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Doctors are already paid absurd salaries in the US and the barriers to entry already high. As much as we all hate dealing with insurance companies, when I lost
by c3534l 11y ago
Doctors are already paid absurd salaries in the US and the barriers to entry already high. As much as we all hate dealing with insurance companies, when I lost my insurance and had to pay for things out of pocket, the difference between what they charged me and what they would have charged an insurance company was obscene. Insurance companies actually do a pretty good job of reducing the costs of medical care, although some of the same power and information asymmetries still exist (that is, I'm saying that doesn't necessarily make the insurance companies the good guys). But the consumer has no bargaining power on his own and he doesn't know enough to challenge or negotiate. And the entire regulatory structure puts all the power in the hands of the doctor, not the patient. I don't see this as being a good trend for consumers. I find this to be very worrying.
Edit: since this my "absurd salaries" remark seems like it might be the most controversial bit, I was thinking of I was referring more to information like this: http://www.motherjones.com/files/blog_physician_compensation_0.jpg http://www.motherjones.com/files/blog_physician_compensation...
That's because it sidesteps many issues like how hard it is to become a doctor by simply comparing the pay of American doctors to the pay of doctors in countries with national healthcare. By "absurd salaries" what I really should have said was that American doctors are paid significantly more than other countries.
Of course everyone, no matter what their job, thinks they work too hard for too little pay.
- pragone 11y ago> Doctors are already paid absurd salaries in the US To put it in context, when I finish all my training, I will owe over $600,000. It's not the doctors being "paid absurd salaries" that makes medical care in this country expensive. It's lawyers - malpractice insurance can take upwards of 25+% of your income - and it's insurance companies, who have shareholders they are responsible to, and it's hospital administration, whose positions keep multiplying.
- Dr_tldr 11y agoAnd yet, when Texas put a cap on medical malpractice awards, the cost of medical care didn't go down at all. Surely you have a good explanation for that and you're not just repeating discredited talking points for personal gain.
- c3534l 11y agoWhoa, calm down now. No need to resort to an ad hominem and speculate on someone's personal motivations.
- ubernostrum 11y agoI don't really see it as pure ad hominem; it's a demonstrable fact that malpractice insurance rates are not tied to malpractice award amounts, and that capping malpractice awards does not rein in the absurd ballooning of malpractice rates.
- hardcandy 11y agoMalpractice insurance rates are not tied to malpractice award amounts? Unless rates were fixed by law and financially guaranteed by the Government, how on earth would that even be possible. Are you just a troll?
- ubernostrum 11y agoMalpractice awards tend to grow at a rate slightly higher than inflation. Malpractice insurance premiums, however, grow at a far higher -- sometimes double-digit -- rate, and do so even when malpractice judgments are capped by law. If the premiums were simply rising because of the amount of money given in a malpractice judgment, we would not see that. Therefore, malpractice premiums are not -- in any meaningful sense -- tied to malpractice award amounts. Typically, the gigantic spikes in premiums seen over the past couple of decades are attributed to other factors in the insurance industry, including the need to make up for investment losses and for losses from other sectors of insurance (i.e., market crashes + 9/11 were not kind to insurers).
- hardcandy 11y agoDo you realize that many hospitals and surgical specialties self-insure themselves? e.g. large groups of orthopods and neurosurgeons will get together and form a co-op with a few attorneys and operate as a self-insurance vehicle, because they are able to gauge risks better than others. Premiums and judgments are way more connected than you are implying.
- deleted 11y ago[deleted]
- bradleyjg 11y ago>> Doctors are already paid absurd salaries in the US >To put it in context, when I finish all my training, I will owe over $600,000. > It's not the doctors being "paid absurd salaries" that makes medical care in this country expensive. It's lawyers - malpractice insurance can take upwards of 25+% of your income - and it's insurance companies, who have shareholders they are responsible to, and it's hospital administration, whose positions keep multiplying. It's a red herring. If you compare physician compensation in the UK to the US, the costs of medical education are made up within the first ten years. Yes, even after malpractice insurance. Hospital administrators are also wildly overpaid, but there just aren't as many of them. Physician compensation as compared to foreign doctors, which get the same or better results, is just too large a piece of the pie to brush under the rug by pointing at other problems.
- carbocation 11y agoAs of ~2012, physician compensation was something like 8.5% of healthcare spending in the USA. This means that in the United States, physician compensation is actually a smaller component of healthcare costs than it is in the UK (where it's ~10% of overall cost).
- JamesBarney 11y agoThis is because the U.S spends 2.6 times as much on health care per capita as the united kingdom.
