• This is a political forum that is non-biased/non-partisan and treats every persons position on topics equally. This debate forum is not aligned to any political party. In today's politics, many ideas are split between and even within all the political parties. Often we find ourselves agreeing on one platform but some topics break our mold. We are here to discuss them in a civil political debate. If this is your first visit to our political forums, be sure to check out the RULES. Registering for debate politics is necessary before posting. Register today to participate - it's free!

When did healthcare problems start?

phattonez

Traditionalist
DP Veteran
Joined
Jun 3, 2009
Messages
30,552
Reaction score
4,221
Location
Los Angeles, CA
Gender
Male
Political Leaning
Other
Might I suggest the early 20th century?

In 1904 the AMA created the Council on Medical Education (CME) whose objective was to restructure American medical education. At its first annual meeting, the CME adopted two standards: one laid down the minimum prior education required for admission to a medical school, the other defined a medical education as consisting of two years training in human anatomy and physiology followed by two years of clinical work in a teaching hospital. In 1908, the CME asked the Carnegie Foundation for the Advancement of Teaching to survey American medical education, so as to promote the CME's reformist agenda and hasten the elimination of medical schools that failed to meet the CME's standards.

. . .

When Flexner researched his report, many American medical schools were "proprietary", namely small trade schools owned by one or more doctors, unaffiliated with a college or university, and run to make a profit. A degree was typically awarded after only two years of study. Laboratory work and dissection were not necessarily required. Many of the instructors were local doctors teaching part-time, whose own training left something to be desired. The regulation of the medical profession by state government was minimal or nonexistent. American doctors varied enormously in their scientific understanding of human physiology, and the word "quack" flourished. There is no evidence that the mass of Americans were dissatisfied with this situation.

. . .

To a remarkable extent, the following present-day aspects of the medical profession in North America are consequences of the Flexner Report:

A physician receives at least six, and preferably eight, years of post-secondary formal instruction, nearly always in a university setting;
Medical training adheres closely to the scientific method and is thoroughly grounded in human physiology and biochemistry. Medical research adheres fully to the protocols of scientific research;[5]
Average physician quality has increased significantly;[6]
No medical school can be created without the permission of the state government. Likewise, the size of existing medical schools is subject to state regulation;
Each state branch of the American Medical Association has oversight over the conventional medical schools located within the state
;
Medicine in the USA and Canada becomes a highly paid and well-respected profession;
The annual number of medical school graduates sharply declined, and the resulting reduction in the supply of doctors makes the availability and affordability of medical care problematic. The Report led to the closure of the sort of medical schools that trained doctors willing to charge their patients less. Moreover, before the Report, high quality doctors varied their fees according to what they believed their patients could afford, a practice known as price discrimination. The extent of price discrimination in American medicine declined in the aftermath of the Report;
Kessel (1958) argued that the Flexner Report in effect began the cartelization of the American medical profession, a cartelization enforced by the American Medical Association and backed by the police power of each American state. This de facto cartel restricted the supply of physicians, and raised the incomes of the remaining practitioners.

. . .

According to Hiatt and Stockton (p. 8), Flexner sought to shrink the number of medical schools in the USA to 31, and to cut the annual number of medical graduates from 4,400 to 2,000. A majority of American institutions granting M.D. or D.O. degrees as of the date of the Report (1910) closed within two to three decades. (No Canadian medical school was deemed inadequate, and none closed or merged subsequent to the Report.) In 1904, there were 160 M.D. granting institutions with more than 28,000 students. By 1920, there were only 85 M.D. granting institution, educating only 13,800 students. By 1935, there were only 66 medical schools operating in the USA.
Between 1910 and 1935, more than half of all American medical schools merged or closed. This dramatic decline was in some part due to the implementation of the Report's recommendation that all "proprietary" schools be closed, and that medical schools should henceforth all be connected to universities. Of the 66 surviving M.D. granting institutions in 1935, 57 were part of a university. An important factor driving the mergers and closures of medical schools was that all state medical boards gradually adopted and enforced the Report's recommendations.
Flexner Report - Wikipedia, the free encyclopedia

Huh, I wonder if this has anything to do with the tremendous price of healthcare in this country.
 
