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>patent and copyright protection Seems legit. >the financial sector Seems legit. >the pay of CEOs and other top executives Seems legit. >and protectionist

>patent and copyright protection Seems legit. >the financial sector Seems legit. >the pay of CEOs and other top executives Seems legit. >and protectionist measures that have boosted the pay of doctors Wait a second... https://3.bp.blogspot.com/_ZPUIbpPl1ME/SwLM3Q8Nl6I/AAAAAAAAAMc/DuMyKl0Gjtw/s1600/Falling+Physician+Income.png https://3.bp.blogspot.com/_ZPUIbpPl1ME/SwLM3Q8Nl6I/AAAAAAAAA... I looked in the paper and he doesn't seem to address this, he just complains that doctors earn more than in other rich countries. He also doesn't mention that doctors in the US have to pay enormous malpractice insurance premiums when comparing them. So who is Dean Baker and why does he hate doctors?

debacle 11y ago
It isn't unfair in any way to point to the American healthcare system as a massive protectionist racket. Doctors, insurance companies, pharma companies, and hospitals are all hard at work ensuring their profits at the expense of patients and the American tax payer. The AMA is a highly self-interested organization.
- crdoconnor 11y ago
  >The AMA is a highly self-interested organization. The decline and extinction of self interested organisations that represent labor is pretty much the only reason why all wealth as accumulated with the 0.01%. AMA is, like most other unions, apparently not doing a very good job of keeping doctors' incomes up. That apparently doesn't stop self interested economists going on an academia-themed anti-union rant.
  - vezzy-fnord 11y ago
    That apparently doesn't stop self interested economists going on an academia-themed anti-union rant. Your promotion of this odd conspiracy about bourgeoisie capitalist economists being bought out by think tanks and promoting anti-labor, pro-capitalist propaganda is just completely baffling to me. You did the same in a previous thread about minimum wages and here again you insinuated in a different post about how Dean Baker's motivation for this paper (being an ACA supporter) must be conspiring to drive down wages of the medical profession to make ACA cheaper. I just don't know how one can respond to you.
    - crdoconnor 11y ago
      >Your promotion of this odd conspiracy about bourgeoisie capitalist economists being bought out by think tanks This economist literally works for a think tank and his paper is published on that think tank's website. For it to be an actual conspiracy that he is bought out I think it would have to actually be hidden from view somehow. I can only speculate as to his motivations behind attacking doctors in this paper, but there isn't a shadow of a doubt that he is attacking them. You literally can't blame doctors' wages on the rise of income inequality if they've been falling. If the paper actually said that they were rising I could have understood but it doesn't. Dean Baker is just doing a rather pathetic exercise in misdirection by talking about wages in other countries and how doctor's wages haven't necessarily been falling as fast as everybody else's. >I just don't know how one can respond to you. Believe me, the feeling's mutual. Apparently some people are impressed by the thin veneer of academic pseudo-legitimacy that comes from putting a couple of equations in a PDF and turn off the critical thinking section in their skulls.
      - vezzy-fnord 11y ago
        "Falling" is of little analytical meaning without a relative benchmark. You weren't displaying critical thought, you were engaging in a trite dismissal and then extrapolating an outlandish motive.
        crdoconnor 11y ago
        >You weren't displaying critical thought, you were engaging in a trite dismissal I read the paper and researched its claims before attacking it. Did you do that before accusing me of trite dismissal?
- mirimir 11y ago
  All economic players are in theory subject to antitrust law. Anticompetitive behavior is in theory illegal. Union supporters negotiated an exception back in the day. So did the AMA, in part because it pretends to be a professional society. But in fact, the AMA has engaged in profoundly anticompetitive behavior from the start. For example, it regulates the physician supply by influencing policies of medical schools. It was modern pharmaceuticals that professionalized doctors and hospitals. Previously, symptomatic mitigation and surgery were about the only options. Doctors were not high-status professionals, barely above blacksmiths. National healthcare was the sane response to this clusterfuck. But not in the US, because that would be socialism. So it goes.
  - chimeracoder 11y ago
