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I hope this helps to decrease the costs of medical care in the US to some extent as it removes one pressure for doctors to earn extra money charging for things

I hope this helps to decrease the costs of medical care in the US to some extent as it removes one pressure for doctors to earn extra money charging for things that might not need to be needed. edit: Just so I am clear I know that there are lots of other influences on healthcare costs and doctor debt isn't the only pressure they face. Doctors do have some influence on cost (if not large) and if pressure on them is removed in any way some of them may choose to spend that extra time helping their patients money go further. Small early influences can have large effects on a system so I am hoping that this kind of influence might change attitudes enough to have a large longer term change.

umanwizard 8y ago
I hope so too, but I can't see why it would. The market forces would be the same. I have no student debt but I still would take a higher-paying job, all else being equal. Not sure why it would be different for doctors. I'm not an economics expert so please let me know if this is a well-studied question and I'm just talking out of my ass.
- retbull 8y ago
  Sure you might take a higher paying job but you might not take one that goes against your values just for money if you don't need it.
- classichasclass 8y ago
  I think, and would hope, that medical school interviews would help to weed out those who are just in it for the money. Even in highly-paid specialties, you have to want to do the work you do. Were there people in my class who were in it largely for the prestige, etc.? Sure. Those people tended to go into high-profile specialties like plastics. But they were the minority, and I think that schools recognize in general these types of students are bad for the profession.
- vlasev 8y ago
  It's not so much about how much you can make but more about how much you need to make to stay afloat. It's a very different story depending on whether you have $0k in debt or $300k in debt.
- scarface74 8y ago
  Not on that scale. But I know plenty of teachers who chose not to be administrators because they enjoyed what they do. I also know many first level software development managers who “self demoted” to become software developers and took a pay cut. Other developers I know took a pay cut and contracted half the year. You can make those choices if you don’t have outrageous expenses- including student loans.
gk1 8y ago
From my (limited) understanding, the high cost of malpractice insurance that doctors must pay is what drives up the cost of healthcare, more so than their student debt.
- trhway 8y ago
  >high cost of malpractice insurance results from high cost of malpractice. So instead of treating the symptom - insurance, one has to treat the original condition - malpractice. To continue the analogy - the trial lawyers in case of malpractice is just like the immune system. When infection (malpractice) happens you see the heavy effects of immune system acting like high fever, yet it would be a grave mistake to suppress immune system instead of dealing with the original cause - infection (malpractice).
  - Bjartr 8y ago
    Malpractice suits are brought over 3x as often in the US as in Canada, and malpractice insurance can cost more than an order of magnitude more. However, in the US there is a much greater incentive to sue. About 21% of malpractice suits that pay out, pay out over $1,000,000. Something that elsewhere would merely net you enough to handle the medical fallout, in the US nets you a lottery jackpot. Because the money on the line is so high it incentives both layers and plaintiffs to aggressively maximize the payout. Like so many other aspects of the US health system, other countries do it better. * All claims were the results of a few minutes of research on Google, I would be interested in learning of evidence that contradicts my claims.
  - scarface74 8y ago
    Sometimes things happen. There are commercials on TV all of the time where lawyers are soliciting people to sue doctors for birth defects like cerebral palsy. I’m glad that my parents spent my childhood focused on therapy, motivation, etc to help me deal with cerebral palsy than placing the blame on the doctor. Yeah my case is relatively minor in the grand scheme of things.
- karmajunkie 8y ago
  This has been conclusive disproven by comparing what happened in different states that enacted tort reform for medical malpractice. The cost of insurance dropped a bit, but there has been no effect the cost of healthcare provisioning.
chimeracoder 8y ago
> I hope this helps to decrease the costs of medical care in the US to some extent as it removes one pressure for doctors to earn extra money charging for things that might not need to be needed. Physician earnings account for about 7% of total spending on healthcare. Of that 7%, the fraction due to student debt specifically is significant from the physician's perspective, but negligible from a systemic picture. This is, of course, assuming that physicians are charging for services that are not be needed in order to boost their earnings, which happens in some cases, but is not as systemic or widespread as people often think, due to the shift away from fee-for-service payment models and towards capitated care, and the opacity of the payment model to the physician at the point-of-care in many care delivery situations.
- Eridrus 8y ago
  I'm really interested in this info, can you tell me where you got the 7% from? Are there good in depth breakdowns of this?
  - chimeracoder 8y ago
    It's a fairly easy statistic to find; here's the first hit on Google: https://www.medicalbag.com/finance/examining-physician-salaries-in-the-united-states/article/710038/ https://www.medicalbag.com/finance/examining-physician-salar... One caveat is that oftentimes you'll see higher numbers (in the range of 15-20%) cited, but that's usually because they're not distinguishing between doctors (MDs) and other clinical staff (nurses, physicians' assistants, etc.). In the aggregate, the latter account for about half, or in other words, roughly equal to what doctors in total pull in. As that article notes, this also doesn't mean that all of that money goes to the physicians themselves. Some portion is taken by the practices and groups that employ them, and a huge chunk of physicians' take-home pay is allocated towards business expenses[0]. For the context of the original article, only MDs are relevant, not what NPs, RNs, and so forth make. [0] Unlike software developers, who generally have their business expenses covered by their employer, physicians are typically expected to cover all of theirs out-of-pocket, which means that the seemingly-high salaries that you often see listed aren't directly comparable to salaries in many other fields, where the out-of-pocket expense are much lower.
