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Should a just goverment provide health care for its citizens. (pg. 4)
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pkcRAISTLIN
quote:
Originally posted by metalgearsolid
That is why state-run health care equals a big no no. It can't possibly work efficient enough to treat the people who need to be treated.


you cant possibly take one example and extrapolate that into an argument against public health care :rolleyes:

not sure about lots of other countries, but over here we have a public & private health care system running side by side. the private system takes some stress off the public, but we still have adequate services for all. not perfect by any means, but anyone that needs life-saving treatment can get it more often than not.

the idea that the private system should run everything is fraught with problems. for instance the privately contracted ambulance services that have operated here from time to time were responsible for a number of deaths.

some things are worth paying taxes for, and a public health system is one of them. especially since its the poor that encounter more health problems.
occrider
quote:
Originally posted by Q5echo
what does that mean exactly? i'm not trying to be argumentative. well, i kinda am. it's seems vague.

the pharmacutical issue is one thing. i suppose that would be an argument to do away with the FDA. there have to be many other forces at work affecting the cost vs. quality issue.

this long article is from 1995 but very timely and informative.


Well the last World Health Organization report that ranked health care systems according to a variety of metrics ranked the US as 34th:

quote:

Thirty-six places to go

Jun 22nd 2000
From The Economist print edition
America’s health-care system is once again pushing itself to the fore of politics. This time, the battle is over spending on prescription drugs for old people. Is that really the main issue?

HEALTH care plagues American politics like a lingering disease. Issues bubble to the surface for a time, only to subside and be replaced by other symptoms. In the Democratic primaries, Bill Bradley championed the plight of the 44m uninsured; they have pretty much disappeared from the political debate since then. Two different versions of a federal bill of patients’ rights, allowing patients to sue their managed-care company, are stuck in Congress. Now the Republicans are scrambling to disprove that they are soft on drug pricing.

Stark evidence of real disease under all these symptoms was provided this week by the World Health Organisation. It ranked the world’s health-care systems according to how well they perform, given the resources invested. Even though the report’s methodology is controversial (see article), the findings are pretty tough for the United States.

The world’s biggest spender on health care, forking out an average of $3,700 per person a year, ranked just 37th overall, behind such health-care luminaries as Morocco and Oman. The United States, argues the WHO, is really three Americas. The top 10% of its people are the healthiest in the world; the middle bulge gets a “mediocre” deal; the bottom 5-10% “have health conditions as bad as in sub-Saharan Africa.”

In its first year, the Clinton administration tried to come up with a grand health-care scheme. Its failure has haunted attempts ever since. Although Americans told pollsters that they wanted health-care reform, when presented with the chance of change, they baulked. As one member of the White House admits, reform ever since has been limited to trying to soothe the most politically sensitive parts of the system.

For the moment, that means prescription drugs. Democrats think this is an issue with which they can clobber George W. Bush. They will seek to portray the Republican Party as soft on drug companies, and they will aim their ads squarely at the elderly, a key group of swing-voters who actually vote. Al Gore, who also tried to tarnish Mr Bradley as a friend of drug companies, moved early to push for plans to help pill-popping senior citizens. Now the Republicans are having to respond.

America leads the world in spending on prescription drugs, doling out an estimated $112 billion this year—a figure that may rise by 11% next year (see chart). Bob Blendon, a health-policy expert at Harvard University, points out that consumers are far more conscious of pill prices than, say, the cost of sutures. The elderly, who account for one-third of the drugs bill, are particularly attentive. Many ailments, from arthritis to impotence, can now be treated by drugs, as Bob Dole never stops telling people; but Medicare, the federally funded health-insurance scheme for the 65-and-overs, which has 37m elderly members, does not pay for these drugs outside hospitals. Meanwhile, health-insurance plans that cover the drug costs of some of these elderly voters are getting less generous. A third of Medicare beneficiaries have no coverage for drugs at all.

The response: a number of bills in Congress over the past 18 months, trying to bridge this gap. The Democrats have tended to lead the way. But this week, the House Ways and Means Committee approved a new bill drafted by Bill Thomas, a Republican (and coincidentally a close ally of Mr Bush). Dr Blendon points out that the Thomas plan offers broadly the same coverage as the Democratic plan Mr Gore is championing. It also costs roughly the same: $160 billion over the next ten years.



