My Bad! It's 14%

[busymom]

Here is the breakdown of taxes in Germany for the average Joe to get universal healthcare and all of the social benefits (2002):

14% of gross wages for healthcare <forget the 5% I mentioned>
6.5% unemployment
19.1% pension
1.7% long term care insurance (This has since risen)

NPR also has a more recent story about how the lower salaries for physicians in Germany has created some interesting problems (I don't know how you would lower salaries here in the US what with medical school debt hovering around $150,000 for new grads!)

Basically, the article talks about the fact that many docs simply close their practices for a week at the end of each quarter because the "sickness" funds run out of money and the docs aren't paid for patient visits...so many of them decide not to work if they aren't...being paid.

http://www.npr.org/templates/story/story.php?storyId=91931036

It's an interesting article that gives two sides of the German story.

[tigereye]

1. thanks for your rational approach to this question

:thumbsup:

I've also wondered: would it be hard for us in the US to have a similar system due to our larger population?

[PA Democrat]

2. Would that 14% also include medical coverage for when you retire?

Like our current Medicare tax?

[busymom]

3. I don't know.

[OwnedByFerrets]

4. Is not the French plan a better one to use/compare?

Ive heard that its the program that should be copied.

[busymom]

5. Let's get the plans out there and dissect them.

Can you post some information about the French plan and I'll dig up what I can on the German plan and post it here.

[Mass]

6. Interesting how you twisted the article. Here is the relevant quote

Some German doctors simply close their doors and take a vacation at the end of every quarter.

[busymom]

8. interesting that you thought I twisted it...

I just wrote it wrong. I meant every quarter.

I think I'm being very balanced about this in trying to present information. I actually just posted a positive article on their health care system.

Do you NOT want to think about the cons as well as the pros? Are you one of those people who will ignore any negative, not try to work to to establish a health care system and avoid some of the mistakes/problems that are known in other systems and then will scream about how unfair it is when things aren't perfect?

I presume so since you took a sentence out of what I posted and tried to twist it to be something that it wasn't.

[busymom]

7. German Healthcare Articles

This is a quick read

http://www.nchc.org/documents/Germany.pdf

Here is one that compares the UK and Germany and then then France and Germany

http://www.civitas.org.uk/pubs/bb3Germany.php

Interesting stuff....

[Hamlette]

9. so 40% of a German's salary goes to pension and health care?

that seems so high. Maybe I don't understand the numbers.

[busymom]

11. When we lived there, we paid about that much...

and...I didn't have a very glamorous job and my husband didn't earn much either. We basically scraped by. We weren't dissatisfied with it though. It is accepted when you live there that you pay for these things, but that it is for the good of society. Everyone pays unless they are dirt poor and so everyone feels invested. There is less resentment from people who earn more because they also benefit from what they are paying in in taxes too. It makes for much less of a divide.

That being said, when I had my son, I didn't have to pay out-of-pocket (I had AOK insurance). Though I had to labor in a room with other women and their husbands and share a room with 3 other women after the delivery, the outcome was still good....ie...a healthy baby after a c-section. The only complaint that I had was that they were so short-staffed. It made for a problem because of the failure of the labor to progress and some other issues, but ultimately, the end result was that we survived, were healthy and it didn't cost us extra!

I was able to get same-day appointments and not have to wait for procedures, etc while I lived there...though I will say Germans are much more accepting of things we would have trouble with. MY fil had a bone marrow biopsy at his bedside with his 3 roomates in the room....and...there isn't money in the system for nice rooms or entryways, etc. But I think we could readjust to that.

There will be compromises and I hope we will all start researching the pros and cons so that before we implement something we figure out what works and doesn't work in other countries with universal coverage and tailor it all to our population and needs here.

[nbsmom]

12. Maybe you haven't done a personal cost-benefit analysis

If you make, say, $70,000 a year and determine that you want/can afford to save $15,500 a year into your 401k, that's 22% right there. This has the net effect of dropping your current marginal tax rate (yay!), but for argument's sake, let's assume that you're still paying 20% in federal and FICA (Medicare and Social Security) taxes (probably a little higher but I prefer rounder numbers.)

