"Sweet son of spell check." -Rating Pending
Question #92747 posted on 11/20/2019 4:36 p.m.
Q:

Dear 100 Hour Board,

There has been a lot of talk lately surrounding universal healthcare. Years ago, I would have said that this is socialist and a terrible idea; now, after having lived abroad and listened to many people's stories, I am much more open (even supportive?) of some form of universal healthcare.

The tricky part is, I'm married to a medical school student. He is pretty nervous about Elizabeth Warren's Medicare for All plan and other similar proposals for universal healthcare. He's worried that he's going to end up working for the government and dealing with all the inefficiencies and regulations that seem to come along with that. And, as much as I'd like to say that he decided to go to medical school for purely altruistic reasons--and as much as these altruistic reasons were the main driving force of this decision (and the reason that he has his eyes on one of the lowest-paying specialties)--I would be lying if I said that the prospect of a comfortable life didn't also factor into the equation (after all, there are many ways to help people, and not all of them require tens of thousands of dollars in med school debt). Overall, we will come out with lots of debt, and there's a real fear that his future job prospects won't be bright after all, that the salaries will be low, etc.

How founded are these concerns? What do you foresee the future for American physicians to be, if we were to institute universal healthcare? How do I support my husband as a future physician while also supporting the right of individuals to receive quality healthcare? And please be patient with us--we want income inequality in the U.S. to decrease, we want to serve people--but we are also human and a little bit selfish sometimes, and it's scary to think that a really big commitment and investment we are making right now might not pan out to give very good returns (both monetarily and otherwise) in the future.

-Wife of future M.D.

A:

Dear Wifey, 

First, let me tell you something that changed my perspective on this issue, which my fave sociology professor told me in his intro class. 

All countries and societies ration their healthcare. Most first-world countries with universal plans ration that care according to need and the severity of the problem. In the United States, we ration our care based on who can pay for it. That. Sucks. 

What that means is that in other countries, everyone regardless of class is treated equally, it's based purely on who is in the most immediate need. But the care is there for everyone. That makes a heck of a lot more sense to me. 

What I can tell you is that your concerns are not unfounded (a change in our healthcare system is likely to cause some people to be uncomfortable, and it's fair to feel that way), but they are also not accurate. Here's why: 

- Our universal healthcare system doesn't have to look the same as every other country's. It is 100% possible that we come up with a creative approach to this problem that is better suited to the needs of the United States. For example, I don't see why we couldn't keep private insurance for people that want it, but make sure that everyone in the U.S. does have access to SOME kind of insurance. Sort of like how BYU accepts alternative health insurance, but if you don't have it, they offer some. (Granted, it has horrible coverage and is crappy for the price you pay, but it's there. Also, don't get me started on the whole thing with BYU-I not accepting Medicaid. They're horrible and they better reverse it or I'm going to drive up to Rexburg myself and give the administration a major talking to.) In any case, the fears you have could be completely avoided just by the nature of how the problem is tackled. 

- From the doctors in Canada (a universal healthcare country) I've talked to, they actually much prefer having the universal system, because it completely eliminates the complexities of billing different insurance companies with different terms and contracts. Instead, you're dealing with ONE entity. Will bureaucracy still be involved? Sure, probably. But instead of trying to work with 200 different forms of insurance, you're dealing with one. 

- Universal healthcare doesn't actually have to mean you're working for the government. That's not how medicare and medicaid work currently, and I doubt that that's the way that it's going to go anyway. That'll make too many people upset. This whole debate is about coverage and affordability. That means it's a talk about insurance.

- The government is not a worse bureaucracy then the current medical world already is. If anything, having one central thing that creates the rules by which people operate will simplify what it means to work in the medical world. But again, like I mentioned, your husband probably won't end up working for the government. It's much more likely that his customers/patients will be paying their bills using a different kind of insurance. That doesn't restrict his practice. 

- You should also know that the salaries that doctors get paid are the way they are because the number of doctors allowed to practice each year is artificially restricted.  They control the number of doctors in practice each year to create a false scarcity, which drives the prices of healthcare. Just something to think about. 

- Doctors in more socialist countries (you know, like Canada) are still most of the highest paid jobs. It's not like you're losing out on whatever dreams of a more lavish lifestyle you might have envisioned. You're still gonna be richer than most people. 

- The same people that are pushing for universal healthcare are also talking about the price of college degrees. They have your interests in mind too, and are well aware of the debts that are incurred by people to finish degrees. 

Anyway, I'm sorry I took so long about this, and I wish I had more time to put a source with each point. What I can promise you is that all of the things I mentioned here are things I have learned from statistics and discussions in my sociology classes. Email me if you have more questions. 

Cheers, 

Guesthouse ☾☀

posted on 11/22/2019 9:01 a.m.
A couple of anecdotes to consider (and I'm sure there are more examples, but these are the ones that I personally know)
1. I grew up in a small town in Washington, near the U.S-Canadian boarder. Canadians would come to medical facilities nearby to get medical work done because the wait was too long in Canada - think non-emergency, but still needs to get done medical needs. After all, the government has limited resources and cannot help everybody, not even everyone who needs something done.
2. My small town had a high elderly population, so a high percentage of the town was on Medicare and Medicaid. The result was that doctors, especially good doctors, rarely moved to town because it was financially risky for them, and I personally know one doctor who stopped practicing because there was too much stress, and before she quit she was spending more time doing paperwork than helping patients.

Miss Frazzled