The big difference lies in who will dole out the money and negotiate with the drug firms. The Democrats favour existing government agencies working through “pharmacy-benefit managers”, the middlemen who negotiate drug prices between drug manufacturers and managed-care companies; the Thomas bill prefers dealing directly through private health insurers, which will compete for the Medicare folk. That option might be more attractive to the big drug companies, who are uneasy about government bodies setting drug prices. One possible sticking point, according to Patricia Neuman of the Kaiser Family Foundation, is that not many insurers want Medicare patients, who are a great deal more expensive than younger workers. Since 1998, roughly a quarter of the HMOs directly involved with Medicare have pulled out.

Since both parties are in dire need of a sop to throw to the elderly, some sort of package extending Medicare coverage for prescription drugs will probably emerge. That still ignores the thornier question of whether drug prices are indeed too high, and whether there is anything that can be done beyond doling out more money. States bordering Canada, such as Maine and Minnesota, have been packing their elderly on buses and sending them across the border to take advantage of lower prices for certain prescription drugs. A recent Congressional report suggested that American prices for some branded drugs are 70% higher than those in Canada, and Maine has just passed a law to try to hold drug prices down.

Already there are a few early initatives in Congress to allow health-care providers to import cheaper drugs from overseas. These may gain strength when a prescription-drug benefit plan is finally approved. But the drug companies will fight them tooth and nail.

This sort of haggling reflects an underlying truth about America’s health-care system that also emerges from the WHO study. More than any other country, America has turned health care into a business. It boasts myriad sorts of health-care companies and patients who, at least some of the time, think of themselves as consumers. This heady mix often spurs innovation in health care. But the conflicting interests of all the different parties—and their deep political pockets—also make wholesale reform extremely difficult.

The WHO report confirms that Americans with ample wealth, or generous employers, have ready access to the highest-tech medicine in the world. On such measures as promptness of service and patient choice, which the WHO ranking exercise calls “responsiveness”, America comes out top. The losers from the current system are those Americans with the least clout: the minority who are poor or workers uninsured by either public or private plans. More than a third of Hispanics, and a fifth of blacks lack regular health insurance, compared with 12% of white Americans. As the WHO study makes clear, despite state-sponsored programmes such as Medicaid, America’s poor have less access to medical care of any sort—including simple things like vaccination—and worse health on the whole.

Although the uninsured can usually find free treatment for acute complaints, such as heart attacks, they lack regular medical attention, which is the key to dealing with chronic, expensive conditions such as diabetes. It was this issue that Mr Bradley tried to inject into the campaign. It did him few favours with most voters. Both Mr Gore and Mr Bush pay some lip service to it in their manifestos; but it is not at the centre of their campaigns. In the end, most countries get the health systems most of their people want. America appears to be no exception.
http://www.economist.com/world/na/d...ory_id=E1_RDJNN


When the OECD did a more recent study of health care the US was by no means a leader:

quote:
Ranking nations' healthcare: US isn't No. 1
A first-ever comparison of healthcare quality could give more impetus to change the US private-public system.
By Alexandra Marks | Staff writer of The Christian Science Monitor
NEW YORK – Americans spend twice as much on healthcare as other countries, but it turns out that they're not getting twice the quality for the price when they go to the doctor or hospital.

In the first international comparison of healthcare quality, researchers found that of the five countries studied, none is consistently the best or the worst. For instance, Australia had the best breast-cancer screening, but the worst survival rates for childhood leukemia. This was best in Canada, but that country had the worst heart-attack survival rates. And while the United States led the way in five-year survival rates from breast cancer, it was the worst for kidney transplants.

"This affords the potential for unprecedented international collaboration ... that will allow countries to identify specific areas where they can improve," says Arnold Epstein, chairman of the Department of Health Policy and Management at Harvard University's School of Public Health in Boston. [ Editor's note: In the original version, the quote was misstated and misattributed.]

Benchmarks set

The goal of the study is to set the first benchmarks for comparing and eventually improving healthcare outcomes around the world - as well as to see whether patients are getting what they pay for.

It's already prompted international action. The Organization for Economic Cooperation and Development (OECD) is using it as a model to create a similar study that will encompass more than 20 countries around the world.

The study is also already affecting how patients are cared for. For instance, the Canadians are looking at ways to improve their treatment for heart-attack patients.