Last edited:

MaggieD

Supporting Member
Monthly Subscriber
DP Veteran
Joined
Jul 9, 2010
Messages
43,244
Reaction score
44,659
Location
Chicago Area
Gender
Female
Political Leaning
Moderate
In my personal opinion, healthcare problems began when insurance policies with low deductibles were free from employers. Same thing has happened in the dental arena -- and veterinary medicine.

If everyone had a $1,500 deductible, prices would be lower. And people wouldn't be in emergency rooms for hangnails.
 

phattonez

Traditionalist
DP Veteran
Joined
Jun 3, 2009
Messages
30,552
Reaction score
4,221
Location
Los Angeles, CA
Gender
Male
Political Leaning
Other
Don't worry, I think that those are a problem too, but I truly believe that this is the root of the problem. You can't restrict supply and avoid the negative consequences.
 

phattonez

Traditionalist
DP Veteran
Joined
Jun 3, 2009
Messages
30,552
Reaction score
4,221
Location
Los Angeles, CA
Gender
Male
Political Leaning
Other
So no UHC supporters want to respond to this thread? Isn't this just a little bit interesting for the debate?
 

tacomancer

Capitalist Social Democrat
Supporting Member
DP Veteran
Joined
Jan 8, 2010
Messages
41,636
Reaction score
22,219
Location
Akron
Gender
Male
Political Leaning
Progressive
I think restricting the supply of medical professionals does contribute to excessive prices for health care.

I would be willing to endorse that relax the AMA hold on the industry as long as doctors were required to make information about the success rates and prices of their treatments available. I would prefer that information be posted in their waiting rooms or outside their facilities. The reason I say this is because the AMA does serve an important function in standardizing training and if there were multiple agencies serving that role or if there were none, we would need some way of telling the good doctors from the bad ones. But generally, competition is good.
 

phattonez

Traditionalist
DP Veteran
Joined
Jun 3, 2009
Messages
30,552
Reaction score
4,221
Location
Los Angeles, CA
Gender
Male
Political Leaning
Other
Why would it be any different than how we do it today with say contractors or mechanics? They set their prices and we hear from word of mouth or from online sites that judge these places. Restrictions on how is allowed to become are doctor are way too tight. As a prospective medical student, I have first hand experience with all the crap you have to go through even in the undergraduate level.
 

tacomancer

Capitalist Social Democrat
Supporting Member
DP Veteran
Joined
Jan 8, 2010
Messages
41,636
Reaction score
22,219
Location
Akron
Gender
Male
Political Leaning
Progressive
Why would it be any different than how we do it today with say contractors or mechanics? They set their prices and we hear from word of mouth or from online sites that judge these places. Restrictions on how is allowed to become are doctor are way too tight. As a prospective medical student, I have first hand experience with all the crap you have to go through even in the undergraduate level.
I see medical issues as being more fundamental to humanity than structures (even though they can fall and thats why we have building inspectors, I don't see body inspectors as something that would work though).

I agree that restrictions are too tight though, but the proof is often in the results and if those results are posted, along with an average for the region (different geographical regions tend to have different issues) and type of doctor, we should know how good the doctor is and if they are worth the money. Essentially, its letting capitalism work by ensuring we have the information to make good decisions.
 

LaMidRighter

Klattu Verata Nicto
DP Veteran
Joined
May 19, 2005
Messages
30,534
Reaction score
10,682
Location
Louisiana
Gender
Male
Political Leaning
Libertarian - Right
I think restricting the supply of medical professionals does contribute to excessive prices for health care.

