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Another "benefit" of Universal Health Care
Posted by: McQ on Thursday, April 12, 2007

And one which is rarely discussed. From the UK:
More than half of doctors questioned in a poll said morale within the profession is "poor" or "terrible", blaming government targets and reforms for the downbeat atmosphere.

A total of 54 percent of the 1,442 online survey respondents said morale within the profession was at a low, with more than two-thirds saying it had worsened during the past year.

Just 2 percent said morale was "excellent" in the survey carried out by the magazine "Hospital Doctor".

Nearly 70 percent said they would not recommend a career in medicine to friends or relatives.

Factors behind the low morale included changing workloads and government moves to centralise hospitals.

"Cost-cutting turn-around programmes have been disastrous for morale," said one respondent.

"Staff have been turned against each other."
Obviously morale is not good among medical workers in the UK, that's a given. But the highlighted sentence is significant. If you think morale is bad now, imagine fewer and fewer people going into health care as a career. You could have the best health care bureaucracy in the world with everything covered and you'd still be victimized by rationed health care. And the rationing mechanism would be the lack of health care workers to deliver it.
"The result of this survey shows how demoralised so many doctors are feeling and how they believe constant government reforms and targets are taking them further away from their initial vocation — to treat patients."

The magazine quoted Stephen Campion, chief executive of the Hospital Consultants and Specialists Association, as saying: "Traditionally, many doctors have followed in their parents' footsteps and increasingly we are hearing doctors saying they wished they hadn't recommended a career in medicine to their children.

"This is indicative of the extreme frustration and low morale hospital doctors are feeling."
But where do they turn for relief? To the same institution which is engaged in cost cutting and reform of the system which moves them further away "from their initial vocation". Sounds promising, no?
 
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Can you say "Negative Feedback Loop"?

Kind of like the comments sections over at Daily Kos, only without all the Bush-bashing.
 
Written By: Robb Allen
URL: http://blog.robballen.com
I’d love to see a look-in on the Japanese system, which just got some compliments from Jonathan Cohn.
 
Written By: Larry
URL: http://
McQ,

This is a silly point. First, as someone who comes from a family of doctors, I’d be willing to bet a lot that if this survey was done in the U.S., it would produce very similar results. Medical schools are not getting the best and the brightest anymore. Morale among doctors, who all hate managed care, is historically low. I know, for instance, that my parents hate their jobs and strongly encouraged me NOT to pursue a career in medicine. So we’ve got the exact same problem here.

Second, and more importantly, literally no one is advocating that the U.S. adopt a health care system like the one in the UK. No one wants to nationalize all the hospitals in the country and have them all be run by a national health service. The most "extreme" idea that is being floated by advocates of universal health care is that we adopt a single-payer system (essencially Medicare, but for all ages). But even under a single-payer system, hospitals would remain private. Only the insurance itself would be run by the government. That’s nothing like the UK system.
 
Written By: Anonymous Liberal
URL: http://www.anonymousliberal.com
This is a silly point.
LOL! Heck, AL, according to you, every point I make is silly. You may want to invest in a new description of my points because this one is getting a bit old.
First, as someone who comes from a family of doctors, I’d be willing to bet a lot that if this survey was done in the U.S., it would produce very similar results. Medical schools are not getting the best and the brightest anymore. Morale among doctors, who all hate managed care, is historically low. I know, for instance, that my parents hate their jobs and strongly encouraged me NOT to pursue a career in medicine. So we’ve got the exact same problem here.
Yeah, but we’ve got recourse here. They don’t have to participate in managed care if they really don’t want too. No one makes them got to work for a managed care system. Harder row to hoe, for sure, but an option.

