[Kez]

$this->bbcode_second_pass_quote('LadyRuby', 'T')he doomers, on the other hand, seem only to acknowledge one possible outcome.

[Flow]

Under the Doomer scenerio, I don't see how any perparation will help - honestly. Basically, in that case, the person with the biggest guns and most remaining resources "wins."

The first group to go are those in poverty, then the majority of the middle class, etc. Unless of course you have stockpile of weopons laying around, then your chances of survivial goes up a notch, but not much.

Owning your home won't do you much good when the people that are starving to death come through your windows and shot you dead on the spot for the can of corn you have in your pantry.

Planting your own garden won't do you much good when that same person raids that garden and if you try to stop him/her you get shot dead on the spot.

Having a "community" that is can maintain it's self is great until that band of Max Mad type rebels, armed to the teeth comes rolling into town, turns you all into slaves working the fields so they can eat. If you die - how well, one less mouth to feed.

4 billion people will die of starvation as the planet can only support 2 billion without oil. This all assumes that China, Europe, Russia, and the USA do not launch their nukes at one another fighting for the remaining oil.

So in the doomers scenerio, what point is preparation again?

[aldente]

I completely agree. Preperation is as valid as wiping ones ass in hindsight.

[rogerhb]

$this->bbcode_second_pass_quote('albente', 'I') completely agree. Preperation is as valid as wiping ones ass in hindsight.

[GreyZone]

$this->bbcode_second_pass_quote('Flow', 'U')nder the Doomer scenerio, I don't see how any perparation will help - honestly. Basically, in that case, the person with the biggest guns and most remaining resources "wins."

The first group to go are those in poverty, then the majority of the middle class, etc. Unless of course you have stockpile of weopons laying around, then your chances of survivial goes up a notch, but not much.

Owning your home won't do you much good when the people that are starving to death come through your windows and shot you dead on the spot for the can of corn you have in your pantry.

Planting your own garden won't do you much good when that same person raids that garden and if you try to stop him/her you get shot dead on the spot.

Having a "community" that is can maintain it's self is great until that band of Max Mad type rebels, armed to the teeth comes rolling into town, turns you all into slaves working the fields so they can eat. If you die - how well, one less mouth to feed.

4 billion people will die of starvation as the planet can only support 2 billion without oil. This all assumes that China, Europe, Russia, and the USA do not launch their nukes at one another fighting for the remaining oil.

So in the doomers scenerio, what point is preparation again?

[Heineken]

$this->bbcode_second_pass_quote('threadbear', '')$this->bbcode_second_pass_quote('Ludi', '')$this->bbcode_second_pass_quote('threadbear', 'M')ost general practitioners make very little money

[Heineken]

$this->bbcode_second_pass_quote('cornholio', 'D')octor's aren't starving, but primary care doctors arent rolling in dough either. After spending 11 years further training after highschool (long hours) a primary care physician will have about 100,000 in debt, zero savings, be renting at age 30 rather than owning a house as their peers do, and have higher risk of suicide and divorce than the average person. They will expect to work more than 60 hours a week, carry a beeper, work some nights and weekends and face endless paperwork and phone calls. In addition to work in the clinic and hospital many get to manage a small business (a clinic) with margins tight enough that going out of business while working 60 hours a week is a distinct possibility. Unlike in the olden-days, today you can bill whatever you want... insurance will decide how much you are paid. Of the dollar you bill 50 cents is collected, of which 25 cents goes to pay overhead. In todays environment you are more likely to be an employee than to own your practice, and more likely to be grouped with nurses and PA's as a "health care provider" rather than revered as a doctor. The pay is higher than the average wage, but so is the screening process, the stress of the training, the duration of the training, the daily workload and responsibility and the risk. If your goal is easy money or unquestioning respect or getting home at a predictable hour primary care is not for you... You will have better luck in technology, law, business or nearly any other field...

Regarding the healthcare dollar, fully 30% goes to administration. The remaining 70% which goes to patient care is divided as below... Physician Services include services provided in the hospital and all clinic visits and the cost of running the clinics...