    > For example, the AMA regulates the physician supply by influencing policies of medical schools. This is a common misconception that keeps popping up again and again. Reposting a comment from just four days ago: The AMA is a common scapegoat, except that the AMA has literally nothing to do with the number of of doctors supply-side. You're probably thinking of the AAMC, which has nothing to do with the AMA, and is responsible for the number of medical students who graduate each year from the US. Except the AAMC has very deliberately and openly increased the number of medical student slots each year for over a decade, specifically with this goal in mind. But even this is a moot point, because the number of people gradating with MDs is not the bottleneck - the problem is that doctors can't practice medicine until they complete a residency program. We graduate more medical students every year than we have residency slots available, so increasing the number of graduates even further will have no effect. Increasing the number of residency slots is up to Medicare, because Medicare funds residency programs nationwide, as residency programs do not make enough money to sustain themselves otherwise.
    - mirimir 11y ago
      Maybe that's so now. But my comment addressed policy over several decades. And the AMA definitely played a role. Virtually all medical school faculty and administration are AMA members. It hasn't necessarily been a formal process, just an old-boys (literally, for decades) network.
- busterarm 11y ago
  It used to be that you didn't need any specialized degrees to make medical prosthetics, just training and a place willing to employ you, until there was suddenly a flood of interest into a well paying field. Then it rapidly self-organized and now basically requires a Masters to have employment consideration. And yes, the underlying technologies and skills required have gotten _a lot_ more advanced recently, but this all started happening before that.
nickbauman 11y ago
Yeah, that last part is bunkum. You don't even have to go to malpractice. A bus driver in Sweden makes 1500 times what a bus driver in India makes. Yet a bus driver in Sweden is not even getting into the top quartile of earners in Sweden, let alone the 1%.
- at-fates-hands 11y ago
  You also have to take into account the cost of living, which is much lower in India: http://www.numbeo.com/cost-of-living/compare_countries_result.jsp?country1=Sweden&country2=India http://www.numbeo.com/cost-of-living/compare_countries_resul... Consumer Prices in India are 67.81% lower than in Sweden Consumer Prices Including Rent in India are 69.48% lower than in Sweden Rent Prices in India are 74.83% lower than in Sweden Restaurant Prices in India are 80.16% lower than in Sweden Groceries Prices in India are 63.10% lower than in Sweden Local Purchasing Power in India is 31.34% lower than in Sweden
  - Terribledactyl 11y ago
    Ok, so a bus driver in Sweden can buy 1500*(1-.8)=300 times more take out meals than one in India.
astazangasta 11y ago
Doctors in the US earn twice as much as the OECD average. Dean Baker talks a lot about how during the era of 'globalization' manufacturing workers were pitted against low-wage third world workers while doctors were shielded from similar competition by professional organizations and barriers to entry by immigration law. Basically, doctors in the US have lots of ways to control the supply of doctors, so their wages are unsurprisingly elevated above the international norm.
- busterarm 11y ago
  And, given the treatment of medical students who graduate outside the continental US, this is still in effect today. Even Americans have a hard road ahead when their only med school options lead them to the Caribbean. Even if they went to Ross.
- jessriedel 11y ago
  I don't have much insight with regard to protectionism, but it's worth pointing out that physician income is low (~8%) as a fraction of the (high) US healthcare spending, compared to other Western countries. http://www.healthcarefinancenews.com/news/physician-compensation-among-lowest-western-nations http://www.healthcarefinancenews.com/news/physician-compensa... Given the large fraction of physician income that goes toward medical malpractice in the US, as well as the higher overall wages in the US, the differential that protectionism needs to explain is nothing like the factor of 2 you suggest.
- zanny 11y ago
  My uncle is an MD in Georgia and had to close his private practice four years ago that he had for twenty because malpractice insurance, the racketing of drug companies, and medicare / medicaid not paying out in timely or reasonable manners left him with negative balance books many months, and the bureaucracy meant he needed two employees just to cover the mountains of paperwork. He estimated that for a simple referral or prescription he needed to produce at least 15 different forms or records and provide them to the insurer / medicare / pharmacy / etc, duplicate them in triplicate, back them up in filing cabinets that took up a quarter of his office, etc. Yes, his business was making probably 600k in revenue a year. And sometimes upwards of 550k of that would end up going to expenses - salaries, rent, certifications, licenses, bureaucratic bullshit, and a half dozen different kinds of insurance. He is now working for a hospital as part of basically a medical monopoly ring in the state being paid much less than the OECD average but that isn't pleasant to hear that the inflated salaries vary greatly depending on location. Hes 60 now. He paid off his student loan debt only five years ago, after working in a hospital for 5 and then his private practice for 20 years after graduating his MD. It is insane, and hilarious, how people are misdirecting the obvious highway robbery of insurance companies, hospital executives, and investors in the industry on the backs of the doctors who are dedicating their lives to medicine.