But researchers concluded that it was the Americans who should take particular note of the findings.

"The US should be particularly concerned about these findings," says Gerard Anderson, director of the Bloomberg School of Public Health at Johns Hopkins University in Baltimore. "If I'm spending twice as much, I'd expect to have the better outcomes." [ Editor's note: In the original version, the quote was misattributed.]

But it turns out, the US was in the middle of the pack for the majority of health issues that were compared.

The study, which was financed by the Commonwealth Fund, a nonprofit foundation in New York, was not designed with any political purpose in mind. Its goal is to help find ways to improve the healthcare received by people around the world. But in the US, where spiraling healthcare costs have become a political issue, it could eventually have a profound effect.

The US is the only one of the five countries studied that doesn't have some kind of government-sponsored universal healthcare system. Instead, the US has a mix of private and public insurance programs, with private companies providing the bulk of care.

Advocates of the current system routinely cite the high quality of care compared to that in government-run health systems when justifying the significantly higher costs.

More awareness

While none of the study's authors would comment on the impact of the findings on the political debate, they did say it would raise some awareness in the short term. But if the OECD begins releasing similar reports on an annual basis, Dr. Epstein said it could have a "profound" impact on the political debate in the US.

The study could also improve the way quality is measured around the world. One of the most frustrating findings for the researchers was that, despite the rising international concern about quality healthcare, there are very "meager" resources for assessing exactly how well doctors and hospitals perform.

It's surprising "how little information is available to monitor the quality of care," says Dr. John Millar of the Canadian Provincial Health Services Authority.
http://www.csmonitor.com/2004/0505/p02s01-uspo.html


Clearly there is something very wrong with our health care system compared with a lot of other countries unless you like to be the sucker that used car salesmen prey on ... now granted not all of it is due to pharmeceutical prices, I posted an article a while back that the majority is due to inefficiency, however, if you think we're getting a fair deal from Pharma (which is what my original post was directed at) you've got to be out of your mind. I mean really isn't it a political decision to block medicare from negotiating drug prices as opposed to a business decision? And if it is a business decision in the name of "research" I'm simply puzzled as to why US citizens get the ass raping by shouldering the entire burden while foreigners benefit from cheaper drug prices because their drug lobbies aren't blocking them from negotiating drug prices. Somebody ... anybody, please justify this ... unless you're Canada because then I can clearly see why you're in favor of such policies.
jdat
quote:
Originally posted by occrider
The US spends more per capita on health care than any other westernized country. Yet many other westernized countries statistically have better health care than the United States. So that begs the question, if we're spending so much on health care why are we getting such a crappy rate of return on each dollar we spend compared to other countries?


There are two issues in the United States, both wrapped into one.

NO COST CONTROL!

The governement is more concerned ( this varies from state to state and city to city depending on local policy ) about price gouging at the gas pump than they are with price gouging with medication and medical care.


The medical profession refuses to have any pricing guidelines set by the governement. Same applies to the pharmaceutical industry.

Is it greed? Is it to pay for potential lawsuits?

Also in many case health insurances set guidelines for reimbursement well below what is usually charged, and that is no accident on their part.

quote:
Originally posted by Q5echo
what does that mean exactly? i'm not trying to be argumentative. well, i kinda am. it's seems vague.



Patient follow up and doctor availability for their patients is lower in the US than other countries.

I will use my personal example ( I have a very serious health issue myself ) and state that the United States has the lowest life expectancy rate for people with that health problem, well below any other country in the world ( part of the rich nations that is ).
The material for the treatment I need isn't always sterilized in the United States.

The same care I need costs around 30 000$ a month in the United States and about 4 to 6000$ a month where I live in France ( and I actually don't pay a penny for it ); yet the quality of care here in France is much better.


quote:
Originally posted by metalgearsolid
I'm sorry to hear that.

That is why state-run health care equals a big no no. It can't possibly work efficient enough to treat the people who need to be treated.


State Run health care is efficient in many countries.
But you will find bad examples in every type of system, as well as in the United States.

A state-run system may be in debt and not want to spend more; or perhaps it will.
A profit-based system may not want to spend more than bare necessities as to not cut into it's profit margin.

quote:
Originally posted by Fir3start3r
Depends on what needs to be done; I've heard some stories about bills being VERY high down there in the States...:nervous:


I have a bill around 40 000$ in the States.