Administrative costs could have been tackled with the Clinton health plan, which was shot down (a single payer system). Pharmacy costs have never been reigned in and we pay a huge premium compared to the rest of the world for our medications. Tort reform has also been limited, and the legal environment encourages defensive (excessive) testing. And, for lack of a national health system the cost of caring for the uninsured is basically passed back to those with insurance through increased charges.

I think the demographics of the baby boom (and increased social security and madicaid expense) will force a major change in the way healthcare is provided in the US... That is probably a good thing.


The system's wealth (and lack of courage) have kept us from honestly discussing rationing of medications and care... We have taken the high road and acted as though such discussions were not necessary or dignified for a topic as important as healthcare. Scarcity and debt will make hard choices necessary. While it is easy to scale up medical systems I'm guessing it will be much harder to scale down services and expectations. Healthcare is a right, but I'm guessing that the healthcare we can afford to provide in the future will look different than that we are used to seeing today.

PS- The demographic of the aging, underinsured, under-saving, entitled, voting majority Baby Boomers that used to be my reason for concern about the future... PeakOil will not help things at all...

[EnergySpin]

$this->bbcode_second_pass_quote('DefiledEngine', '
')
Really? As far as I know, doomers advocate socialism (or rather, draconian forms of it). Do the soft-landers despise capitalism and current world-systems?

[EnergySpin]

$this->bbcode_second_pass_quote('threadbear', '
')
There are so many extraneous costs associated with the profession that many gp's are now working for corporate clinics that control their costs, but lower their wages. I imagine this is particularly true for any doctor trying to start up a practise. Last I heard, it's not uncommon for a doc to clear 50,000. per year in the US.

[cornholio]

$this->bbcode_second_pass_quote('Heineken', '
')A spirited defense, cornholio. It doesn't explain, though, why the U.S. is the only major Western nation without nationalized health insurance; in essense, why the U.S. is the only such country that treats health care as a for-profit business.

I can think of plenty of reasons, but high among them I would rank your own AMA and a thousand other lobbying entities for caregivers. Doctors complain about the current criminal system but, when it comes down to it, do nothing to overturn it. That's because they don't want to lose any status or $$ or their chance for EVEN MORE. Hey, they're only human. But I have to laugh every time I read health care organizations' literature preaching about the primacy of "the patient."

Although it's a pretty graph (source?), I seriously doubt that 70% of the health care dollar truly reaches the patient directly. For one thing, you don't seem to have considered the effect of $100 Band-Aids. Perhaps 70% of the health care dollar reaches the patient, but it is a ridiculously inflated dollar.

Let's put the question another way: If doctors were willing to give up their Jaguars and drive Ford Focuses instead, how much more of that health care dollar would reach the patient?

[threadbear]

$this->bbcode_second_pass_quote('Heineken', '')$this->bbcode_second_pass_quote('threadbear', '')$this->bbcode_second_pass_quote('Ludi', '')$this->bbcode_second_pass_quote('threadbear', 'M')ost general practitioners make very little money

[EnergySpin]

$this->bbcode_second_pass_quote('threadbear', '
')
Much as I like the universal health care, it's important to note that Canada has numerous problems with their system, as they restrict foreign docs. The license providers create high barriers to entry and the govt. (so far) has aided and abetted them. This has created a shortage of specialists, and strangely, particularly general practioners (primary care) docs. Many people think our system, with waiting lists etc... is all due to the universal system, thinking that the ensuuing brain drain to the US is the problem.

That has been a small part of the problem, for sure. But there millions of foreign professionals of all types who can't leap the barriers thrown up by the various licensing boards in this country, and that HAS to stop.

BTW, My doctor here in Canada just emigrated from Oregon. So there appears to be a reverse brain drain happening. American doctors and nurses are accepted without a problem.

[GreyZone]

An acquaintance of mind literally did go bankrupt as a partner in a clinic in a smaller rural town in Wisconsin a few years ago. Fortunately he has a great math background, some programming experience, and dabbled in digital music programming a great deal. He ended up giving up his dream of being a doctor and immediately got a $90K+ per year job writing software for a company that did device drivers for digital music instruments. He and his wife are happy they have a good income but disappointed he could not continue as a doctor.

My brother is a physical therapist with his own practice going back over a decade now after working for others for several years. He often mentions to me that he considers leaving the medical profession for reasons similar to those mentioned by others above. He also mentions that he generally has it better than many physicians he knows.

