“Physicians elsewhere do not bear the same financial burden. I traveled in 2019 to the Netherlands, Australia, and Taiwan, which have three distinct health care systems that still manage to cover all of their citizens: universal private insurance, a public-private hybrid, and single payer, respectively.
In the Netherlands, physicians take three years of undergraduate studies, three years of master’s studies, and complete a one- to two-year internship before being licensed; certain specialties then require further training. Dutch university students typically graduate with much less debt (less than 25,000 euros on average, or about $26,200) than their American counterparts. In Australia, the training requirements would look familiar to US doctors — a decade or so of education and then on-the-job training — but the tuition would not, with annual medical school costs capped at less than $10,000 per year. Taiwanese doctors likewise spend significantly less money on their education, even relative to differences in cost of living, than US doctors.
What all of those countries have in common is more robust public support for higher education and generous loan repayment programs. The high cost of college is a longstanding issue in the US, and that contributes to the prohibitive cost of a medical education for reasons that have little to do with health care itself.”
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“There is another way in which the US health system places an unusual burden on doctors: the headaches of health insurance paperwork. As left-leaning policy analyst Matt Bruenig wrote on the recent brouhaha over insurers and doctors after the killing of Brian Thompson, at least some of the excess pricing of US medical services can be attributed to the administrative costs that providers incur while dealing with private insurers.
The demands of insurance claims on doctors’ time and attention not only make for a less pleasant working experience, they also take them away from patients, which can contribute to worse health outcomes.
Here is perhaps the most telling statistic, from the Commonwealth Fund’s 2024 international survey of doctors: 20 percent of US doctors said they spend “a lot” of time on paperwork or disputes over medical bills. That was nearly double the rate in the country with the next highest share; 12 percent of Swiss doctors said the same working in their country’s system, which also relies on private insurers to oversee benefits.
Only 5 percent of Dutch doctors and 9 percent of Australian doctors said paperwork and billing took up a large chunk of their time.
This wasteful activity affects both the cost and quality of our health system. Among wealthy countries, US patients have the fewest number of consultations with a doctor in a given year, with the exception of Sweden, and spend the least time with their physicians. Time and money spent on administrative work, for both insurers and providers, account for about 30 percent of the excess medical spending in the United States.”
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“The average physician salary in the US ranges from about $260,000 (for endocrinologists and pediatricians) to $550,000 (for certain surgeons). The most elite providers earn more than $1 million annually.
Dutch general practitioners, by contrast, make about 120,000 euros ($126,000). Even senior hospital surgeons typically earn about 250,000 euros. Australia, with a more robust private market, can be more generous: While primary care doctors earn between AUD$100,000 and $150,000 ($60,000 to $93,000) on average, senior practitioners make more and specialized surgeons can rake in as much as AUD$750,000 ($460,000) — much closer to the American norms.
Doctors in Taiwan — where, it should be noted, nationwide average incomes are about half of what you find in the United States — can make between $60,000 and $100,000 per year. The policy experts I spoke to there agreed that doctors are underpaid relative to the high number of patients they see, substantially more than a typical American physician will see in a day.
Whatever complaints American physicians may have, doctors in those countries feel undercompensated.”
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“The blame game between insurers and doctors is ultimately a distraction. Other countries have private health plans and private providers and yet don’t experience nearly the same waste and out-of-control price increases as the US has. The whole system — the prices and how they’re paid — will need to be addressed in the long run. As one landmark health economics paper put it 20 years ago: “It’s the prices, stupid.””
“The U.S., the U.K. and Australia will start joint work on hypersonic missile technology and electronic warfare capabilities under the umbrella of the AUKUS security pact.
The decision, announced Tuesday by the leaders of the three governments, is the latest move in an international race for hypersonic weapons, which can travel up to 10 times the speed of sound, making them much harder to detect.
It is also a further example of the deepening security partnership between the U.S., Britain and Australia, after their creation of AUKUS last September scuppered a mega submarine deal for France, souring relations between Washington and Paris. Developing hypersonic missiles represents a long-term aim for Canberra, which is seeking to step up the long-range strike capabilities of the Australian Defence Force.”
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“In March, Russia said it had used a hypersonic missile to strike an ammunition warehouse in western Ukraine. Last year, China reportedly tested two hypersonic weapons, causing alarm at the Pentagon.
The U.S. successfully tested a hypersonic missile in mid-March but did not announce it for two weeks to avoid increasing tensions with Russia, according to media reports.”