And lastly I will add this:
Most of health care research and advancement is made inside the United States.
The unfortunate part is that it seldom gets used there.
There was an article I read a while back that is for doctors who take care of me:
Why is State-of-the-Art ESRD Technology Better Outside of the U.S.?

The main issues pointed out in the article preventing advances in the US are:
Regulatory Constraints, Educational Constraints and Economic Constraints ( for profit companies are the main issue preventing progress State side) on on Advanced Technology.
Moral Hazard
quote:
Originally posted by Fir3start3r
Depends on what needs to be done; I've heard some stories about bills being VERY high down there in the States...:nervous:


As you know I'm an insurance adjuster and I primarally handle injury claims. I recall one loss for a truck driver who rolled his rig just outside of Philidelphia. Unfortunately for this gentleman his left arm was out of the driver side window when he rolled. He suffered extensive injuries to his left arm. He required the following surgeries; bone graft and internal fixation, muscle graft, nerve graft, skin graft, and extensive debridement in order to save the arm. I was advised by the hospital (who shall not be named) that the surgeries alone would cost $190,000 US, the ward rate for intensive care unit was $2,500/day (he would be required to stay there 5 days prior to being stable enough to be flown to a Canadian hospital). Unfortunately, his medical coverage was for $100,000 Canadian (which is about 10x the norm of US auto policies). When I advised the hospital of this they told me that the best they could do then was to remove the arm. No lie! The arm could be saved but and I quote "if no one will pay then we're not going to save it." Rather then have this gentleman lose his arm we (his insurer) decided we would pay beyond the coverage. Seriously, how ed up is that.... "if no one will pay then we're not going to save it."

Quick additional.... The hospital refused to feed this gentleman for a day and a half as no one had committed to paying for his treatment and they wouldn't give away food.
colonelcrisp
quote:
Originally posted by Moral Hazard
As you know I'm an insurance adjuster and I primarally handle injury claims. I recall one loss for a truck driver who rolled his rig just outside of Philidelphia. Unfortunately for this gentleman his left arm was out of the driver side window when he rolled. He suffered extensive injuries to his left arm. He required the following surgeries; bone graft and internal fixation, muscle graft, nerve graft, skin graft, and extensive debridement in order to save the arm. I was advised by the hospital (who shall not be named) that the surgeries alone would cost $190,000 US, the ward rate for intensive care unit was $2,500/day (he would be required to stay there 5 days prior to being stable enough to be flown to a Canadian hospital). Unfortunately, his medical coverage was for $100,000 Canadian (which is about 10x the norm of US auto policies). When I advised the hospital of this they told me that the best they could do then was to remove the arm. No lie! The arm could be saved but and I quote "if no one will pay then we're not going to save it." Rather then have this gentleman lose his arm we (his insurer) decided we would pay beyond the coverage. Seriously, how ed up is that.... "if no one will pay then we're not going to save it."

Quick additional.... The hospital refused to feed this gentleman for a day and a half as no one had committed to paying for his treatment and they wouldn't give away food.



proffit based healthcare at its best.......... despite how flawed our system is at times..... thank god im canadian.... just dont go to st thomas elgin general hospital in SW ontario.... they set the bone crooked when i broke my toe....
NeoPhono
quote:
Originally posted by Moral Hazard
As you know I'm an insurance adjuster and I primarally handle injury claims. I recall one loss for a truck driver who rolled his rig just outside of Philidelphia. Unfortunately for this gentleman his left arm was out of the driver side window when he rolled. He suffered extensive injuries to his left arm. He required the following surgeries; bone graft and internal fixation, muscle graft, nerve graft, skin graft, and extensive debridement in order to save the arm. I was advised by the hospital (who shall not be named) that the surgeries alone would cost $190,000 US, the ward rate for intensive care unit was $2,500/day (he would be required to stay there 5 days prior to being stable enough to be flown to a Canadian hospital). Unfortunately, his medical coverage was for $100,000 Canadian (which is about 10x the norm of US auto policies). When I advised the hospital of this they told me that the best they could do then was to remove the arm. No lie! The arm could be saved but and I quote "if no one will pay then we're not going to save it." Rather then have this gentleman lose his arm we (his insurer) decided we would pay beyond the coverage. Seriously, how ed up is that.... "if no one will pay then we're not going to save it."