carbocation 11y ago
Physician income is not currently the most important part of US healthcare expenditures. In fact, administrators and administrative costs lead to more expenditure, and do not directly contribute to patient care. So, I have to agree that cutting physician income is not going to fix the problem. In fact, physician income could be set to 0 and it would only reduce healthcare expenditures by ~15%, last I looked.
- jessriedel 11y ago
  Physicians income is only 8.6% of healthcare costs. Maybe 15% includes nurses? http://www.jacksonhealthcare.com/media-room/news/md-salaries-as-percent-of-costs/ http://www.jacksonhealthcare.com/media-room/news/md-salaries...
  - carbocation 11y ago
    Yes, I might have lumped direct care providers together (MDs, PAs, NPs, RNs, MAs, etc), or perhaps I just misremembered. Thanks for the link.
nostromo 11y ago
What's the source for that chart? And why is it so old? The Washington Post paints a very different picture regarding pay for doctors: https://www.washingtonpost.com/business/salary-gaps-and-doctor-shortages-growing/2012/02/10/gIQAPkZM4Q_graphic.html https://www.washingtonpost.com/business/salary-gaps-and-doct...
- crdoconnor 11y ago
  The Washington Post graph isn't adjusting for inflation and it's cherry picking specific specialities that have experienced pay growth.
gozur88 11y ago
Enormous malpractice insurance and also most other rich countries subsidize the training of doctors. In the US by the time you hang out your shingle, unless you've gotten someone else to pay for your schooling (scholarships, say, or the military), you're a quarter million dollars in debt.
- chimeracoder 11y ago
  > and also most other rich countries subsidize the training of doctors. The US actually does subsidize the training of doctors, to the tune of tens of billions of dollars per year through Medicare alone. That said, most people don't realize how heavy of a debt load doctors carry. Doctors reported incomes are much larger than their actual take-home pay due to things like malpractice insurance, which means that in the end, it's not unusual for a doctor these days to plan to make their last payment on these loans in their forties. Put another way: most doctors are literally past what is thought of as childbearing age by the time their "investment" has broken even, and that's not even counting things like a mortgage, etc. that many people would want to have when starting a family.
  - carbocation 11y ago
    > it's not unusual for a doctor these days to plan to make their last payment on these loans in their forties To underscore this, take someone who goes straight through: finish undergrad at 22, med school at 26, internal medicine at 29, cardiology at 33. Again, no gap year, no research, certainly no PhD. At age 33, this person will have enough income to start making meaningful payments toward their debt, rather than just paying subsidized interest. It would be near-heroic to pay this off before 40 unless they were in private practice in the Midwest. And this is the best possible case: shortest training time, lucrative specialty, private practice.
    - gozur88 11y ago
      Right. If you don't consider the training period you have a ridiculously rosy picture of the economics for a doctor. And as you say, this is the best case. Few doctors make anything like what cardiologists make. In addition to all the debt you rack up, finishing your schooling in your 30s represents a huge opportunity cost - in the US a software developer with a BS has grossed something like a million dollars by then.
dogma1138 11y ago
Malpractice insurance cant be the main cause as doctors not working in private practice usually have insurance provided to them by the hospital/HMO. The biggest problem that I can think off is med school tuition costs. The cheapest med school in the US costs over 30,000 per year, the median yearly tuition cost for US medical students is around 50,000 USD. So that's 2-3 years of pre-med and 5 years of med school which can cost upwards of half a million dollars in the US. When most doctors start their career with nearly 300,000 dollars in debt which they pay interest on you going to be damn sure they'll require a hefty sum to pay it back. To put that in perspective if the doctor can pay out 25,000 per year on their student loans it would take them about 15 years to pay out their debt. To put that in perspective 25,000$ is the average yearly salary in Spain.