“In response to Australian court decisions holding media companies legally liable for the comments by users, CNN has blocked access to some of its Facebook pages from users in that country.
This is an inevitable outcome of a bad decision and a reminder of why it’s important not to try to force government-mandated moderation policies onto massive social media platforms that will inevitably lead to either censorship or lack of access to information.”
“While Australia was pivoting to China, Beijing was orchestrating its own pivot: Xi had delivered a very different address to his countrymen before his speech to the Australian parliament.
In January 2013, shortly after becoming the chairman of the Communist Party and just months before becoming Chinese president, Xi laid out plans to make China a global superpower through economic and technological might.”
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“That meant going after the Western alliance —with Australia as the weakest link. So while publicly promising sincerity and trust, Xi secretly sought to squeeze the island nation.
First came the cyberattacks, with Chinese state-linked hackers going after the Australian parliament, the country’s Bureau of Meteorology, the Australian National University and numerous others.
Then came attacks on Australia’s Chinese-language media, with reports of coercion, bullying and intimidation at any outlet daring to depart from the Communist Party line.
Reports emerged that China had reached deep into the Australian political establishment, seeking to steer policy in China’s favor. Investigations found Beijing-linked businesses were the largest sources of donations with foreign ties, and the money went to both sides of the political spectrum.
The financial intrusions rattled Australian politics. In 2017, Australian Labor Party Senator Sam Dastyari was forced to resign over his ties to Chinese Communist Party-linked donors.”
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“Later in 2017, China’s security chief warned Labor leadership the party would risk losing support among Australia’s Chinese diaspora community if it didn’t back an extradition treaty Beijing wanted.
And over the past 18 months, China hit Australia with a series of trade restrictions and tariffs in response to Canberra’s call for an independent investigation into the origins of the coronavirus pandemic, which emerged from the Chinese city of Wuhan.
Meanwhile, China was also building its military might in the region, making sweeping claims to the South China Sea and squeezing Hong Kong and Taiwan — moving southward toward Australia.”
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“Australia, having once extended Beijing a hand of friendship, is now back in the arms of its old associates.
Earlier in September, Canberra announced a wide-ranging security partnership with the U.S. and U.K. The pact, dubbed AUKUS, comes amid a broader Australian attempt to pivot its economy away from China.
“The level of Chinese economic coercion and cyber espionage against Australia was once unimaginable, so our security agencies have learned to consider worst-case possibilities,” said Rory Medcalf, head of the National Security College at the Australian National University and author of “Indo-Pacific Empire.”
AUKUS, he said, “is an alignment made in Beijing.”
Under the new Anglo-American alliance, the U.S., U.K. and Australia have agreed to share advanced technologies with one another, including artificial intelligence, cybersecurity, quantum computing, underwater systems and long-range strike capabilities. Australia also abandoned a submarine deal with France worth more than €50 billion to acquire American nuclear-powered submarines instead.
“It’s a remarkable collapse in Australia-China relations and a massive deterioration in Australia’s security outlook that’s led to this outcome,” said Michael Shoebridge, a director at the influential Australian Strategic Policy Institute (ASPI) think tank, which receives funding from the Australian and other governments.”
“lays the groundwork for Australia to acquire at least eight nuclear submarines with support from the US and the UK. Australian Prime Minister Scott Morrison said it also marks the “first major initiative” of a tripartite new security agreement among the countries under the acronym AUKUS (pronounced AWK-us, according to the AP).
“This initiative is about making sure that each of us has a modern capability — the most modern capabilities we need — to maneuver and defend against rapidly evolving threats,” President Joe Biden said in Wednesday’s joint announcement with Morrison and British Prime Minister Boris Johnson.
The AUKUS submarine deal replaces a previous agreement between France and Australia for France to deliver 12 non-nuclear submarines.”
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“In public remarks..French officials, including Le Drian, have not held back their shock at Australia’s decision to turn to the US and the UK. “We had established a trusting relationship with Australia, and this trust was betrayed,” Le Drian said on Thursday, according to Politico.”
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“French President Emmanuel Macron’s decision to withdraw his country’s ambassadors to the US and Australia in response to the pact marks a surprising breakdown in France’s historically close relationship with the US — but Australia’s decision to look to the US for its submarine fleet is less surprising.
