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For the most part I found this very long Time article by Steven Brill about the problems with American health care cost to be interesting. It did correctly highlight that the biggest problem is that Americans are overcharged for almost everything related to medicine, but I was thrown off by his bizarre insistence this doesn’t include doctors. After making a pretty strong case for Medicare-for-all Brill argues that it won’t work because that would somehow turn all doctors into paupers.
In fact, those numbers would seem to argue for lowering the Medicare age, not raising it — and not just from Janice S.’s standpoint but also from the taxpayers’ side of the equation. That’s not a liberal argument for protecting entitlements while the deficit balloons. It’s just a matter of hardheaded arithmetic. [...]
If that logic applies to 64-year-olds, then it would seem to apply even more readily to healthier 40-year-olds or 18-year-olds. This is the single-payer approach favored by liberals and used by most developed countries.
Then again, however much hospitals might survive or struggle under that scenario, no doctor could hope for anything approaching the income he or she deserves (and that will make future doctors want to practice) if 100% of their patients yielded anything close to the low rates Medicare pays.
(emphasis mine)
This is simply an absurd statement. American doctors are among the best paid, if not the best paid doctors, in the entire world. An American primary care doctor will make about 40 percent more than a German doctor. Most first world country pays their doctors noticeably less, yet these countries still have plenty of doctors and people who want to be doctors.
While it is impossible to address the completely subjective claim that American doctors should simply “deserve” to be paid so much more than their international peers, there is zero reason to believe Medicare-for-all would stop people from wanting to become doctors or prevent them from making a very good salary. A surgeon that saw only Medicare patients would still make hundreds of thousands a year.
Brill even earlier acknowledged that some Central Florida hospitals thrive by almost exclusively serving Medicare patients. It stands to reason that to attract doctors these hospital are paying competitive salaries
Being a doctor is a very socially desirable job, and in other countries with a single payer system it is still one of the highest paid jobs there are. While Medicare pays slightly less than private insurance in the United States for many procedures, it still tends to pay more than private or public insurance in other countries and all those countries have plenty of doctors and would-be doctors.
The idea that Medicare-for-all would turn being a doctor into an undesirable impoverished profession is pure fantasy.
Photo by Kathy McGraw under Creative Commons license
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Bullshit propoganda, of course. But thanks for the update. It’s really pretty silly esp bc USA Docs earn way more than anywhere else. True that they often have big debts to pay coming out of Med school, but still… to say that they’ll “suffer” if they have Medicare patients is a bald-faced lie. But any lie’ll do if you want to appeal to those in the upper 99%, in this case.
The cost of medical care in the U.S. is only marginally affected by physicians’ incomes and even their exorbitant malpractice premiums. It’s the 30% rake off for profits for executives and shareholders in insurance and pharma.
Medicare pays a LOT LESS than private persons. In fact it would have never gotten off the ground had the profession not cooperated.
That said, my guess is most physicians would be happy with a decent guaranteed salary and benefits like any other middle class worker business person. Many as I do favor single payer government insurance. At one time it was 80% give or take. Polls vary widely.
Attacking the profession is attacking the best friends the suffering have and is frankly suicidal.
But you have to consider two separate things – one, this nation allows its doctors to have to shoulder huge student loans. In Australia, anyone becoming a doctor has their entire college and grad level education paid for by the state. Other nations provide similar arrangements.
Two: after you get your license and are practicing as an MD, you have humongous malpractice insurance premiums to pay for. And of course, for citizens in the other nations that have Single Payer Universal HC, the state-offered health insurance and decent Social System is the back up to assist anyone injured by a doctor’s screw ups. So the citizens there don’t go to court and ask for such huge settlements when a doctor makes a mistake.
The reason I myself and any other American will sue the surgeon for bumbling an operation and knicking my spinal column is not just because I am money hungry and that I don’t care to be in a wheelchair – it is because I will need lifetime help for my condition, and will not be able to afford my health insurance once my “previous condition” status involves my being an invalid. (Obama’s ACA forces the Big Insurers to take on any and everyone, but that doesn’t mean the Big Insurers don’t charge a pretty penny for including a person who has serious medical needs.)
You forget however that a German doctor would emerge from college debt-free, and immediately buy a large German car before constructing a fairly ostentatious house (I actually know a few – youngish ones – and they actually do that). The problem is that pretty much everything in the United States is a rip-off. Education is obviously one of the very biggest rackets out there. I think the malpractice insurance argument for doctor’s costs is a red-herring. The German doctors can also be found liable and need it too.
Although, there is a another thing – insurance, of any description. Compare the coverage offered on a US car policy to that offered on a German one for instance. The liability limits are different by an order of magnitude. I’m covered up to 10 million euros (yes that’s right) over here. And the insurance policy costs me about $600 a year. I could go on and on and on about this. The list is endless. The US public are fleeced every waking and every sleeping moment, no matter what they do. Your lives are just one gigantic shake-down.