debacle 11y ago

It isn't unfair in any way to point to the American healthcare system as a massive protectionist racket. Doctors, insurance companies, pharma companies, and hospitals are all hard at work ensuring their profits at the expense of patients and the American tax payer. The AMA is a highly self-interested organization.

crdoconnor 11y ago
>The AMA is a highly self-interested organization. The decline and extinction of self interested organisations that represent labor is pretty much the only reason why all wealth as accumulated with the 0.01%. AMA is, like most other unions, apparently not doing a very good job of keeping doctors' incomes up. That apparently doesn't stop self interested economists going on an academia-themed anti-union rant.
- vezzy-fnord 11y ago
  That apparently doesn't stop self interested economists going on an academia-themed anti-union rant. Your promotion of this odd conspiracy about bourgeoisie capitalist economists being bought out by think tanks and promoting anti-labor, pro-capitalist propaganda is just completely baffling to me. You did the same in a previous thread about minimum wages and here again you insinuated in a different post about how Dean Baker's motivation for this paper (being an ACA supporter) must be conspiring to drive down wages of the medical profession to make ACA cheaper. I just don't know how one can respond to you.
  - crdoconnor 11y ago
    >Your promotion of this odd conspiracy about bourgeoisie capitalist economists being bought out by think tanks This economist literally works for a think tank and his paper is published on that think tank's website. For it to be an actual conspiracy that he is bought out I think it would have to actually be hidden from view somehow. I can only speculate as to his motivations behind attacking doctors in this paper, but there isn't a shadow of a doubt that he is attacking them. You literally can't blame doctors' wages on the rise of income inequality if they've been falling. If the paper actually said that they were rising I could have understood but it doesn't. Dean Baker is just doing a rather pathetic exercise in misdirection by talking about wages in other countries and how doctor's wages haven't necessarily been falling as fast as everybody else's. >I just don't know how one can respond to you. Believe me, the feeling's mutual. Apparently some people are impressed by the thin veneer of academic pseudo-legitimacy that comes from putting a couple of equations in a PDF and turn off the critical thinking section in their skulls.
    - vezzy-fnord 11y ago
      "Falling" is of little analytical meaning without a relative benchmark. You weren't displaying critical thought, you were engaging in a trite dismissal and then extrapolating an outlandish motive.
      - crdoconnor 11y ago
        >You weren't displaying critical thought, you were engaging in a trite dismissal I read the paper and researched its claims before attacking it. Did you do that before accusing me of trite dismissal?
mirimir 11y ago
All economic players are in theory subject to antitrust law. Anticompetitive behavior is in theory illegal. Union supporters negotiated an exception back in the day. So did the AMA, in part because it pretends to be a professional society. But in fact, the AMA has engaged in profoundly anticompetitive behavior from the start. For example, it regulates the physician supply by influencing policies of medical schools. It was modern pharmaceuticals that professionalized doctors and hospitals. Previously, symptomatic mitigation and surgery were about the only options. Doctors were not high-status professionals, barely above blacksmiths. National healthcare was the sane response to this clusterfuck. But not in the US, because that would be socialism. So it goes.
- chimeracoder 11y ago
  > For example, the AMA regulates the physician supply by influencing policies of medical schools. This is a common misconception that keeps popping up again and again. Reposting a comment from just four days ago: The AMA is a common scapegoat, except that the AMA has literally nothing to do with the number of of doctors supply-side. You're probably thinking of the AAMC, which has nothing to do with the AMA, and is responsible for the number of medical students who graduate each year from the US. Except the AAMC has very deliberately and openly increased the number of medical student slots each year for over a decade, specifically with this goal in mind. But even this is a moot point, because the number of people gradating with MDs is not the bottleneck - the problem is that doctors can't practice medicine until they complete a residency program. We graduate more medical students every year than we have residency slots available, so increasing the number of graduates even further will have no effect. Increasing the number of residency slots is up to Medicare, because Medicare funds residency programs nationwide, as residency programs do not make enough money to sustain themselves otherwise.
  - mirimir 11y ago
    Maybe that's so now. But my comment addressed policy over several decades. And the AMA definitely played a role. Virtually all medical school faculty and administration are AMA members. It hasn't necessarily been a formal process, just an old-boys (literally, for decades) network.
busterarm 11y ago
It used to be that you didn't need any specialized degrees to make medical prosthetics, just training and a place willing to employ you, until there was suddenly a flood of interest into a well paying field. Then it rapidly self-organized and now basically requires a Masters to have employment consideration. And yes, the underlying technologies and skills required have gotten _a lot_ more advanced recently, but this all started happening before that.