Specifically, China’s military buildup, and its quest for dominance in the South China Sea — a major trade route for Australia — made the French submarines obsolete before they were even delivered. Because the US-made submarines rely on nuclear power, they have a far greater range than conventional submarines, don’t require refueling, and have better stealth capabilities — meaning they can stay underwater for months at a time without being detected, Australian National University researcher AJ Mitchell explained in the Conversation this week.”
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“In addition to the advantages of nuclear submarines, Australia’s previous deal with France — a $66 billion submarine contract, finalized in 2016, that would have provided Australia with 12 conventional, diesel-powered Barracuda submarines — has been rife with difficulties.”
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“On top of cost overruns and delays, there were other issues as well. Shortly after Australia and France reached the agreement in 2016, the French shipbuilder, then called DCNS, revealed it had been hacked and documents related to a separate Indian submarine project exposed. And while France’s submarine technology — conventional, diesel-powered attack vessels that could be switched to nuclear power — may have made sense when Australia’s relationship with China was less contentious, that relationship has soured recently due to China’s aggressive foreign policy in the Pacific and elsewhere.”
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“Australia and the US reportedly conspired to keep the developing deal from France, even as officials from both countries met with their French counterparts. Biden discussed the future of their alliance with Macron in June, and Secretary of State Antony Blinken made no mention of the pact when he met with Le Drian that same month in Paris.
Australia also hid its plans from France when Morrison and Macron met in June, although Morrison says he did raise concerns about the viability of diesel-powered vessels, according to the Hill. Australia’s defense and foreign ministers even met with their French counterparts late last month and issued a joint statement about furthering their defense cooperation, specifically citing the submarine program.”
“Australia’s highest court has upheld a controversial and potentially destructive ruling that media outlets are legally liable for defamatory statements posted by online commenters on Facebook, a decision that could result in massive amounts of online censorship out of fear of lawsuits.
The case revolves around a television program from 2016 on Australia’s ABC TV (no relation to America’s ABC network) about the mistreatment of youths in Australia’s jail system. Footage of Dylan Voller in a restraining chair was part of the coverage. When media outlets covered this program and posted links to the coverage on Facebook, users made comments about Voller, and this prompted Voller to sue the media outlets. The comments were defamatory, Voller claimed, and he argued that the media outlets themselves were responsible for publishing them.
The media outlets countered that, no, they were not the publishers of third-party comments on Facebook and were not responsible for what they said. The outlets have been appealing to the courts to toss out the lawsuits, and they’ve been losing.”
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“The country’s top justices determined that media outlets in the country are, indeed, publishers of the comments that users post on Facebook under stories that they link.
The logic here is absolutely terrible and destructive. Facebook has control over the tools for managing comments on media pages. The media outlets themselves do not, and they can’t “turn off” commenting on their Facebook pages. They do have the power to delete comments after the fact or use filtering tools that target keywords (to stop people from making profane or obscene comments) and can block individual users from the page.
Using these tools to try to prevent defamatory comments requires constant monitoring of the media outlet’s Facebook page and would demand that moderators be so agile as to remove potentially defamatory content the moment it appears before anybody else could see it. Nevertheless, the justices concluded that this is enough control over the comments for media outlets to be considered publishers. Two of the justices were very blunt that simply participating on Facebook made Fairfax Media Publications a publisher of the comments”
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“It is easy to assume, as these other justices apparently have, that such a decision could not possibly cause a disastrous amount of online censorship because media outlets should know when a controversial story might lead to defamatory comments. The judges actually note this in the ruling. They seem to think that this is only an issue with certain types of stories and that the appearance of defamatory comments can be predicted in advance.
This is complete rubbish, and anybody with any experience on social media already knows this. Trolls, scammers, and spammers range far and wide (that’s the point of them), and it’s incredibly naive to think that a story that has no controversial elements can’t end up with third parties posting defamatory nonsense under them.”
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“it’s why Section 230 of the U.S. Communications Decency Act, which generally protects websites and social media platforms (and you) from liability for comments published by others, is so important. It’s not just to protect media outlets from being held liable for comments from trolls. It’s to allow social media participation to even happen at all. Some large media outlets or companies might be able to afford around-the-clock moderation to attempt to catch problems. But even if they could, let’s be clear that they’re going to avoid as much risk as possible and delete any comment that has a whiff of controversy. Why would they allow it to stand if it could get them sued?
But smaller companies and outlets—and there’s no reason to think this ruling applies only to media outlets—will either have to hope Facebook gives them better tools to control who posts on their page or just not have social media presences at all.”