re: Fixing Healthcare

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That their should be government funded “Charity Clinics” established throughout the country where healthcare professionals can be required to work 1 day a week in order to “forgive” some their educational debt.

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So if you want to get part of your post-grad debt “forgiven” then you have to work 1 day a week in a “Government Charity Clinic”.

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is not what you described.

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What is so hard to comprehend? You want debt forgiveness you work 1 day a week. It ain’t working for 2-3 years for 1/3 pay at BIA but it would be something.

To be fair, he his idea doesn't equate to indentured servitude, he just worded it poorly.

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That their should be government funded “Charity Clinics” established throughout the country

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These already exist. In Louisiana alone, there were 10 charity hospitals up until a few years ago when their operations were sold to private partners. A few closed, a few remained clinics, but I would wager to say that no significant amount of people in LA is >45 minutes in a car from one of these centers- New Orleans, Houma, Bogaloosa, Baton Rouge, Monroe, Shreveport, Alexandria, Lafayette, Lake Charles. I don't think expansion of the system offers much except for significantly greater cost.

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where healthcare professionals can be required to work 1 day a week in order to “forgive” some their educational debt.

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Hard pass. Most of these are in academic centers and don't have difficulty filling staff positions to begin with. There is also already a Public Service Loan Forgiveness program which is somewhat in limbo, but states if you make 10 years of payments (graded by income on a 20 or 25 year payback period) while working for a nonprofit organization, the rest of your debt is forgiven. Usually equates to 3-6 years of residency/Fellowship + a few years more. There was a lot of outcry that physicians would be getting $200,000 tax-free gifts for jobs they would've taken anyway for only 4-7 years of "real world" (not training) work with salaries in the $200,000-400,000 being quite common.




But how about this: let's pretend these centers don't exist and you're facing the scenario where no where in LA offers free care for the indigent. Government is wildly inefficient at running hospitals and clinics. Louisiana just got out of it because of their inability to not lose their arse consistently.
So how about an alternative where the government decides these people need care, allow local providers to sign up to provide it for:
1) the tax break alone of being able to write off these visits
2) some amount of compensation, be it $x/visit or $y/annually if you take on z number of patients
3) loan forgiveness of $X if you enroll in this program where you sign up uninsured and provide care for them in your clinic just like other patients for y years, with a minimum of this many and a maximum set by you


#2 is essentially Medicaid expansion, but there were too many people who needed it driving reimbursement down so far that no provider around most of LA could accept them and keep the lights on.

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he just worded it poorly.

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Uh, ok? Maybe you know him. But all I have is his words. They are what they are, and he even requoted them.

There is a very large functional diffeeence between paying back something with money (which is fungible) vs being forced to pay debt back with forced labor.

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Approximately 50% of what you pay goes to insurance companies

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What? You think retention is 50%? No way you can think that.

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Start with “most people had affordable healthcare before the ACA.”

40 million uninsured

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40 million isn’t a majority. Nor is a real number.

I'm always amazed at the misinformation regarding insurance companies. So much fake news is being sold and bought by the left to the left for propaganda's sake.

It's so weird when it's so easy to refute.

Every time I ask a prog what they believe a typical target loss ratio is I get crickets in return.

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40 million uninsured,

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And half of them didn't want it

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demand the AMA stop limiting the number of doctors so much.

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You focus on this quite heavily, but there were over 1200 unfilled residency positions last year alone which have nothing to do with the AMA and everything to do with
1) the people interviewing not thinking the applicants were qualified, because significantly more applicants than spots were available
2) the applicants not believing the training program was good enough or in a desirable enough location that they would rather not work for a year than go there.


The AMA has everything to do with the spots- I will give you that. But until they're essentially all filled, I think they aren't the biggest problem. The training is very resource intensive and just can't simply continue at any given scale. There are Caribbean medical schools with 1,000 person classes starting three times annually and 50% graduation rates and even worse match rates (residency jobs secured). Are some great students there? Sure.
LSU New Orleans takes 200 annually with a much higher rate on both graduation and matching.
Could LSUHSC-NO expand and be adequate? Probably. They would have to change the way a lot of things work, including lectures and anatomy labs, which are some very strong suits that play into the aforementioned rates.

The real kicker though is what happens during the 3rd and 4th years of medical school. As you would expect, at LSU, you get a schedule with your name on it with a few options and the option to go find something on your own, bring it back, and have it approved. The people you work with are expecting you when you show up.
In the Caribbean schools, they're mostly on their own to find their rotations and have them approved. There aren't consistent pipelines to places consistently set up to teach medical students how to do what they need to learn to do. This is the real difference between the two systems. There is a limited amount of people that can fit within the LSU system and maintain both quality of care and education. The other system is a "you go figure it out, but do these things" crapshoot that may land them a job.

So when it comes to the AMA "not expanding" medical schools, it is true that to some extent, the schools themselves don't necessarily make an effort to expand beyond what they're used to, but they also just aren't capable of doubling in size over any real defined period of time and maintain quality.

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Or I worded poorly but people that actually know Healthcare could comprehend the General jist of my statement. Sorry you don’t know the industry. Usually in cases like that is is wise to keep ones trap shut.

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He’s a troll. Either from intention or from a manifestation of over-confident stupidity. Either way, you’re better off just not engaging.