Quick additional.... The hospital refused to feed this gentleman for a day and a half as no one had committed to paying for his treatment and they wouldn't give away food.


First, I find it nearly impossible that they did not give the guy food. If that is the case then the hospital is at fault and they should be held responsible. Secondly, the primary job of the health care system is to stabilize, then fix/repair if possible. The hospital stabilized, and that, by law, was their only responsibility.

100 years, maybe even 50 years ago, that truck driver would not be just missing a limb, he more than likely would be dead. What is the difference between then and now? Technology and expertise. That is what you're paying for if you want to retain a limb that would have naturally been lost. If you want the same prices that you paid 25 or 50 years ago for heath care, then expect the medical care you would have gotten 25 or 50 years ago.

You can say that is as cold and callus as you'd like, but that is the truth. There is and always will be limited resources, limited professionals trained to care for the sick/injured and limited time in which to administer care. You're paying for all of those things. If you can't or won't pay, then they will turn their attention to someone that will. They saved his life, that was their job. No matter how much you may disagree, saving a limb is extra.

You also have to realize how many people go into taking care of someone in the condition the trucker found himself in. There are just too many to list, but I'll at least take a stab at it. There's the surgeon, the surgical team (3-5 people), anesthesiologist, ICU nurse (usually 1 on 1 care), a nurses aide, pharmacist, pharmacy tech, physical therapist, social worker, dietitian, dietary tech, phlebotomist (depending on the hospital), respiratory therapist, unit clerk, janitors, administration, records personnel, billing personnel, laundry service, waste removal, product suppliers on and on and on. More than likely with a complex operation such as saving a limb, you will have several surgical teams; cardiovascular, orthopedics, neurology, maybe even an endocrinology team.

Now a days we not only take for granted that we have the technology and ability to save an arm, we think it should be cheap and affordable. Medical care is not fast food, but we think it should be; cheap, affordable and easy to get. All I have to say is look at the quality of food you get at McDonald's. Do you really want your health care to be of the same variety?

Medical care is expensive and it always will be. We can do a lot to make it more affordable to more people, but it will still be expensive, if quality is important. But we have to remember, we're talking about saving people and saving quality of life. We will buy cars or houses with monthly payments that far exceed what we think is reasonable for health insurance which without, makes all those other goodies we buy pretty pointless. That in my opinion, is a big priority problem.
jdat
NeoPhono I understand your point on how it is inevitable that health care costs will rise with time as options for care will increase.

But where does your comment come in?
What relevance does it have?

Take this persons case and the quality of care he could have received in Canada had the accident taken place there. It could have been the same or potentially better who knows; but in the end what justifies such a price difference?

In my earlier post I gave my own personal example of the living hell I had to go through with medical care and it's quality; the same thing would cost around 30 000$ a month in the United States and around 7000$ here in France yet the medical profession ( stateside ) recognizes that the quality of care is far superior abroad.

What justifies the price difference especially given the fact that the care itself is far worse in the United States?


Ps:I realize this quality of care issue does not apply to all cases.
NeoPhono
quote:
Originally posted by jdat
NeoPhono I understand your point on how it is inevitable that health care costs will rise with time as options for care will increase.

But where does your comment come in?
What relevance does it have?

Take this persons case and the quality of care he could have received in Canada had the accident taken place there. It could have been the same or potentially better who knows; but in the end what justifies such a price difference?

In my earlier post I gave my own personal example of the living hell I had to go through with medical care and it's quality; the same thing would cost around 30 000$ a month in the United States and around 7000$ here in France yet the medical profession ( stateside ) recognizes that the quality of care is far superior abroad.

What justifies the price difference especially given the fact that the care itself is far worse in the United States?


Ps:I realize this quality of care issue does not apply to all cases.


Price difference? Do you really think that there is a $23,000 dollar difference in the cost of care? No, it's that in once case, the primary responsibility of paying lies in the hands of the individual, whereas in the other it lies in the hands of the government, or the taxpayers, depending on how you look at it. In the US, your cost of care is also inflated to pay for those who can't or won't. In reality, we already have a socialized system in that those who can pay also pay the bill of those who can't. There are ways for the cost of health care in the US to be reduced substantially, however to think that identical procedures cost over three times more in the United States is not true, it's looking at the numbers with the wrong prospective.