I would be willing to endorse that relax the AMA hold on the industry as long as doctors were required to make information about the success rates and prices of their treatments available. I would prefer that information be posted in their waiting rooms or outside their facilities. The reason I say this is because the AMA does serve an important function in standardizing training and if there were multiple agencies serving that role or if there were none, we would need some way of telling the good doctors from the bad ones. But generally, competition is good.
I agree that basic standards have to be set, I just disagree with how it is done. I'm not a fan of the AMA in any sense of it's being and have some second hand experience with them as my mother and godfather are medical professionals. My mom is an LPN, my godfather is a former Oncologist current General practicioner and both have told me horror stories about some of the legally licensed quacks that have some horrid habits in their practices, even with the AMA in place many doctors are still mis-diagnosing or improperly providing care not through accident but negligence and gross incompetance. So to summarize my position I do believe in a minimum quality standard, but agree with the op that competition will bring that about if the regulations allow for both competitive market influences and legal responsibility to truly compliment each other.
 

tacomancer

Capitalist Social Democrat
Supporting Member
DP Veteran
Joined
Jan 8, 2010
Messages
41,636
Reaction score
22,219
Location
Akron
Gender
Male
Political Leaning
Progressive
I agree that basic standards have to be set, I just disagree with how it is done. I'm not a fan of the AMA in any sense of it's being and have some second hand experience with them as my mother and godfather are medical professionals. My mom is an LPN, my godfather is a former Oncologist current General practicioner and both have told me horror stories about some of the legally licensed quacks that have some horrid habits in their practices, even with the AMA in place many doctors are still mis-diagnosing or improperly providing care not through accident but negligence and gross incompetance. So to summarize my position I do believe in a minimum quality standard, but agree with the op that competition will bring that about if the regulations allow for both competitive market influences and legal responsibility to truly compliment each other.
I wasn't disagreeing that we need more competition. In fact, I think this is one area where more competition would be good. However, I think the data should be out there for all to see, which is why I recommended posting the success rates somewhere a person can easily find it. Relying on word of mouth is essentially the same as relying on rumor, at least I see them to be equivalent, and rumors tend to have accuracy issues. A person can get a bad reputation real quick based one one problem when in fact they could be doing pretty good overall.
 

phattonez

Traditionalist
DP Veteran
Joined
Jun 3, 2009
Messages
30,552
Reaction score
4,221
Location
Los Angeles, CA
Gender
Male
Political Leaning
Other
I see medical issues as being more fundamental to humanity than structures (even though they can fall and thats why we have building inspectors, I don't see body inspectors as something that would work though).

I agree that restrictions are too tight though, but the proof is often in the results and if those results are posted, along with an average for the region (different geographical regions tend to have different issues) and type of doctor, we should know how good the doctor is and if they are worth the money. Essentially, its letting capitalism work by ensuring we have the information to make good decisions.
How do you feel about the line I quoted at the beginning of the Wikipedia quote that "There is no evidence that the mass of Americans were dissatisfied with this situation." Clearly there was a way to tell whether a doctor was good or not. I mean you wouldn't just go to a guy that called himself a doctor and expect good treatment without some proof to back up his claim.
 

tacomancer

Capitalist Social Democrat
Supporting Member
DP Veteran
Joined
Jan 8, 2010
Messages
41,636
Reaction score
22,219
Location
Akron
Gender
Male
Political Leaning
Progressive
How do you feel about the line I quoted at the beginning of the Wikipedia quote that "There is no evidence that the mass of Americans were dissatisfied with this situation." Clearly there was a way to tell whether a doctor was good or not. I mean you wouldn't just go to a guy that called himself a doctor and expect good treatment without some proof to back up his claim.
The first thing that comes to mind was that there was less division of labor back than due to a lack of technological and scientific sophistication (wasn't stuff like phrenology still popular at that time?). Since we are not more sophisticated in those areas, people expect more (as they should, or else there is no point in technological progress). Also, there is less division of labor and specialization than and people were able to do a great % of what a doctor could (again due to the primitive conditions). This is no longer the case today.
 