blang 8y ago
Changing how compensation is structured, would probably be the most effective way to discourage things that might not be needed.
acomar 8y ago
Doctor's pay is not the driving factor behind increasing medical bills... administrative expenses at providers in insurance, opaque and arcane cost structures negotiated as deals between providers and insurance companies, and record profits at both insurance companies and providers point to a system that's cannibalizing itself. This will do nothing to costs even if implemented universally as it does nothing to address the actual causes of rising medical expenses.
- karmajunkie 8y ago
  There's no single bogeyman behind rising medical costs but it's ridiculous to say that provider compensation has nothing to do with it. The single biggest driver, IMHO, is fee for service and medical supplies, but every aspect of the medical industry plays some role.
- beat 8y ago
  I'm convinced that it's the cost structure, implemented by many-to-many negotiation between providers and insurers, that drives the uniquely high cost of the US health care system. (Unique as in twice as much per capita as the rest of the industrialized world.) Japan's system is structurally very similar to ours - employer-provided private insurance - with one key difference. In Japan, pricing for all medical goods/services are set by a government agency, with an eye to keeping the industry functional/profitable while keeping costs under control. There are no "networks". Everyone knows what it's going to cost, everywhere.
  - chimeracoder 8y ago
    > I'm convinced that it's the cost structure, implemented by many-to-many negotiation between providers and insurers, that drives the uniquely high cost of the US health care system. (Unique as in twice as much per capita as the rest of the industrialized world.) Japan's system is structurally very similar to ours - employer-provided private insurance - with one key difference. In Japan, pricing for all medical goods/services are set by a government agency, with an eye to keeping the industry functional/profitable while keeping costs under control. There are no "networks". Everyone knows what it's going to cost, everywhere. In the US, Medicare pays for 40% of the market, and they set prices unilaterally. In addition to providers are legally required to charge private insurers more, Medicare has no mandate to keep the industry profitable, and in fact their reimbursement rates are about 7% lower than COGS. In other words, providers are (in the aggregate) losing money on Medicare patients on a per-patient basis, even before they account for overhead (building maintenance, staff wages, etc.). Medicare knows this and admits as much - not just in their annual reports, but because they actually have a number of different stipend programs that provide extra money to providers who see a lot of Medicare patients, because otherwise they would literally go bankrupt and close their practices (ie, if they don't see enough privately-insured patients to be able to make up the gap, they will go out of business). Medicare is, actually, the biggest beneficiary of price opacity in the American healthcare system today, but that opacity is not going anywhere.
pastor_elm 8y ago
why would doctors willingly give up making extra hundreds of thousands of dollars?
- robotresearcher 8y ago
  Why would a university willingly give up millions of dollars in tuition? Some people and institutions optimize for other things once they have enough money. Alas, this couldn’t have a large effect on health costs anyway, since costs are dominated by things other than doctor pay.
  - karmajunkie 8y ago
    They're not giving it up—it's being paid by the interest on a rather large endowment.
    - naveen99 8y ago
      They are giving up interest on a rather large endowment.
      - stevenwoo 8y ago
        From the article they are 450 million into a roughly estimated 700 million needed to fund this new initiative.
      - amdavidson 8y ago
        An endowment that wouldnt exist except for the free tuition.
        robotresearcher 8y ago
        Part of this money could only have been raised by a free tuition program. But many top med schools have somehow accrued huge endowments without offering free tuition. So that part may not be enormous. It’s an awesome program for these students.
mabbo 8y ago
Why would it? Hospitals in America aren't actually a free market. You cannot choose not to buy, and in emergency situations you can't actually compare prices between sellers. Hospitals charge whatever they can get away with and insurance companies get a discount because they have some leverage- but you and I don't. All this would really do is help lower the medical providers costs. Likely it will give them additional funding to lobby against socialized health care.
- mbostleman 8y ago
  Generally speaking, when exactly can you compare prices in a non-emergency situation? I have gotten to the point that every time I see my doctor, I ask for the costs because I enjoy the awkward and ultimately unanswerable question and I like bringing the problem to the surface rather than pretending it doesn't exist.
  - ksdale 8y ago
    It's truly ridiculous how hard it is for hospitals to answer this question sometimes. We've occasionally received the answer that they won't know the price until after the appointment because they won't know which code to charge until they've provided service. Then you ask what the cost of the likely codes are and they still have no idea.
    - mbostleman 8y ago
      Right. There's too many levels of abstraction. It's like trying to find the implementing code and all you keep finding is interfaces.
  - deleted 8y ago
    [deleted]
  - pandler 8y ago
    The cost of what? The end-user cost that you’re billed or their costs to provide the service?
mbostleman 8y ago
If the subsidies are private it would be a great way to solve the "free education" for everyone promise that is gaining traction (I'm assuming education will also be pitched as a right if it hasn't already). But as long as health is not a free market, then the price isn't going to necessarily go up or down in response to costs. The price will continue to be function of political power and monopolistic practices as it is now.
jxf 8y ago
Doctors have very little influence on the overall cost of care, especially where drugs are concerned. Do you think that when Mylan raises the price of EpiPens from $50 to $500 that it's a market-based decision, for example? No; that's just an exercise of monopoly power.