We're now at 42% and we haven't calculated what you're paying in terms of state income taxes, sales taxes, or health insurance. Let's use 3% for each (and only the health insurance and state income taxes have any favorable tax treatment.)

So now you're at 51%.

I don't know about you, but 51% seems like the high number to me.

[Hamlette]

15. but most of us are not self employed

so FICA and Medicare is lower...more like 9-10%.

Also, the 40% figure in the OP does not take into account federal or any local taxes so that doesn't seem fair in your comparison.

Not many of us are putting 22% into our 401K, we're lucky to get 10% in but that just cheats other tax payers out of our share of federal taxes. You are also assuming the German gov't is putting 22% into the retirement/pension accounts of each worker which does not fit the example, it appears to only be 19% (very generous) but here, the employer pays some of SS does the employer contribute anything in Germany?

I'm not saying right or wrong. I'm just saying I'm surprised. Also, we don't pay for unemployment in the US.

My whole issue with health care in the US is the cost benefit analysis. We pay the most (we're number 1...yay) but we rank 37th in terms of quality of care. I'd give up a private room to equal those two numbers out.

[nbsmom]

17. Okay, let me walk it back for your a little more...

Yes, I used a very aggressive savings percentage, but that was so that the focus could be on the effective cost of health care and not on our crazy-ass federal tax system.

Assuming that you were in the position to contribute 22% of your 70K annual salary, that still leaves you in a 25% top bracket. (And no, I don't think it 'cheats' other tax payers but that is an entirely different soap box.) Then once you've added your sales tax (not deductible), your state and local taxes (deductible to AMT phaseouts), and net cost of health care (assuming that you don't reach 7% AGI levels at which point it is meaningful for your Schedule A), you are usually looking at a percentage that far exceeds 40%.

Simply put, we need to fix our healthcare system if only to protect our 'investment' in the program thus far, as Medicare is effectively unfunded after 2018.

To your other point, since unemployment seems to be largely a locally policed item (witness the exploding numbers of employer-denied claims in areas like Colorado, for example), I'd say that was an example of getting what you (don't) pay for.

I have worked in group benefits for many years, on both employer group and payor side. Trust me -- the current system is broken primarily because there is a profit motive in a system that needs to be devoid of profit. No one should be allowed to benefit at the expense of another human being. Period.

(And based on the way you cavalierly allude to 'giving up a private room', I'll wager that it's been a while since you actually had to access the system yourself. May you continue to enjoy your blissfully ignorant good health.)

[Hamlette]

20. geez, really?

You thought my comment about a private room was cavalier? I don't get it. You think I would insist on a private room? I was being flippant, as in "who needs a private room" and I'd bet you good money I've spent much more time in hospitals than you have. In fact, I've been in huge wards (well, 30 people in a room) for as long as 3 months at a time. My feeling is, I'm sick, I don't care. I was in and out of hospitals for surgeries every couple of years for 30 years. Not exactly sure why that makes me blissfully ignorant. As far as I know, there are no more wards but I've been accessing the system for myself and my father who was 6 years dying since I was a teen.

Actually, since you've worked in group benefits, I'm sure you know that UI is NOT locally policed. Any change in our state law has to be approved by the feds and we are audited continuously. If we don't pass the BAM audit, we are fined. I'm legal counsel for the UI office in neighboring Utah and am very familiar with Colorado's laws. They are tough if you quit but the same as the rest of the states if you are laid off or fired. California is having problems right now but I've not heard anything about Colorado being above the national norm. I did hear Colorado may have to get a federal bailout for unemployment benefits but what that means to me is Colorado is paying benefits. And last I heard, only about half the states had sufficient reserves to not need help. And I'm sure you know that even if the employer denies the claim, the UI office must make a decision and issue benefits if appropriate by the end of the week after the week during which the claim was filed. Maximum of 12 days. So, employers can do what they want. If they contest it without proof, we allow and pay. And under Java, we must continue paying while the case is on appeal. I'm sure you also know that the UI system is the only law I'm aware of that has a built in bias toward awarding benefits. It's federal and all states must follow it. UI laws must be liberally construed to award benefits.