Last edited:

LaMidRighter

Klattu Verata Nicto
DP Veteran
Joined
May 19, 2005
Messages
30,534
Reaction score
10,682
Location
Louisiana
Gender
Male
Political Leaning
Libertarian - Right
I wasn't disagreeing that we need more competition. In fact, I think this is one area where more competition would be good. However, I think the data should be out there for all to see, which is why I recommended posting the success rates somewhere a person can easily find it. Relying on word of mouth is essentially the same as relying on rumor, at least I see them to be equivalent, and rumors tend to have accuracy issues. A person can get a bad reputation real quick based one one problem when in fact they could be doing pretty good overall.
I forgot to address the transparency issues, whoops! Totally agree with you on that. It is frustrating that you have to actually ask for an itemized bill to get one for your care and you're lucky if they actually honor the request, no argument from me.
 

phattonez

Traditionalist
DP Veteran
Joined
Jun 3, 2009
Messages
30,552
Reaction score
4,221
Location
Los Angeles, CA
Gender
Male
Political Leaning
Other
The first thing that comes to mind was that there was less division of labor back than due to a lack of technological and scientific sophistication (wasn't stuff like phrenology still popular at that time?). Since we are not more sophisticated in those areas, people expect more (as they should, or else there is no point in technological progress). Also, there is less division of labor and specialization than and people were able to do a great % of what a doctor could (again due to the primitive conditions). This is no longer the case today.
Yes, and homology was popular back then as allopathic medicine at the time was ghastly. Homology then actually did less harm than allopathic medicine, explaining its popularity. However, with this Flexner Report and states abiding by it, medical schools had to train only allopathic medicine, and only so many.

I still think that you could find the good doctors by independent certification agencies and popular reviews. As for the price issue, that's an issue with insurance which is a problem that was created in order to respond to the problem created by the Flexner Report.
 

tacomancer

Capitalist Social Democrat
Supporting Member
DP Veteran
Joined
Jan 8, 2010
Messages
41,636
Reaction score
22,219
Location
Akron
Gender
Male
Political Leaning
Progressive
Yes, and homology was popular back then as allopathic medicine at the time was ghastly. Homology then actually did less harm than allopathic medicine, explaining its popularity. However, with this Flexner Report and states abiding by it, medical schools had to train only allopathic medicine, and only so many.

I still think that you could find the good doctors by independent certification agencies and popular reviews. As for the price issue, that's an issue with insurance which is a problem that was created in order to respond to the problem created by the Flexner Report.
While we have consumer reports for cars and toasters, I think the medical field is complex enough that you have to have specialized knowledge to understand it. Also, there is the problem of having to subscribe to such a publication. If someone is having a medical emergancy, than they are not going have time to do so. If your car breaks, you could possibly get a rental or a loaner.

Plus there are already places that rate doctors Rate A Doctor & MD's - Physician Reviews & Ratings - Improving Patient Care Online and they tend to have issues with doctors suing them in an effort to try to fix their reputations, which introduces the possibility of corruption of data based on the fear of a lawsuit. I don't think it would be a good system.
 

phattonez

Traditionalist
DP Veteran
Joined
Jun 3, 2009
Messages
30,552
Reaction score
4,221
Location
Los Angeles, CA
Gender
Male
Political Leaning
Other
During an emergency you would probably only go to a company that you like (something like Kaiser). You would demand certain certifications that doctors can get from private issuers and the companies that hire them would demand certain qualifications. There are plenty of mechanisms for quality assurance in the free market.
 

Boo Radley

DP Veteran
Joined
Dec 20, 2009
Messages
37,066
Reaction score
7,028
Gender
Male
Political Leaning
Liberal
There was an article in Newsweek back in the early 80's, I doubt I can find it now. It showed that there was no satuation vel for doctors in an area. More dctors move i, and all do well. So, at the time, limiting number of doctors likely made sense, just as increasing them today makes sense. We'll see what happens with this.

But a lot of factors contribute to cost. If we remove all third party payers from the system, prices would likely go down, but nt far enough. Much of the care we expect, and much of justifiably so, would not be affordable. Thus only the wealthy would have access. The middle class would be excluded from much of it. As the poor could forget it. Doctors are clear that they won't allow that for good and bad reasons. But, they would fight any effort.