CNN just ran a segment on this article. They highlighted this guy who got bills totalling 474,000 and they showed some of the costs, like $39 for every blood glucose test, and there were hundreds of them, and $12 for the little cup that pills are brought to you in. They also noted that the bill for this guy was a small fraction of what medicare pays. Insurance companies also negotiate with hospitals but this guy had a cut rate policy. Goes to show you. Get old fast, and get on medicare or don’t get sick.
The individual burden of a medical education is eclipsed by the public support for both undergraduate and medical schools. The argument that becoming an MD is just so expensive is pure BS. The public bares a far greater share of the financial burden than the individual, without the individual’s direct benefits.
And perhaps if the medical community would police themselves, and sanction or remove incompetent practitioners, the malpractice issue would be less of a concern.
Most countries have substantial financial support for medical education. And US medicial schools deliberately do not expand so as to keep physician salaries high. It’s a guild. With all the problems of medieval guilds.
The AMA politicized the health care debate when Harry Truman wanted to create a national health service and it has been hollering “commie, commie” every time the government seeks to do something about health care. It is no coincidence that the physicians in Congress are Tea Party Republicans, specialists, eaten up with a sense of privilege. Broun, Coburn, Barrasso…
And single-payer health care bill in the US must include arrangements for dealing with mistakes, punishing incompetent professionals, subsidizing medical education and breaking up the cartels among providers, medical supply companies, and medical device companies.
I saw recently that some doctor practices are charging flat annual fees for access. Any info on how that is working?
It is hard to believe doctors will not be paid enough under single payer. If education costs are a problem, we can fix that one pretty easily. It’s only money after all.
If we are serious about controlling health care costs, then we need to get single payer health care. Insurance companies perpetuate the rip off and their cost structure is way over the top with profit, income taxes et. al.
And I agree we need to break up the cartels. Health care should be a public utility. We all need it, sooner or later.
Yea, it’s so oppressive for Dr’s in countries with Single Payer /s
http://www.youtube.com/watch?v=GOZmvaFfjtk
glad to hear that the doctors who treat me to all sorts of unnecessary and harmful procedures or don’t take responsibility for my care when I’m sick are making their nut.
Dentists head my list, but others are close behind
Rather than admitting minimum wage and low-payed 12-1B visa holders to serve corporate America, we could open the doors to medical professionals, and lower doctor’s salaries.
Of course, that won’t happen. While our politiians are perfectly happy to have competition for low wage and middle income jobs, they tend to protect the higher income professions.
Let’s open the doors wider for other professional and semi-professionals and workers.
Don’t forget there are tons of workers in other countries willing to work for 10 cents and hour also.
Dentists are not physicians.
They sure think they are
Doctors make most of their money on their investments in Phrma, medical equipment and diagnostics, and other private services which they use and promote heavily, and which are charged at ridiculous margins to reap gigantic profits for those companies.
THAT’S where the exorbitant cost of medical care comes from, not from doctors’ salaries or other direct compensation.
Yep .unregulated monopoly. The best rip-off ever invented.
Yup (and yup to Elise, who brought up the same point). It’s not at all uncommon for doctors to come out of medical school with $250,000 in debt, and you can add at least $50,000 to that if the doctor is specializing (as most nowadays do) in a particular branch of medicine — something considered necessary at specialists make more money than do GPs.
That’s why the Students Not Banks action of FDL’s, which resulted in Obama engaging in actual student loan reform, may have helped create the most beneficially significant single move so far of his administration.
In Greece, whose health care system I experienced directly after a motorcycle crash, doctors receive a good upper-middle-class stipend. Any doctor who gets caught taking further money from patients is no longer a doctor. And that is how they attract to the medical profession people who want to practice medicine and healing—-rather than people who want to be golf pro’s and sailboat captains. I cannot tell you the number of American doctors whom I’ve seen doing virtually ZERO for their patients while collecting those visit checks (and setting up the next ones) like a greed machine. I’d rather suffer all my “ailments of age” as they are than see a doctor or go to a hospital—come what may. I’ve seen too many people literally destroyed by American “health care.”
Heh, Stephen Brill is saying all American doctors are in it for the money.
It may be a myth, but I heard of an old Chinese practice, where everyone in the village pays the village doctor a stipend – until that person gets sick. Then the payments stop until health returns. This encourages the doctor to be proactive – a public health watchdog. Cool, yes?
I believe you – the ‘tell’ for pharma and insurace companies was, during the health care debate of 2009, when caps on prices was suggested, and everyone jacked their prices up immediately – proving they are in it for the money, not the milk of human kindness.