There is nothing local about the policing of the UI system.

But, what do I know, I'm blissfully ignorant.

[nbsmom]

21. Didn't mean to push any buttons

I'm very sorry to hear of your extended and unfortunate experiences in the healthcare systems. (FWIW, I would think that this collective experience would help you take a less quantitative and more qualitative approach overall. )

BTW, I referenced Colorado because they were the focus of a couple of recent investigations involving employers who laid off a bunch of folks with _no_ notice, only to helicopter corporate folks in expressly to deny the claims (apparently playing percentages.)

I know you know this, but with UI, it's all about keeping their going-forward premiums down, and perhaps if they weren't so blatant about it, it would probably still work.

California has been the site of some far more egregious examples recently (e.g., CNL owned TGI Fridays locations closing again with no notice, and no unemployment or severance awarded. Guess CNL felt that if their HQ was in FL, then FL law supersedes CA law. Please, please, please don't get me started.) Employers are counting on underfunded EDD agencies' lag time, and remember CA just dodged a $42 BB bullet -- do you think investigating denied UI claims was a top priority? Gaaaaa...

My apologies -- I was not trying to belittle your life experience, I was only wishing you years of continued good health.

[Hamlette]

23. the rumor will blaze through the CO UI office and claims will be paid

the employer in most cases must prove it replaced the worker in a discharge if not, benefits are awarded.

Yes, there have been lots of layoffs but I don't know of any UI office not passing BAM audits Not even CA. CA's problem is an under staffed office and not meeting time limits on appeals.

On health care, I'm surprised you think I don't want quality care? I'm just saying, having worked (professionally and personally) with the health care system it is bloated by stuff that doesn't contribute to the quality of care only the cost of care. And having been treated in it for 40 years my experience is the quality of care is not determined by whether I have a private room.

[ayeshahaqqiqa]

10. My doc works for no salary at our clinic

hiring out to work with another physician a couple of days a week to pay her bills. So I laugh when I read about doctors who won't work unless they are paid. I know that isn't always the case.

[busymom]

13. That is admirable,....ummm...

maybe she doesn't have huge medical school loans, is married to someone who can support her financially?

I have volunteered in the past to teach both Biology and German for free...and I enjoyed it, but...lets be honest here...

Will you work consistently (say 4 weeks a year) without being paid? I would never ask that of you.

Can you imagine calling a plumber for a serious plumbing issue, having him come to your house and diagnose and fix everything and then not paying him/her and thinking "how selfish that he wants me to pay him!" ?

My mom is a nurse practitioner and she does volunteer medical missions in honduras once a year for a week out of passion. My husband has done medical missions in Africa...

That is a choice that comes from the heart though, and is different than expecting someone to work one month out of the year without pay.

[ayeshahaqqiqa]

16. She is over 60

and student loans are paid off. And I don't begrudge any MD for wanting to get paid--it is a hard, demanding profession. My response was to the impression I got that doctors are greedy for money. I might have been mistaken in my impression.

[Teaser]

24. I wouldn't do it.

I've got a mortgage to pay, and a family to feed.

Someone wants me to work, they will pay me.

[vaberella]

14. Once again...if it's 100% Treatment. No matter the case. As for Germany, you're missing something.

with equal opportunity for everyone and it's 100% Guaranteed as it would be by the Government I don't care the percentage I would take the tax. At any given moment a person could be in a life threatening situation or know someone or have a family in such a position then they should have the opportunity to receive appropriate health care. It cut the racial disparity and the income disparity our current health care situation causes.