What recourse do the Brit docs have? Their system is the only system they have and they’re apparently discovering it isn’t very responsive to their wants or needs. They’re simply there to do business the way the government directs.
Second, and more importantly, literally no one is advocating that the U.S. adopt a health care system like the one in the UK.
There are plenty of advocates on the left for "universal health care". Whatever flavor they come up with (and I’m not talking about "universal health insurance") it will require governmental control (Medicare, btw, is a managed care system). So it isn’t at all out of the question that a morale problem just like that the Brits are facing wouldn’t be a consequence of that system, regardless of "model".
 
Written By: McQ
URL: http://www.qando.net/blog
LOL! Heck, AL, according to you, every point I make is silly.
Well, if he calls you silly and worse, it saves him from having to actually accept that you might have a point. To him you are just a stupid southerner or something
 
Written By: cap joe
URL: http://
Morale of doctors isn’t only low in the U.K.

I don’t have a scientific poll available, but I’m the son of a doctor and, growing up, had a lot of friends who’s parents are/were doctors. Even without universal health care causing extra headaches, I can attest that U.S. doctors are all quite fed up with the current state of things.

While growing up, a friend of mine’s dad (a brain surgeon) told my friend that he wasn’t allowed to be a doctor when he grew up. My dad wasn’t as commanding about it, but he successfully crushed any dreams my brother and I had about becoming doctors ourselves with his repeated warnings not to get into health care.

In the experience of my dad and my childhood friends’ parents, U.S. doctors are still raking in a nice living, but each year they have to work more and more for less and less, all while dealing with ever growing bureaucratic regulation.

My dad finally called enough enough and left his job as a medical director of a rehab center. He now works for an insurance company reviewing disability cases. Only having to work 40 hours a week, with no weekends & holidays "on call", he basically feels like he’s perpetually on vacation.
 
Written By: kazoolist
URL: http://kazoolist.blogspot.com
Anonymous Lib,

You seem to be duped into agreeing that govt control of medicine, to any degree, is preferable to a free market system. Am I reading you correctly?

As a physician in private practice at a major hospital in a big city, I am met with challenges on a daily basis. These challenges are many and varied, but not limitted to decreasing re-imbursement (if I am re-imbursed at all) and increasing regulations coming from all angles (not just the govt).

As much as I might agree that doctors hate managed care, I know NO PHYSICIAN, who has come from the UK, Canada, or other country with socialised medicine who does not loathe the impact that govt has had on their practices to an even greater extent than that of managed care. It is an exponentially greater issue to them, and they routinely voice concerns about HillaryCare and govt regulations.

Have you ever worked at a VA, the epitome of govt run medicine? The contrast of "Job Satisfaction" between working at a VA vs private practice is even more extreme.

Having said that, I wish all of our citizens were forced to endure the experience of being treated at a VA. It would be alarming, and hopefully eye opening to any fool promoting the govt as the best provider of medical care. It is a disgrace that our soldiers, past and present, must endure these monuments of inefficiencies.

The govt has been slowly suffocating private practice, directly thru regulations and funding cutbacks, and indirectly by allowing managed care to replace free market forces. I hope private practice survives, for my sake, as well as the sake of the patients.

I would go into medicine again, if given the chance, and I would encourage my children to do so, as long as we have a chance to practice without the shackles of govt control. That would be untenable, and I can understand the results of the British poll cited by QandO.

Keep the govt out!

 
Written By: Mark Cancemi
URL: http://
McQ:
Yeah, but we’ve got recourse here. They don’t have to participate in managed care if they really don’t want too. No one makes them got to work for a managed care system. Harder row to hoe, for sure, but an option.
"Managed care" is such a loaded term, I don’t know exactly what you mean. But, if you’re implying that a health care provider could start their own hospital or private practice and bill clients directly - refusing to do business with PPOs, HMOs, MCOs, POSs, and Medicare - that’s technically true. But such a venture would have a "snowball’s chance in Florida" of being financially viable.
 
Written By: kazoolist
URL: http://kazoolist.blogspot.com
For those unacquainted with the "wonders" of socialized medicine, I recommend NHS Blog Doctor. It’s author is a doctor in Britain who pulls no punches when discussing the NHS. A choice quote:
Dentists are being forced to take holiday to avoid treating patients because the NHS has run out of money. The scandal reveals how the Government’s reform of NHS dentistry has failed patients and dentists just a year after the controversial shake-up.

