GTO , here is what you said........

Thank you for the response.

First off, I'm not aware that taxpayers pay for the doctor's educations in this country; at least not in an outright sense. If you mean by a Cuban style type of health care where the government pays for a doctors education and then the doctor works for the greater good of their society in a so called 'free' health care system, (which is actually in a completely oppressed socialist/communist country); then that's not the way it works in this country; (at least not yet; Oboma is working hard on it though). Maybe someone can help me out here; but my understanding of how it works here is that if the student/doctor can't pay for their education outright; then they get their education through scholorships and/or student loans.

Now here are the facts........

Graduate Medical Education in USA

Li-Cheng Xu, M.D., Ph.D.
Diplomate of the American Board of Internal Medicine,
Fellow of Oncology/Hematology,
Memorial Sloan-Kettering Cancer Center,
New York, NY 10021

Historical Aspects of Graduate Medical Education in the United States

In the United States, the federal government is the largest single explicit financing source for graduate medical education. Of the federal programs and agencies that support graduate medical education (Medicare, Medicaid, and the Departments of Defense and Veteran Affairs), Medicare is by far the largest single source of such funds. Over the past decade, the Reagan, Bush, and Clinton administrations all proposed reducing these educational payments. Until 1995, however, key congressional committees chaired by legislators who championed the interests of large teaching hospitals repeatedly thwarted those efforts. In 1995, with newly elected Republican majorities in control of the House and Senate, Congress enacted legislation that would have reduced Medicare's total spending by $270 billion and Medicaid's by $182 billion over seven years, while cutting taxes by $245 billion. President Clinton vetoed that measure, asserting that the budget cuts were too draconian and that the tax cuts favored the wealthy.

The 1997 budget law altered the formulas by which Medicare subsidizes graduate medical education. The program recognizes the costs of education in two ways: it provides direct medical-education payments to hospitals that cover a share of residents' stipends, faculty salaries, administrative expenses, and institutional overhead allocated to residency programs; and it provides an indirect medical-education adjustment that reflects the added patient care costs associated with the operation of teaching programs. Medicare's direct payments for graduate medical education are based on hospital-specific, per-resident amounts that are determined by adjusting audited 1984 costs for inflation. Medicare pays a portion of this amount that is equal to the proportion of a hospital's inpatient days that is accounted for by Medicare beneficiaries. Medicare's direct payments for graduate medical education totaled $2.2 billion in fiscal 1997 --47 percent more than in 1990. The reduction in direct payments over five years is slated to total $700 million.

Medicare's indirect medical-education adjustment is based on the number of full-time-equivalent residents who are being trained in the inpatient and outpatient departments of a teaching hospital. Generally, the more residents there are, the greater the payments to a hospital will be. Such payments to teaching hospitals totaled $4.6 billion in 1997 -- 84 percent more than in 1990. Congress sliced $5.6 billion off Medicare's indirect teaching payments over the next five years by changing the formula to make the payments less generous. For the first time, Congress imposed a cap on the number of residents the program will support by its direct and indirect teaching payments. The key factor driving Medicare's educational payments upward was a national increase of 26.4 percent in the number of residents in training between 1989 and 1996 (from 82,789 to 104,609).