The portion you quoted was not actually written by me. It was a comment written by CT. 

Despite living in a country (Australia) with good quality socialised medicine (well actually semi-socialised, there are public and private sectors, but the public is much bigger), I can see that keeping the system fair and efficient requires the right attitudes on all parties: Drs, the government, and society. What are these attitudes? Well on the part of Drs, I think the main two are: no back-breaking debt when you finish uni (fees are subsidised) and (the more important one): a very strong ethical standard in medicine that chasing money is bad. It’s professional suicide amongst the boards (colleges here) to be seen as a dollar doctor. Sure, it still happens, but you can’t have both: a reputation as an outstanding Dr, and a business aproach to medicine. On top of that, advertising is effectively banned in health. On the part of the government and society, I can sum up the attitude as follows: we cherish the public health system, because we know at any time, any of us could get sick. There are howls whenever anyone tries to tamper with the system (which is good and bad, but mostly good). It’s a bit like the UK, but we have a thriving private sector too. What do you get going private? Basically, exactly the same treatment, but a choice of Dr…that’s it. Medicines are subsidised by the govt., and the insurance companies have NO say whatsoever in clinical decision making. This of course relies on Drs not being greedy.
So, in summary, our system works well for us, but I would be wary of adopting it in America…attitudes, not money or structure make it work or fail, and I think the attitudes in the US might be incompatible with public health. That’s the questons for Americans to address I think, I personally, I don’t believe they’re ready for it yet. But I would encourage all people in the US to have the debate: changing things will take a generation, starting with funding for medical schools – where the almighty dollar rules from the get-go because of educational debts.

Despite the hopes you and I would share, I don’t think there is any doubt that any system with a global budget, funded through tax revenue will drive down physician reimbursement. American physicians (both in unadjusted dollars and as a ratio to the average household income) earn more than physicians in any OECD nation (see here).

Certainly more than any physician in any country with a single payer or socialized medicine scheme. While America currently doesn’t enjoy a ‘free market’ system, the further and further government takes over as the payer in health care (they already make 40% of health care expenditures) the less and less leverage physicians will have to keep their fees high. Any single payer system will significantly drive down doc’s earnings.

That isn’t, in entirety, a condemnation of either a single payer of socialized system. Maybe a cut in what physician’s make is a trade off that is worth making.

In addition we need to realize that the consequences of lack of access to care (e.g. being uninsured), while devastating, are probably less than most alarmists believe. Consider that ALL of America’s discrepancy in infant mortality, as compared to the rest of the western world, can be explained completely by our increased number of LBW babies. These low birth weight kids in turn are largely attributable not to a lack of access to prenatal care but to lifestyle choices.

I use that merely as an example to say that Americans simply live sicker lifestyles than the rest of the world. See here.

Certainly, while not the major driving force behind our increased health care spending, it does play a part. It takes more money to care for sicker individuals (and Americans aren’t just sicker because they present later in the disease process).

With that pet peeve laid out we must admit that improving access (through a single payer or socialized system) would almost certainly improve America’s health outcome measures (life span, infant mortality, cancer survival rates, etc) even though we might not achieve the same levels as western Europe.

Those who would argue that single payer systems are somehow failing in the rest of the world are deluding themselves. Those systems certainly have draw backs (namely increased rationing) but all evidence seems to imply they improve population sized outcome measurements. The only real logical argument against them (and the one I subscribe to with my relatively libertarian mindset) is a philosophical one…and I’m not sure such an argument sits well with the American people.

For instance:
“Sorry you were diagnosed at Duke stage D, but we couldn’t take a few bucks from those living on the rich side of town in order to get you in to see a PCP and get you a regularly scheduled colonoscopy because…well, it’s their money and they really wanted that new big screen television.”

Oh well, I’ll stick to my guns. Redistributing wealth for something as evanescent as a “right” to health care just isn’t appropriate.

Despite the hopes you and I would share, I don’t think there is any doubt that any system with a global budget, funded through tax revenue will drive down physician reimbursement. American physicians (both in unadjusted dollars and as a ratio to the average household income) earn more than physicians in any OECD nation (see here).

Certainly more than any physician in any country with a single payer or socialized medicine scheme. While America currently doesn’t enjoy a ‘free market’ system, the further and further government takes over as the payer in health care (they already make 40% of health care expenditures) the less and less leverage physicians will have to keep their fees high. Any single payer system will significantly drive down doc’s earnings.

That isn’t, in entirety, a condemnation of either a single payer of socialized system. Maybe a cut in what physician’s make is a trade off that is worth making.

In addition we need to realize that the consequences of lack of access to care (e.g. being uninsured), while devastating, are probably less than most alarmists believe. Consider that ALL of America’s discrepancy in infant mortality, as compared to the rest of the western world, can be explained completely by our increased number of LBW babies. These low birth weight kids in turn are largely attributable not to a lack of access to prenatal care but to lifestyle choices.

I use that merely as an example to say that Americans simply live sicker lifestyles than the rest of the world. See here.

Certainly, while not the major driving force behind our increased health care spending, it does play a part. It takes more money to care for sicker individuals (and Americans aren’t just sicker because they present later in the disease process).

With that pet peeve laid out we must admit that improving access (through a single payer or socialized system) would almost certainly improve America’s health outcome measures (life span, infant mortality, cancer survival rates, etc) even though we might not achieve the same levels as western Europe.

Those who would argue that single payer systems are somehow failing in the rest of the world are deluding themselves. Those systems certainly have draw backs (namely increased rationing) but all evidence seems to imply they improve population sized outcome measurements. The only real logical argument against them (and the one I subscribe to with my relatively libertarian mindset) is a philosophical one…and I’m not sure such an argument sits well with the American people.

For instance:
“Sorry you were diagnosed at Duke stage D, but we couldn’t take a few bucks from those living on the rich side of town in order to get you in to see a PCP and get you a regularly scheduled colonoscopy because…well, it’s their money and they really wanted that new big screen television.”

Oh well, I’ll stick to my guns. Redistributing wealth for something as evanescent as a “right” to health care just isn’t appropriate.

-Another Jeffrey, MD