The research comes after official figures showing the number of adults seen by an NHS dentist has dropped by 69,000 in the last year, with 11,000 fewer children now getting NHS care.
 
Written By: Jordan
URL: http://
Here’s an example of what our current insurance system is causing:

http://www.cmadoc.com/

Really good doctors (I’ve seen him) walking on the insurance system and going private.

Of course, increasing the cause of why this doctor stopped taking insurance will only push us more into the two Americas system. Oh well.
 
Written By: Ryan
URL: http://
To be fair, while I don’t think universal health care is a good idea in the US, systems on continental Europe do better, and I’ve known German doctors who ridicule both the British and American systems of being ’opposite extremes.’ Discover has an article this month about the low quality of American health care in comparison to the rest of the industrialized world. So criticizing Britain is, well, criticizing the British system. You can’t really make generalization about all health care systems.
 
Written By: Scott Erb
URL: http://faculty.umf.maine.edu/~erb/blog.htm
"Managed care" is such a loaded term, I don’t know exactly what you mean. But, if you’re implying that a health care provider could start their own hospital or private practice and bill clients directly - refusing to do business with PPOs, HMOs, MCOs, POSs, and Medicare - that’s technically true. But such a venture would have a "snowball’s chance in Florida" of being financially viable.
I’d bet a lot of that has to do with your specialty and where you locate your practice.
 
Written By: McQ
URL: http://www.qando.net/blog
AL and kazoolist are right. Here is the poll of our doctors. Apparently low morale is a benefit of our non-universal system as well.

Obviously morale is not good among medical workers in the US, that’s a given...etc. etc. etc.
 
Written By: Retief
URL: http://
As a physician, I can promise you we’re far more likely to drop Medicare in the future than a private insurer. Our own group has placed a hold on accepting new Medicare patients. The profit margin (per patient) is about one half of a privately insured patient, taking a new Medicare patient represents a real opportunity cost for a medical organization. With projected budget cuts, this difference will only grow over time, resulting in real access issues for a growing older population.

The point is, Medicare isn’t keeping up with market forces as it is, let alone if the government tries to expand it to a larger population. It isn’t hard to guess what the outcome might be.
 
Written By: Galen
URL: http://
Discover has an article this month about the low quality of American health care in comparison to the rest of the industrialized world.
Of course—how else are they going to bring about socialized health care in the US.
 
Written By: Don
URL: http://
You guys are skating around the main point when you’re trying to take on AL here.

He’s creating a strawman. His point is that the US free market is creating the same low morale as the UK government system. It’s a pointless debate, BECAUSE THE USA DOESN’T HAVE A FREE MARKET HEALTHCARE SYSTEM!

Hell, Switzerland has more a private system than we do. 50% of every dollar spent on US healthcare comes from the government. The Swiss, it’s somewhere around 25-27%.

You know where we went wrong, and they went right? They kept an actual market, and just insured the poor. They have people shop around for insurance, instead of having in provided by employers. Thus, the market for individual insurance is competitive, not based on costs being low only if you have more than 1,000 employees to sign up. We decided, instead, that we’d run everything through employers, by giving them huge tax incentives to cover their workers, and make it nearly impossible for individuals to get private insurance. Hence, we destroyed the market, and turned everything into third-party payments.

Markets satisfy customers, providers, and keep costs down. The US doesn’t have much of a market, and everyone hates our system. The Brits have even less of a market, and everyone hates their system more. The Swiss kept a market, and while they pay more than everyone else in Europe (although less than Americans) for care, they all seem to be pretty satisfied with their extremely high-quality care.

Of course, my goal is a true free market without even the mandates the Swiss bring in, but if we had to have some sort of mandated system, I’d rather look at the Swiss system than the Brits.
 