I love how they misinterpret the German system in this story and what would make the US' situation extremely different. The German immigration policy versus US is the big thing. We have an extremely young population in relation because of immigrants coming into the US. The German's have an aging population. And its mentioned in the article that the average life expectancy is 65 years of age. In the US our immigrant population would actually offset the costs of universal health care because the pool is massively large and will grow if immigrants are included into the mix. Actually the failure of the German system at one point was because of their immigration policy and it affected their social programs. That won't happen with the US, considering we have thousands of immigrants that flood our nation regularly. If we were to have Universal health care or some form of a national health care system provided by the Government, the taxes from the immigrant population and non-immigrant would be offset. I had actually proposed to my professor when she talked about this, if this was the reason why Germany actually opened citizenship to people (a legislation that was relatively recent, I believe, but could be wrong)who could prove German lineage no matter the generations you were raised in another. That won't happen in the US.

This is the reason that I won't put too much stock in German system. Culturally, and policy wise we're very different. The US has always been known as an immigrant country. Even with the advent of the EU which would open trade between the nations and of course labour, the EU treaties proposed mandates to lower the influx of immigrants from one nation to another---so the German social policy on public provisions became a bit unsustainable. However, ours are not. Especially if we take into consideration Mexican immigration excluding the many others that we have coming from Eastern Asia and Africa, or South America.


So all in all yes I do support the health care initiative and if the 14% is based on German numbers, because I thought the US numbers were along the lines of 7%...either way it would make no difference. Oh and doctors would still make 5 figures. I noticed a lot of the doctors living out of their means. That doctor making 5 figures but bought a 400,000 house was one of them. Look, this is a realistic income. His wife was basically not working when she was listed as a free-lance web designer and of course he had to pay to join a practice and that fee had to be taken into consideration. So if that was highly expensive and with the house...and a child plus a wife who's in and out of work....it will be hard. But the money still puts him in the upper income bracket of more Americans.

As a note, I believe that doctors who specialize make in the high 5 figures. Like endocrinologists, anasthesiats (sp?), and surgeons. General practitioners make the lower 5 figures that you see mentioned in the article. I think a specialist can make up to 300,000+ if not more. They make a great deal and they also have clinics, travel to different hospitals, are professors in schools and do the like. So there is plenty of opportunity to make serious money in the Germany policies for practitioners of any level. Specialization is the key for big moola.

[dtotire]

18. Sick Around The World (PBS Documentary)

Tells about health plans in United Kingdom, Japan, Taiwan, kGermany, Switzerland.
Watch it if you haven't seen it before.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

[vaberella]

19. Yeah, just read the preview and will watch.

But from the reading alone...in particular on Germany what am I supposed to get from it?

[Pharlo]

22. I have a nephew going the

MD/PhD route - by the time he completes his education he'll be close to a million in debt. Even had he chosen the strict MD, there is no way he would complete his education for a mere 150,000 dollars. While the cost of certain medical schools alone may come out to 150,000 dollars, that in no way covers the entire educational package for a medical degree in the US.

And yes, this will affect what a doctor must charge in order to practice in the US. Until the cost of the medical education is subsidized by the US government, the cost of a medical education needs to be taken into consideration by any attempt to limit physicians fees.

Another factor to consider is malpractice insurance. Is the government going to cover this? Restrict legal payouts against physicians? How do these other countries do it?

What costs of being a physician need to be rolled over into the 'health care tax'?

Since many countries that have subsidized health care DO subsidize the education of their medical community and do limit the fees a physician can charge, these are questions the US system will have to consider.

[Bread and Circus]

25. I'm not sure what you are getting at but I think it's silly to look at tax structure...

you have to look at other indexes of health care expenditure to look at the real cost of our system, namely cost per capita.

US citizens pay nearly $7000 per capita for health care.
In Germany it's less.
In other industrialized nations it is A LOT less.

The difference is our privatized patchwork for profit insurance system.

WE PAY MORE per person, bottom line.

It's just hidden in the way we pay as the streams of revenue are in a variety of ways: employee medicare contribution, employer medicare contribution, employer bought health care, copays, deductibles, donut holes, out of pocket self pay, putting the hospital bill on a credit card, employee premiums, individual bought premiums, etc.