So, whatever we do has to be done with the understanding that we won't be going backwards.
 

phattonez

Traditionalist
DP Veteran
Joined
Jun 3, 2009
Messages
30,552
Reaction score
4,221
Location
Los Angeles, CA
Gender
Male
Political Leaning
Other
I don't follow. Why would decreasing the amount of doctors back then have made sense?

And do you think that hospitals showing prices for services would increase competition and therefore lower cost?
 

tacomancer

Capitalist Social Democrat
Supporting Member
DP Veteran
Joined
Jan 8, 2010
Messages
41,636
Reaction score
22,219
Location
Akron
Gender
Male
Political Leaning
Progressive
During an emergency you would probably only go to a company that you like (something like Kaiser). You would demand certain certifications that doctors can get from private issuers and the companies that hire them would demand certain qualifications. There are plenty of mechanisms for quality assurance in the free market.
Most people aren't going to ask for certain certifications because they won't understand them unless they specialize in that knowledge. I work in IT and people assume I can do all things IT when I have a specialty, but people do not understand that. The medical field is even more complex, has more acronyms, more terminology, etc. Assuming people can know those certifications is unrealistic because people simply are not smart enough to know everything about everything or even a subset about everything. Heck, I am smarter than average, but theres a ton of stuff I don't know and I am attempting to learn new things constantly. I will never know enough to know how to demand quality from every professional field.

Plus in an emergency, people are going to be confused and disorganized and are prone to make mistakes. Relying on rationality, forsight, or anything like that isn't going to work. And they sure as heck are not going to have time to do research to figure out what they should be asking for. They will ask for a doctor and could get anything if the field is left wide open.
 
Last edited:

Boo Radley

DP Veteran
Joined
Dec 20, 2009
Messages
37,066
Reaction score
7,028
Gender
Male
Political Leaning
Liberal
I don't follow. Why would decreasing the amount of doctors back then have made sense?

And do you think that hospitals showing prices for services would increase competition and therefore lower cost?
For doctors, making sure all of them made a very good living. For the state, controlling the excessive cost.

I have no problem with hospitals showing prices, but all of them would charge about the same. All will find a way to jack up to cover those who don't pay. And while a wealthy person not in an emergency may be able to negotiate, the emergent patient really can't. This isin part why normal capitalistic policies don't work well here. how much will you haggle for your daughter's life?
 

lizzie

DP Veteran
Joined
Oct 22, 2009
Messages
28,581
Reaction score
31,550
Location
between two worlds
Gender
Female
Political Leaning
Libertarian
Some of them started when people learned that they could get a monthly check for them.;)
 

Harry Guerrilla

DP Veteran
Joined
Dec 18, 2008
Messages
28,955
Reaction score
12,423
Location
Not affiliated with other libertarians.
Gender
Male
Political Leaning
Libertarian
For doctors, making sure all of them made a very good living. For the state, controlling the excessive cost.

I have no problem with hospitals showing prices, but all of them would charge about the same. All will find a way to jack up to cover those who don't pay. And while a wealthy person not in an emergency may be able to negotiate, the emergent patient really can't. This isin part why normal capitalistic policies don't work well here. how much will you haggle for your daughter's life?
If you bothered to read his initial post, you would have seen that doctors used to practice discriminative pricing.
Lower prices for lower income people, higher for higher income people.
 

WI Crippler

DP Veteran
Joined
Oct 10, 2006
Messages
15,429
Reaction score
9,577
Gender
Male
Political Leaning
Centrist
I don't think that restricting the number of healthcare practitioners is necessarily a bad thing. Prehaps it is a bit overdone, but having professional standards and a selection process whereby the best candidates are taken increases the quality of care, and avoids a supplier-induced demand for healthcare services. . For those who point out that there is mal-practice and mistakes by those who did get chosen, I could only imagine it would be worse if it were expanded to everybody who just wanted to get into a program.