nickbauman 11y ago

Yeah, that last part is bunkum. You don't even have to go to malpractice. A bus driver in Sweden makes 1500 times what a bus driver in India makes. Yet a bus driver in Sweden is not even getting into the top quartile of earners in Sweden, let alone the 1%.

at-fates-hands 11y ago
You also have to take into account the cost of living, which is much lower in India: http://www.numbeo.com/cost-of-living/compare_countries_result.jsp?country1=Sweden&country2=India http://www.numbeo.com/cost-of-living/compare_countries_resul... Consumer Prices in India are 67.81% lower than in Sweden Consumer Prices Including Rent in India are 69.48% lower than in Sweden Rent Prices in India are 74.83% lower than in Sweden Restaurant Prices in India are 80.16% lower than in Sweden Groceries Prices in India are 63.10% lower than in Sweden Local Purchasing Power in India is 31.34% lower than in Sweden
- Terribledactyl 11y ago
  Ok, so a bus driver in Sweden can buy 1500*(1-.8)=300 times more take out meals than one in India.

astazangasta 11y ago

Doctors in the US earn twice as much as the OECD average. Dean Baker talks a lot about how during the era of 'globalization' manufacturing workers were pitted against low-wage third world workers while doctors were shielded from similar competition by professional organizations and barriers to entry by immigration law. Basically, doctors in the US have lots of ways to control the supply of doctors, so their wages are unsurprisingly elevated above the international norm.

busterarm 11y ago
And, given the treatment of medical students who graduate outside the continental US, this is still in effect today. Even Americans have a hard road ahead when their only med school options lead them to the Caribbean. Even if they went to Ross.
jessriedel 11y ago
I don't have much insight with regard to protectionism, but it's worth pointing out that physician income is low (~8%) as a fraction of the (high) US healthcare spending, compared to other Western countries. http://www.healthcarefinancenews.com/news/physician-compensation-among-lowest-western-nations http://www.healthcarefinancenews.com/news/physician-compensa... Given the large fraction of physician income that goes toward medical malpractice in the US, as well as the higher overall wages in the US, the differential that protectionism needs to explain is nothing like the factor of 2 you suggest.
zanny 11y ago
My uncle is an MD in Georgia and had to close his private practice four years ago that he had for twenty because malpractice insurance, the racketing of drug companies, and medicare / medicaid not paying out in timely or reasonable manners left him with negative balance books many months, and the bureaucracy meant he needed two employees just to cover the mountains of paperwork. He estimated that for a simple referral or prescription he needed to produce at least 15 different forms or records and provide them to the insurer / medicare / pharmacy / etc, duplicate them in triplicate, back them up in filing cabinets that took up a quarter of his office, etc. Yes, his business was making probably 600k in revenue a year. And sometimes upwards of 550k of that would end up going to expenses - salaries, rent, certifications, licenses, bureaucratic bullshit, and a half dozen different kinds of insurance. He is now working for a hospital as part of basically a medical monopoly ring in the state being paid much less than the OECD average but that isn't pleasant to hear that the inflated salaries vary greatly depending on location. Hes 60 now. He paid off his student loan debt only five years ago, after working in a hospital for 5 and then his private practice for 20 years after graduating his MD. It is insane, and hilarious, how people are misdirecting the obvious highway robbery of insurance companies, hospital executives, and investors in the industry on the backs of the doctors who are dedicating their lives to medicine.