WE PAY MORE per person, bottom line.

It's extremely misleading to look at Germany's tax structure and compare it to our notwithstanding because just looking at that totally disregards things like after tax purchasing power equivalents, minimum wage, job availability, job security, hours per week work, paid leave, quality of life, affordability, progressivity of tax structure, etc.

As for physician pay itself that may be a different matter and in a lot of case single payer system pays less for specialty care but the same or more for primary care.

Then you have to look at end product - patient satisfaction and outcomes, not to mention wait times. And on those accounts, Germany is competitive and sometimes superlative.

P.S. American doctors go on vacation too.

[busymom]

26. well

I lived in Germany for years and know quite a bit about the patient satisfaction end of it...and I'll tell you that there are about 45% of Germans currently pretty dissatisfied because of the rising costs, wait times, increased co-pays and other issues. It's not the panacea.

My dh is a doctor. He left Germany and came to the US because the way things are structure in Germany doesn't allow for free market competition at all. The State actually sets how many physicians are allowed to open up a practice in a certain area. Doctors can wait on waiting lists for years and years and not ever be able to get into a practice.

There are no continuing ed requirements in Germany like there are here. Once you're a doc, you're a doc. In the US, you have to re-sit board certification exams every 10 years which requires reading and actively participating in continuing education.
In Germany, there is also a messed up system of docs in the hospitals and a weird hierarchy. The head doctor in charge of your treatment for kidney disease might actually be an anesthesiologist who...doesn't know a lot about kidneys...because he's the doc in charge. So the kidney doc can say his opinion, but the final say is the one above him.

There are no infectious disease specialists in Germany. My husband's father died from sepsis. It was completely treatable. The treating doctor? An anesthesiologist. By the time my husband managed to get from the US back to Germany, it was too late. He tore the anesthesiologist a new butthole, but...dead is dead...and there is no such thing as lawsuits.

As to vacations? My husband rarely takes them. I know that there are a lot of DU talking heads who suggest that doctors should earn else and if they "choose" to work more that's there choice.

Little known fact? My husband worked 100+ hours/WEEK for 8 years of residency and fellowship training. Vacation? HAHAHAHAHA Not really.

HE is in practice now and works ~60 hours/week most weeks...but he answers his pager for his patients daily. He is one of 2 specialists for his field in the group practice. He takes call for the entire hospital every night, but for his patients every day. This man has gone in in the middle of the night to the ER to see a newly diagnosed HIV patient who is suicidal (not his field..he diagnosed the HIV). I am used to him picking up his cellphone and calling back the hospital when I'm in mid-sentence. Last night, he wasn't on call and his pager was downstairs. He didn't hear it go off and we didn't keep the phone in our room because...he wasn't on call. He was paged several times and then the hospital started calling him multiple times. We didn't hear it and so obviously, we didn't answer. The police were sent to our house to wake him up.

Medicine is not and will never be a 9-5 job. Patients get sick at all hours of the day and night and they want their doctors to take care of them. There aren't enough doctors and training spots...and there's not enough money in the system to have double the docs so that someone is on during the day and someone else at night.

When I was in the hospital due to my lymphoma, my internist came in and saw me every day...even on her day off...without compensation...because she cared.

The customer service part of medicine will get lost if we completely shit on providers. If you want to cut pay dramatically, you will also have to get rid of medical school debt, the ability to sue and should expect less from your doctors. I don't imagine that people will be jumping through hoops to do the same amount of work and sacrifice for dramatically less pay.

The running joke in Germany was that getting sick on the weekend was the best way to die. German docs get 6 paid weeks of vacation a year just like everyone else AND they don't work weekends.

I know that's totally off-topic though.

[Bread and Circus]

27. I don't believe you.

I'm not saying you are lying or anything. I'm willing to accept that you saw what you saw (or think you saw). However, the research doesn't stack up to your commentaries. Germany has some of the best patient outcomes of all the industrialized countries.

