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gorskon's profile
David Gorski, MD, PhD
David Gorski, MD, PhD
David Gorski, MD, PhD
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@gorskon

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David Gorski, MD, PhDVerified account

@gorskon

Surgeon/scientist promoting science in medicine and exposing quackery. Editor of Science-Based Medicine. My opinions do NOT represent those of my employers.

Michigan, USA
sciencebasedmedicine.org
Joined October 2009

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    1. David Gorski, MD, PhD‏Verified account @gorskon 16 Dec 2020

      I'm puzzled. I've encountered someone who's very much for #M4A but loudly decries "centralized medicine"? Does he not realize that single payer systems, like the NHS or Medicare-for-All, are the very epitome of "centralized medicine"? 🤔

      5 replies 3 retweets 56 likes
    2. Iain Roberts‏ @_Iain_Roberts 16 Dec 2020
      Replying to @gorskon

      The UK is single *provider*. (Practically) all doctors and hospitals are part of one bureaucratic entity, the NHS. Canada is single *payer*. Healthcare providers are independently run, publicly funded.

      1 reply 0 retweets 2 likes
      David Gorski, MD, PhD‏Verified account @gorskon 16 Dec 2020
      Replying to @_Iain_Roberts

      In practice, centralized insurance IS centralized medicine. DRGs, anyone? Clinical care guidelines, pay for performance. I could go on and on. Also, in Canada, unlike a M4A system proposed for the US, the provinces are responsible for administering the plan, correct?

      10:37 AM - 16 Dec 2020
      • 2 Likes
      • the sailing science shill ⛵️ Lucinda Catchlove
      4 replies 0 retweets 2 likes
        1. Addleben‏ @Addleben 16 Dec 2020
          Replying to @gorskon @_Iain_Roberts

          There are plenty of clinical guidelines here. You don't have to follow them. They're *guidelines*. And people talk about pay for performance. Never seen it.

          0 replies 0 retweets 0 likes
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        1. Iain Roberts‏ @_Iain_Roberts 16 Dec 2020
          Replying to @gorskon

          I don't disagree. I'm just saying there are significant differences in the degree of centralization. Your acquaintance may have meant that. Of course, they may have just had no idea what they were talking about.

          0 replies 0 retweets 1 like
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        2. Lucinda Catchlove‏ @fifilamoura 16 Dec 2020
          Replying to @gorskon @_Iain_Roberts

          The provinces administer the plan in Canada (and in Australia it's the states that do it). But doctors don't work directly for the state, they bill the state and (outside of hospitals and CLSC/community clinics in Quebec) are privately run clinics or practices. I'm not quite...

          2 replies 0 retweets 0 likes
        3. Lucinda Catchlove‏ @fifilamoura 16 Dec 2020
          Replying to @fifilamoura @gorskon @_Iain_Roberts

          ...sure about how CLSCs bill the government to be honest but they're run by the state and inspired by a community clinic that was started to serve what was at the time (and continues to be for the most part) a very working class/poorer area of Montreal.https://ccpsc.qc.ca/en/history 

          0 replies 0 retweets 0 likes
        4. End of conversation
        1. Lucinda Catchlove‏ @fifilamoura 16 Dec 2020
          Replying to @gorskon @_Iain_Roberts

          There are also entirely private practices/clinics in Canada that operate outside of the medicare system (healthcare providers have to exclusively private or public). This is somewhat controversial and generally not that profitable unless it's a specialty like psychiatry or pain.

          0 replies 0 retweets 0 likes
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