carbocation 11y ago

Physician income is not currently the most important part of US healthcare expenditures. In fact, administrators and administrative costs lead to more expenditure, and do not directly contribute to patient care. So, I have to agree that cutting physician income is not going to fix the problem. In fact, physician income could be set to 0 and it would only reduce healthcare expenditures by ~15%, last I looked.

jessriedel 11y ago
Physicians income is only 8.6% of healthcare costs. Maybe 15% includes nurses? http://www.jacksonhealthcare.com/media-room/news/md-salaries-as-percent-of-costs/ http://www.jacksonhealthcare.com/media-room/news/md-salaries...
- carbocation 11y ago
  Yes, I might have lumped direct care providers together (MDs, PAs, NPs, RNs, MAs, etc), or perhaps I just misremembered. Thanks for the link.

nostromo 11y ago

What's the source for that chart? And why is it so old? The Washington Post paints a very different picture regarding pay for doctors: https://www.washingtonpost.com/business/salary-gaps-and-doctor-shortages-growing/2012/02/10/gIQAPkZM4Q_graphic.html https://www.washingtonpost.com/business/salary-gaps-and-doct...

crdoconnor 11y ago
The Washington Post graph isn't adjusting for inflation and it's cherry picking specific specialities that have experienced pay growth.

gozur88 11y ago

Enormous malpractice insurance and also most other rich countries subsidize the training of doctors. In the US by the time you hang out your shingle, unless you've gotten someone else to pay for your schooling (scholarships, say, or the military), you're a quarter million dollars in debt.

chimeracoder 11y ago
> and also most other rich countries subsidize the training of doctors. The US actually does subsidize the training of doctors, to the tune of tens of billions of dollars per year through Medicare alone. That said, most people don't realize how heavy of a debt load doctors carry. Doctors reported incomes are much larger than their actual take-home pay due to things like malpractice insurance, which means that in the end, it's not unusual for a doctor these days to plan to make their last payment on these loans in their forties. Put another way: most doctors are literally past what is thought of as childbearing age by the time their "investment" has broken even, and that's not even counting things like a mortgage, etc. that many people would want to have when starting a family.
- carbocation 11y ago
  > it's not unusual for a doctor these days to plan to make their last payment on these loans in their forties To underscore this, take someone who goes straight through: finish undergrad at 22, med school at 26, internal medicine at 29, cardiology at 33. Again, no gap year, no research, certainly no PhD. At age 33, this person will have enough income to start making meaningful payments toward their debt, rather than just paying subsidized interest. It would be near-heroic to pay this off before 40 unless they were in private practice in the Midwest. And this is the best possible case: shortest training time, lucrative specialty, private practice.
  - gozur88 11y ago
    Right. If you don't consider the training period you have a ridiculously rosy picture of the economics for a doctor. And as you say, this is the best case. Few doctors make anything like what cardiologists make. In addition to all the debt you rack up, finishing your schooling in your 30s represents a huge opportunity cost - in the US a software developer with a BS has grossed something like a million dollars by then.

dogma1138 11y ago

Malpractice insurance cant be the main cause as doctors not working in private practice usually have insurance provided to them by the hospital/HMO. The biggest problem that I can think off is med school tuition costs. The cheapest med school in the US costs over 30,000 per year, the median yearly tuition cost for US medical students is around 50,000 USD. So that's 2-3 years of pre-med and 5 years of med school which can cost upwards of half a million dollars in the US. When most doctors start their career with nearly 300,000 dollars in debt which they pay interest on you going to be damn sure they'll require a hefty sum to pay it back. To put that in perspective if the doctor can pay out 25,000 per year on their student loans it would take them about 15 years to pay out their debt. To put that in perspective 25,000$ is the average yearly salary in Spain.