- carbocation 11y agoAnd if you paid physicians $0, the US would still spend about 2.4 times as much on health care per capita as the United Kingdom. In the context of this thread, this is the relevant point.
- knughit 11y agoDo you think lawyers consume malpractice insurance? Juries and lawsuit winners consume malpractice insurance
- kasey_junk 11y agoDo you have a source for that 25% number. Eveeytime I've looked before it was closer to 10% which is still high, but other industries have similar rates.
- neurotech1 11y agoWhich college/medical school cost that much? In either Federally Qualified Health Centers [0], or other federal/military hospitals, the Federal Tort Claim Act [1] basically covers the malpractice insurance. There other programs that allow non-profit medical centers limited coverage under the FTCA. [0] https://en.wikipedia.org/wiki/Federally_Qualified_Health_Center https://en.wikipedia.org/wiki/Federally_Qualified_Health_Cen... [1] https://en.wikipedia.org/wiki/Federal_Tort_Claims_Act https://en.wikipedia.org/wiki/Federal_Tort_Claims_Act
- hardcandy 11y agoWhat do you consider to be ''absurd salaries''? A friend of mine is a hard working (50 hours/week) 35 year old GP in San Francisco and makes about $175k all-in, which is about the same as the average base + cash bonus (excluding options) of all our white collar friends (mostly software developers, but also some in finance and other fields). He left medical school with about $50k in student debt (very low relative to the average) and only started a ''real'' job at 30 (8 years after his peer group, who by then had accumuluated savings of several hundred thousand dollars each). I also know a neurosurgeon who makes significantly more than this but given the sacrifices required to train into and hold that job, I'm not sure any amount of money would be fair compensation. Medicine is unique in that you have to pay providers higher salaries to work in more remote, less desirable locations, which is the opposite of how most professions are structured. But without this, rural populations would have almost no access to specialist care.
- ZanyProgrammer 11y agoHow is 175K not absurd? Only a white collar engineer in SF would say that's a piddly salary. Wake me up when your doctor friend has to commute in from Stockton.
- samfisher83 11y agoI think the Doctor has a little more job security as well. Medical industry has a higher barrier to entry.
- hardcandy 11y agoOut of curiosity then, what would you consider appropriate salaries for GPs, general surgeons, and specialized surgeons like neurosurgeons, orthopods, or ENT? Keeping in mind that medical school costs an extra $250k (whether in debt to sallie mae or paid for by mom and dad), and the post-bac education timelines are 7 years for GPs (4+3), 9 years for surgeons (4+5), and 11 years for neurosurgeons (4+7).
- JamesBarney 11y ago
- Spooky23 11y agoInsurance creates all sorts of weird market abstractions. There's a phony "rack rate" that you pay as an individual. Everyone else negotiates discounts. Medicare is the price floor, and gets the best price. Everyone else is in the middle.
- noja 11y agoSo the US healthcare market doesn't work because... doctors??
- lvs 11y agoIf you think MD salary increases are even a tiny speck of the driving force for cost increases in US healthcare, you know less than nothing about the topic.
- jostmey 11y agoAh, then I must have a negative amount of knowledge about the subject.
- colechristensen 11y ago>the difference between what they charged me and what they would have charged an insurance company was obscene Those numbers you see are entirely imaginary. Insurance companies don't pay them, individuals don't pay them, they're just artificially inflated prices used for negotiation. They give a significant discount to people without insurance. Insurance companies individually negotiate (significant) discounts to this base price. It's inflated to make people think they're getting a better discount.
- trgn 11y agoReading the Hippocratic Oath right now, it's painfully hilarious how far removed that pledge is from the way medicine is practiced right now (taken from wikipedia) "Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient;" "I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug." "I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick." How quaint! That's what a Norman Rockwell painting would sound like if it came to life.
- stephenboyd 11y agoThis article is about how the unionized doctors are more interested in performing their work at high quality for less money, and how that's in conflict with their administrator's incentives to have the doctors get paid bonuses to favor quantity at the expense of quality. The administrators are failing at appealing to these doctors' greed because it is outweighed by their sense of professionalism and satisfaction with their current pay. Also, consider that medical expenses in the US are over 3 times what they are in similar countries, while the chart you've linked to shows doctors in the US being paid about 25% more. That's significantly more, but not enough to be driving the absurd costs. I agree that its unfair for the patients to have no bargaining power.
- chillwaves 11y agoWe can negotiate treatment down without insurance just as effectively (likely more so) with single payer health care.