase their revenue and profits, at the expense of everyone else.. By the way, Obamacare will do the exact opposite of what was claimed; it will raise prices.
      • Sep 5 2013: I agree about ObamaCare and it illustrates my belief that too much government involvement is already the reason that health care costs so much.

        It is in the best interests of anyone in a profession to make sure that as few people as possible are in it with them. They will manipulate the rules to achieve that end. The government has helped all professions with this by making the rules for being licensesed for and practicing professions difficult and expensive to follow. The solution will not be to get government more involved.
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          Sep 5 2013: "It is in the best interests of anyone in a profession to make sure that as few people as possible are in it with them. They will manipulate the rules to achieve that end"

          So screw the good of our fellow countrymen and women needing medical help or our ability to lower prices and increase accessibility, lets make sure there are as few as possible doctors and medical personnel available to keep prices at a premium. May those individuals make every effort to maintain that situation. Maximum profit and to hell with the availability of health care for our fellow citizens in general .. is that the plan that will improve our nation?
  • Sep 5 2013: You are assuming a shortage Where when why etc. There are so many variables what do we want and what do we want to change?
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      Sep 5 2013: George, in Canada it is not uncommon to wait 13 hours at an emerg to see a doctor. Suppose, you were to go to a grocery store and had to wait 13 hours at a checkout. Would you feel they had a shortage of checkouts?

      How about waiting 13 hours in line for any service, would you feel that perhaps they needed a few more persons to cope?

      If every time you went to gas up you had to expect 13 hours in line and you KNEW that something could be done about it, but that this occurred so they could keep prices high wouldn't you object?

      I feel the need to be dealt with in a reasonable amount of time is far more important when applied to your physical health, than when you are waiting at say a gas pump would you agree?
      • Sep 6 2013: Thank you I always wonder as I am in Texas, and we are told that all the Doctors in Canada moved to Florida. I am glad to hear that that is not true, but so many urban tales are not true. Now I know you have some real health problems too. I do hope it will get better, but in the real world few people have shown much interest in what I think.
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          Sep 6 2013: We all are experts on at least one thing that being ourselves and how we feel. I expect that how you feel about things likely is common to alot more people than you might originally think.

          All countries have issues and so have room for improvement. Together, we can make a positive difference.
      • Sep 7 2013: Thank you , and it's good to get the true story about Canadian medicine.
  • Sep 5 2013: What determines the number of students at a particular medical school? The number of medical schools?

    Does the government or external entities (AMA, etc.) control the number of doctors for a given population?

    I think there may be other forces at play besides just economic factors.

    Interesting article:
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      Sep 5 2013: "For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians."

      "It didn't happen," says Harvard University medical professor David Blumenthal, author of a New England Journal of Medicinearticle on the doctor supply. "Physicians aren't driving taxis. In fact, we're all gainfully employed, earning good incomes, and new physicians are getting two, three or four job offers."

      "Because physicians are affluent and in short supply, they tend to locate where they want to live — not, as McDonald's or a Chinese restaurant might, where the most customers are."

      "We face at least a decade of severe physician shortages because a bunch of people cooked numbers to support a position that was obviously wrong," Cooper says. "This is a desperate situation. And we need to act now because it takes a long time to train a doctor."

      The above excerpts were taken from the offered article at

      Robert I tend to agree with you that external forces are artificially creating doctor shortages to drive prices up with utter disregard for the medical well being of the nation.

      Our nations would benefit from having more doctors, financially and health wise health care would be far more accessible/