I've personally had 1/3 of my physical therapy class drop out because they could not meet the requirements set down by CAPTE to continue in the program. I don't think dropping the program guidelines so we could have more therapists would necessarily have been a good thing for the healthcare industry or the profession of physical therapy.
 

phattonez

Traditionalist
DP Veteran
Joined
Jun 3, 2009
Messages
30,552
Reaction score
4,221
Location
Los Angeles, CA
Gender
Male
Political Leaning
Other
For doctors, making sure all of them made a very good living. For the state, controlling the excessive cost.
Huh? Less doctors control cost? And the reason doctors didn't make that great of a living back then was because their services just weren't that valuable and a lot of people had them. That would definitely not be the case today as it is a very specialized field and few can acquire the skills, so they would have high wages. The problem today is that a lot of good talent is left out of the industry because of stupid quotas.

I have no problem with hospitals showing prices, but all of them would charge about the same. All will find a way to jack up to cover those who don't pay.
The hospital that did not jack up prices would get a lot more business. Do I need to explain competition?

And while a wealthy person not in an emergency may be able to negotiate, the emergent patient really can't. This isin part why normal capitalistic policies don't work well here. how much will you haggle for your daughter's life?
Emergency room services are probably something you should figure out ahead of time then making sure that you go to the hospital with prices you can deal with.
 

phattonez

Traditionalist
DP Veteran
Joined
Jun 3, 2009
Messages
30,552
Reaction score
4,221
Location
Los Angeles, CA
Gender
Male
Political Leaning
Other
Most people aren't going to ask for certain certifications because they won't understand them unless they specialize in that knowledge. I work in IT and people assume I can do all things IT when I have a specialty, but people do not understand that. The medical field is even more complex, has more acronyms, more terminology, etc. Assuming people can know those certifications is unrealistic because people simply are not smart enough to know everything about everything or even a subset about everything. Heck, I am smarter than average, but theres a ton of stuff I don't know and I am attempting to learn new things constantly. I will never know enough to know how to demand quality from every professional field.

Plus in an emergency, people are going to be confused and disorganized and are prone to make mistakes. Relying on rationality, forsight, or anything like that isn't going to work. And they sure as heck are not going to have time to do research to figure out what they should be asking for. They will ask for a doctor and could get anything if the field is left wide open.
You didn't answer my claim about places like Kaiser that would only hire the qualified doctors. Companies would gain a good reputation for hiring good doctors.
 

phattonez

Traditionalist
DP Veteran
Joined
Jun 3, 2009
Messages
30,552
Reaction score
4,221
Location
Los Angeles, CA
Gender
Male
Political Leaning
Other
I don't think that restricting the number of healthcare practitioners is necessarily a bad thing. Prehaps it is a bit overdone, but having professional standards and a selection process whereby the best candidates are taken increases the quality of care, and avoids a supplier-induced demand for healthcare services. . For those who point out that there is mal-practice and mistakes by those who did get chosen, I could only imagine it would be worse if it were expanded to everybody who just wanted to get into a program.

I've personally had 1/3 of my physical therapy class drop out because they could not meet the requirements set down by CAPTE to continue in the program. I don't think dropping the program guidelines so we could have more therapists would necessarily have been a good thing for the healthcare industry or the profession of physical therapy.
You should see the great students that are left out of the medical field because of the insane standards and stupid crap we have to do. We have to have a "well-rounded education" to get into medical school. Now tell me, why do students have to waste their time studying English and Philosophy and History to get into medical school? I mean I like the classes, but they're almost completely worthless to a doctor.

Some average Joe in a completely unregulated market could open up his own business and call himself a doctor and he probably wouldn't get more than a few patients for a few weeks. He would have no references, no certification, nothing. Why would anyone go to him unless they really had to take a chance? The market tends to clear out the crap and favor those who know what they're doing. The crap loses business while the knowledgable gain that business.
 
Top Bottom