Written By: Brad Warbiany
URL: http://unrepentantindividual.com/
"the low quality of American health care in comparison to the rest of the industrialized world."

That’s simply absurd. I’m very interested in the comparison because I simply don’t buy it.
 
Written By: Aardvark
URL: http://
AL is right. I know several doctors. All of them hate the current system. AL, to his credit, never calls the current system "free-market".

The UK health system, widely acknowledged to be abyssmal, is not the only universal health care system in existence. AL is right that the UK is not being proposed in America. His implicit argument is, I think, "You can’t judge the efficacy of one universal care system by one bad one, especially when there are many others that are just fine." If that’s his implicit argument, he’s right again.

Disagree with what he probably wishes to see? As an anarchist, I have better free-market chops than any of you, so of course I disagree. But I have the good graces to read what he actually said. He’s right.

- Josh
 
Written By: Wild Pegasus
URL: http://www.no-treason.com
What’s the pay differential between UK and USA doctors I wonder?

My Dad told me never to work for the government because it was too boring. I will tell my kid never to do international trade because its too competitive. Sounds like everyone has complaints about their jobs that they tell their kids.

I wonder if there are numbers for how many US doctors move to the UK to work and vice versa? I would bet its a one way trip to the USA for more than the other way round.
 
Written By: Harun
URL: http://
Also, doctor’s long hours are no determined by managed care or the market, but by the medical system set up by doctors themselves, no?
 
Written By: Harun
URL: http://
So doctors and healthcare workers in the UK system and the US system are all equally unhappy.

That’s because they both work in identical systems: The THIRD PARTY PAYER system is the problem, it really makes little difference who the third party is.

Unfortunately, nobody in America is advocating getting rid of the Third Party Payer system, which means it only gets worse from here.

By the way, is the goal of the "healthcare system" to make doctors happy or patients happy? Just checking.
 
Written By: DS
URL: http://
Dentists are being forced to take holiday to avoid treating patients because the NHS has run out of money. The scandal reveals how the Government’s reform of NHS dentistry has failed patients and dentists just a year after the controversial shake-up.
Oh god - just what the British need, dental problems. Austin Powers, where’s your toothbrush???
 
Written By: meagain
URL: http://
"By the way, is the goal of the "healthcare system" to make doctors happy or patients happy? Just checking."

Good point. I hate my job in many ways because the goal of my job, i.e. to keep customers happy is very difficult nowadays, but I am guessing my customers like that...
 
Written By: Harun
URL: http://
By the way, is the goal of the "healthcare system" to make doctors happy or patients happy?
How much of a "healthcare system" will you have without doctors? You can’t afford to make them too unhappy, can you?
 
Written By: Mark A. Flacy
URL: http://
LOL! Heck, AL, according to you, every point I make is silly. You may want to invest in a new description of my points because this one is getting a bit old.
Not true, McQ, I just tend not to comment when I agree with you. Agreement is boring.

Thanks to some of the commenters for actually reading what I wrote. My point was simply this: comparisons to the UK system are silly because it’s not very representative and no one is proposing that we create that type of system here. There are all kinds of systems that provide universal care, some that work far better than others, and it’s a cheap debate tactic to focus on the worst system and pretend that it is somehow representative. Our health care system is terrible. So is the UK’s, but for very different reasons. A sane health care system would look very little like either of these two systems. The bottom line is that many countries provide health care to every citizen at a much lower cost than we do and with much better outcomes and overall customer satisfaction. That’s just a fact.

We need to do something about our system. That’s the Great Debate of our time.
 
Written By: Anonymous Liberal
URL: http://www.anonymousliberal.com
"But even under a single-payer system, hospitals would remain private. Only the insurance itself would be run by the government"

That reminds me of an episode of "The Sopranos". Tony became a silent partner in a hardware store. The store remained the legal property of the original owner, but somehow it went from a profitable business to bankruptcy.
 
Written By: timactual
URL: http://

 
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