To put things another way, in socialized systems, such as the UK, there is a set health budget every year. A committee is then given the task of deciding where and how that money will be spent. If something occurs to you and the money alloted for that procedure is used up for the fiscal year, you get put on a waiting list until funds become available. That's where you run into long wait times to see specialists and stories like these as the "system" tries to meet patient needs while running on a limited budget and keeping costs to a minimum:

5,000 elderly 'killed each year' by lack of care beds

UK health service "harms 10 percent of patients"

British Healthcare To Be Rationed

Grappling with deficits

My rationale is this: I want to know that if I have the resources available, I will have top-quality care when I need it. I don't want to have to worry that if I get sick at the end of a budget period I'm going to have to wait until the government finds money to take care of me. Right now in the US, the average cost of health care, per month, per person is $250. Most people I know pay much less than that, however. That's less than a car payment and less than a house loan payment for all but the cheapest of cars and houses. Hell, I pay more for my car insurance than I do for my health insurance each year. We have this mindset though that health care should be "free." Show me one country with truly free health care that doesn't have budget and care issues, approaching crisis. The UK health system has a current budget deficit of 800 million pounds, the Canadian federal government has cut their contribution to provincial health care programs from funding 50% of health expenditures down to 20%. How long do you think these "free" health care systems have left?

As far as the Canadian system goes, I'd recommend this article.

Socialized Medicine: The Canadian Experience
weymouth
Has anyone heard of Revolution Health? It is a health plan that a bunch of businessmen are trying to create. It is interesting and might work.

www.revolution.com/health
Moral Hazard
quote:
Originally posted by NeoPhono


You have completely missed the point. My concern is not the difference in cost, in fact I did not even mention what the surgical interventions would have cost in Canada, my concern is that clearly quality and functionallity of human lives takes a back seat to profitability in the US medical system. If the arm can be saved then save the arm and work out who will pay and how later! The idea that persons sworn to do no harm would allow a man to lose his arm and by extension his livelihood and suffer a tremendous loss of ability to preform his activities of daily living for the sake of profit is simply not acceptable IMO.

NeoPhono
quote:
Originally posted by Moral Hazard
You have completely missed the point. My concern is not the difference in cost, in fact I did not even mention what the surgical interventions would have cost in Canada, my concern is that clearly quality and functionallity of human lives takes a back seat to profitability in the US medical system. If the arm can be saved then save the arm and work out who will pay and how later! The idea that persons sworn to do no harm would allow a man to lose his arm and by extension his livelihood and suffer a tremendous loss of ability to preform his activities of daily living for the sake of profit is simply not acceptable IMO.


And you've missed my point. The medical team did their job in saving the patient's life. End of story. From that point on, if the patient doesn't pay, the medical professionals don't get paid. As morally wrong as you may feel it is for them to decide not to return function to the man's arm, it is just as wrong to feel that the medical professionals should be forced to save the arm. And please don't tell me similar situations do not occur in socialized systems as those waiting for hip replacements are put on waiting lists for years to months and diabetics waiting for amputations die before their name is called. No matter what system you find yourself in you will always find limitations in the form of time and money. Time was not the limitation in the trucker's case, it was money. Time is the limitation in socialized medicine, and money is quickly becoming the other dominate limiting factor.

I guess you could look it at like this. The three "essentials" of life (according to grade school textbooks) are food, clothing and shelter. Can you go into any restaurant and demand free food? Can you go into any clothing store and demand free clothes? Can you drive by an empty house and demand that it be yours? How then can you demand any service from any hospital be free? Especially when it is one that has no impact on saving your life. If you said "yes" to all of those questions, then I believe communism is what you're looking for.

Bottom line: the people asking for the money aren't just doing it for a "profit" they're also doing it to make a living. As outrageously expensive as you may think it is, there are a lot of people with a lot of mouths to feed that go into restoring fucntion to an arm. How much would you value your arm at?
metalgearsolid
Neophono, do you really think it is ok for a doctor who just got out of med school to be payed over $100,000 with not much experience? You have Neuro-surgeons who get out of med school and their starting salary is over $400,000.

I think doctors are over payed that is what is wrong with the system we have. They are not doctors they are more business men than doctors.
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