Secondly, I'm a U.S. Physician, so I understand full well what your husband went through and faces now.


The system in the US is broken and we pay MORE per capita for less care. That's just a simple truth. Unless we face that truth as a society, we will continue on an immoral and illogical path.

Truthfully, in the US, procedural based care should come down some and primary care income should be raised. I agree that those who go to school/res/fellowship the longest should get paid the most, however it is so out of balance that it is hurting our system to deliver quality care across the board.

Overall though, I think physician compensation isn't too out of line for what physicians have sacrificed, the amount of training they undergo, and the role they play in society.

The bigger issue is getting the administrative costs and profit margins out of health care.

A single payer system could address that while maintaining good salaries for those that actually care for patients.

[busymom]

28. You don't believe me, but you say I'm not lying...

Well my dear doctor...please do your homework.

I am absolutely correct.

Do you also not believe it when you hear stories about people dying in US ERs waiting to be treated or terrible issues with insurance companies in America? I personally, have never had my policy canceled without cause or been denied treatment in America, but I have a friend whose insurance company for some reason approved a mastectomy but not the anesthesia and it took 2 weeks to sort out.

Am I lying about that too or...since you know how fucked up things are in America...will you take my word for it.

Everything that I said about the system for physicians in Germany is true, but costs in Germany are contained by lower physician salaries too. The sick fund often runs out for docs before the end of the quarter, so many of them close their offices for the last week of the quarter instead of working for no pay.

We would have to do away with student loan debt for docs in order to lower salaries.

And Germany has a terrible bureaucracy when it comes to everything...health care included. Actually, everything in Germany required a visit to city hall for some signature for something....

[Bread and Circus]

29. It sounds like you have a vested interest in the current US system which

is obscuring your judgement.

No one is saying we should adopt the German system either.

I just don't find your anecdotal information very useful.

[busymom]

35. No. You're wrong.

It wasn't supplying anecdotal information, I was supplying information about some of the things not working in Germany. I am 100% for universal coverage...I want us to talk about the pros and cons and get all of the information. I hear people here screaming "medicare for all or nothing" (god help us) or talking about wanting what they have in Canada, the UK, Germany, or France. I forget that I'm at DU though, the underground for people who only can accept hearing what they want to hear and dismiss as untruth anything that doesn't fit into that picture.

[sandnsea]

33. I think there are pros and cons to everything

And one of the things that bothers me is that left wing idealogues are just as incapable of looking at the entirety of an issue as the right wing idealogues are. I don't understand it. Obviously there are downsides to the German medical system, or the Canadian or the French. I don't have to know anything at all about it to know that that has to be true. Nothing can be perfect to every human being. It's just a simple fact. We have got to be willing to look at every system honestly when we craft our own.

I am in Oregon. Due to the implementation of the OHP several years ago, I do not have medical choice in my home town. We have ONE clinic and the reason we have ONE is because the state will not approve medicaid payments to any other. It is to control duplication of services. I live in a smaller town in Montana and we had 3 clinics. Each one had their own small lab and other overhead. Oddly enough, going to the doctor was cheaper there. In any event, I do know what it's like to be stuck with a doctor who you are not 100% satisfied with. OTOH, it's delightful to be able to see a doctor which was not the case when I didn't have health insurance.

Finally, as the wife of a doctor, you will never know what it is like for the rest of us because you will alway be "Dr. Busy's Wife". My son was turned down for medical care when he could only walk stooped over because of a herniated disc. $500 or no visit. That's what they said. He eventually went to an acupuncturist for $50, was given a different set of exercise, and has been pain free for several years. But, people DO get turned away for treatment, all the time.

[busymom]

34. I know...we have been turned away for

dental care for my son. Again...we didn't have dental insurance for all of my husband's training and one of our children had dental issues. We were literally told "pay in advance or no service". We could not pay and ultimately, this became a costly medical issue for that son....which was really too bad and not our fault.