The system is broken. There are various possible fixes but something certainly has to change. I don't personally advocate national health care but if Japan and Germany can pay workers good wages and have working national health care systems and spend a smaller portion of their GDP on effective health care than the US, then we ought to at least look at those systems. I also think that the Delphi (and possible GM) bankruptcies may bring the national health care issue to the fore in the 2006 and 2008 elections in the US. The US has 1/7th of the population uninsured and spends 13% of GDP on healthcare. Recent studies indicate the quality of care is not the best either. Japan and Germany have near 100% coverage, higher quality care than the US on average, and spend about 10% of GDP.

Ideologues who advocate only free market or socialist solutions to everything need to be avoided. The bigger questions revolve around what works and understanding why it works in a particular context.

[EnergySpin]

$this->bbcode_second_pass_quote('GreyZone', '
')
Ideologues who advocate only free market or socialist solutions to everything need to be avoided. The bigger questions revolve around what works and understanding why it works in a particular context.

[threadbear]

$this->bbcode_second_pass_quote('EnergySpin', '')$this->bbcode_second_pass_quote('threadbear', '
')
Much as I like the universal health care, it's important to note that Canada has numerous problems with their system, as they restrict foreign docs. The license providers create high barriers to entry and the govt. (so far) has aided and abetted them. This has created a shortage of specialists, and strangely, particularly general practioners (primary care) docs. Many people think our system, with waiting lists etc... is all due to the universal system, thinking that the ensuuing brain drain to the US is the problem.

That has been a small part of the problem, for sure. But there millions of foreign professionals of all types who can't leap the barriers thrown up by the various licensing boards in this country, and that HAS to stop.

BTW, My doctor here in Canada just emigrated from Oregon. So there appears to be a reverse brain drain happening. American doctors and nurses are accepted without a problem.

[cornholio]

GreyZone- I agree. There will be a change, but at a cost. The trouble is the american consumer wants more but is unwilling to make choices. More cheap generics but less innovation and research? More drug imports but less quality control (may be a myth)? Cheaper care but less "right to sue"? Cheaper care but some rationing of treatments and proceedures (you might not get that chemo drug or heart bypass surgery or catheterization...)? Scarcity and debt will force the changes, but the consumer and the involved industries will go kicking and screaming : ) Regarding medicine as a career I think demographics paint a picture of medical services being in huge and increasing demand (as baby boomers age) but of deminishing funding. The work is there if you want to do it (it is a great career) but the money may not be there. Interesting times ahead.

[Heineken]

Cornholio et al.: I know there are good, selfless docs, and I'm pretty sure you are one of them. The problem is that they are obviously not the ones steering the health-care monster truck. And, for all their protestations about the mess, I don't think the "good" doctors are trying hard enough to get their hands on the steering wheel.

Any measure that would really change the status quo gets hooted out of town. Harry and Louise see to that. And the health care industry can resurrect them any time it wants to.

The people? They aren't going to fix anything in this country, not since the corporate government established total mind control over them some time ago.

[Heineken]

$this->bbcode_second_pass_quote('cornholio', 'G')reyZone- I agree. There will be a change, but at a cost. The trouble is the american consumer wants more but is unwilling to make choices. More cheap generics but less innovation and research? More drug imports but less quality control (may be a myth)? Cheaper care but less "right to sue"? Cheaper care but some rationing of treatments and proceedures (you might not get that chemo drug or heart bypass surgery or catheterization...)? Scarcity and debt will force the changes, but the consumer and the involved industries will go kicking and screaming : ) Regarding medicine as a career I think demographics paint a picture of medical services being in huge and increasing demand (as baby boomers age) but of deminishing funding. The work is there if you want to do it (it is a great career) but the money may not be there. Interesting times ahead.

[cornholio]

$this->bbcode_second_pass_quote('Heineken', 'T')he people? They aren't going to fix anything in this country, not since the corporate government established total mind control over them some time ago.

[Heineken]

It all depends on one's perspective, cornholio. From my point of view, as someone about to lose his health insurance, the system needs to be fixed now. Others, of course, are fat and happy with things as they are.