Of course, I get the other end of the spectrum...Dr. Busy's wife...the one who has not medical secrets despite HIPPA regulations...when I had cancer and was getting treatments, I couldn't sneeze without it rippling through the hospital. There is a definite downside, which is no privacy and living in a little fish bowl sometimes.

[kiva]

36. I don't doubt that a substantial number of Germans

are 'pretty dissatisfied' with their health system, but I thinks that's simply part of our general human tendency to complain. My question would be what percent of Germans (or Brits, or French for that matter) would want to trade their system for ours. A recent article I read said that the vast majority of Canadians (sorry, don't have the link and can't remember the exact percent) would NOT want our system, and I suspect it's pretty much the same for residents of other countries with some form of guaranteed health service.

[caseymoz]

30. I think anyone who wants to be a doctor and qualifies should be educated for free.

This will stop the shortage of doctors and would let them start their practice debt-free.

Second, medical boards should be far more willing to pull a doctor's license, which would stop the rise of malpractice insurance. This would also be reduced through making putative lawsuit damages above a certain amount to a government program for medical research and pharmaceutical r&d.

Also, it would be impossible to have a universal health care system without some reasonable control on costs, otherwise MDs and hospitals will raise their prices astronomically.

[Pharlo]

31. "...anyone who wants to be a doctor and qualifies...."

Now you're opening a whole other kettle of fish - the number of available med school slots per year. There are not a sufficient amount of openings available on an annual basis to give everyone who wants to be a doctor, and academically qualifies, a slot (many times it comes down to extracurricular activities of applicants).... And, eventually, this is going to come back and bite us in the ass, because we need more doctors than we can produce. There are some areas in this country where doctors are just not locally available....

Now, do we expect the government to open more medical schools? And how much will that increase the cost of medical care?

Personally, I agree with you, anyone who wants to be a doctor and qualifies should be guaranteed a free education - AND have to spend time in remote areas where doctors are not currently available - because many times these are poor areas where doctors cannot practice and afford to pay back their education loans, cover malpractice insurance, and cover living expenses.

[caseymoz]

32. Two solutions on your first point:

First, if there's a demand for more medical schools and it's paid for by the government, I'm certain the free market will meet demand eventually, but the problem will be keeping them from raising their charges to the government infinitely. Second, you could put the potential students on a waiting list, and for extracurricular activities in the meantime, you could have them work in a hospital on the lower rungs, as clerks, orderlies and such, or in other medical areas, like clinics or doctors' offices.

This has other advantages: it will give doctors a background conducive to being more appreciative and less arrogant toward those working on the lower rungs. One problem with hospitals is the class division and the breakdowns of communications that entail, which lead to accidents. This helps make the medical staff more of a team. Second, it puts people working on the lower rungs on a career track from the very beginning. This will make them more attentive and responsible. It also will serve as that "extracurricular activity" that you describe.

And you're absolutely right that those who graduate from med school then should be required to work in remote areas to start their MD careers.

For the government creating medical schools: maybe they can build them, supply them with necessary materials to start, but then auction it off and license them to a private company, a charity, or turn it over to the State, City, or County. The costs of building them might be high, but after initial costs, it won't add anything additional.

It might work.

[hay rick]

37. Mistaken again?

Here are a couple links on the German health care system:
http://www.euro.who.int/document/e68952.pdf
http://www.medhunters.com/articles/healthcareInGermany.html

Quoting from the latter article:
"Contributions to the state-regulated health plans (currently around 14% of the employee's gross income and shouldered equally by the employee and the employer)..."

and from the first article:
"Contributions are shared equally between the insured and their employers. Taking the current average contribution rate of 13.5% as an example, the insured persons pay 6.75% out of their pre-tax income below the threshold and the employer pays the same amount in addition to wages. For people with earnings below a threshold of DM 630, only employers have to pay for contributions (at a rate of 10% for all funds)."

So it's about 7% of income. Note also, another quote from the first article: "After retirement, contribution payments for the state-regulated plans stop (although private patients continue payments), but coverage is continued until death."

Sounds OK to me.