umanwizard 8y ago

I hope so too, but I can't see why it would. The market forces would be the same. I have no student debt but I still would take a higher-paying job, all else being equal. Not sure why it would be different for doctors. I'm not an economics expert so please let me know if this is a well-studied question and I'm just talking out of my ass.

retbull 8y ago
Sure you might take a higher paying job but you might not take one that goes against your values just for money if you don't need it.
classichasclass 8y ago
I think, and would hope, that medical school interviews would help to weed out those who are just in it for the money. Even in highly-paid specialties, you have to want to do the work you do. Were there people in my class who were in it largely for the prestige, etc.? Sure. Those people tended to go into high-profile specialties like plastics. But they were the minority, and I think that schools recognize in general these types of students are bad for the profession.
vlasev 8y ago
It's not so much about how much you can make but more about how much you need to make to stay afloat. It's a very different story depending on whether you have $0k in debt or $300k in debt.
scarface74 8y ago
Not on that scale. But I know plenty of teachers who chose not to be administrators because they enjoyed what they do. I also know many first level software development managers who “self demoted” to become software developers and took a pay cut. Other developers I know took a pay cut and contracted half the year. You can make those choices if you don’t have outrageous expenses- including student loans.

gk1 8y ago

From my (limited) understanding, the high cost of malpractice insurance that doctors must pay is what drives up the cost of healthcare, more so than their student debt.

trhway 8y ago
>high cost of malpractice insurance results from high cost of malpractice. So instead of treating the symptom - insurance, one has to treat the original condition - malpractice. To continue the analogy - the trial lawyers in case of malpractice is just like the immune system. When infection (malpractice) happens you see the heavy effects of immune system acting like high fever, yet it would be a grave mistake to suppress immune system instead of dealing with the original cause - infection (malpractice).
- Bjartr 8y ago
  Malpractice suits are brought over 3x as often in the US as in Canada, and malpractice insurance can cost more than an order of magnitude more. However, in the US there is a much greater incentive to sue. About 21% of malpractice suits that pay out, pay out over $1,000,000. Something that elsewhere would merely net you enough to handle the medical fallout, in the US nets you a lottery jackpot. Because the money on the line is so high it incentives both layers and plaintiffs to aggressively maximize the payout. Like so many other aspects of the US health system, other countries do it better. * All claims were the results of a few minutes of research on Google, I would be interested in learning of evidence that contradicts my claims.
- scarface74 8y ago
  Sometimes things happen. There are commercials on TV all of the time where lawyers are soliciting people to sue doctors for birth defects like cerebral palsy. I’m glad that my parents spent my childhood focused on therapy, motivation, etc to help me deal with cerebral palsy than placing the blame on the doctor. Yeah my case is relatively minor in the grand scheme of things.
karmajunkie 8y ago
This has been conclusive disproven by comparing what happened in different states that enacted tort reform for medical malpractice. The cost of insurance dropped a bit, but there has been no effect the cost of healthcare provisioning.

chimeracoder 8y ago

> I hope this helps to decrease the costs of medical care in the US to some extent as it removes one pressure for doctors to earn extra money charging for things that might not need to be needed. Physician earnings account for about 7% of total spending on healthcare. Of that 7%, the fraction due to student debt specifically is significant from the physician's perspective, but negligible from a systemic picture. This is, of course, assuming that physicians are charging for services that are not be needed in order to boost their earnings, which happens in some cases, but is not as systemic or widespread as people often think, due to the shift away from fee-for-service payment models and towards capitated care, and the opacity of the payment model to the physician at the point-of-care in many care delivery situations.

Eridrus 8y ago
I'm really interested in this info, can you tell me where you got the 7% from? Are there good in depth breakdowns of this?
- chimeracoder 8y ago
  It's a fairly easy statistic to find; here's the first hit on Google: https://www.medicalbag.com/finance/examining-physician-salaries-in-the-united-states/article/710038/ https://www.medicalbag.com/finance/examining-physician-salar... One caveat is that oftentimes you'll see higher numbers (in the range of 15-20%) cited, but that's usually because they're not distinguishing between doctors (MDs) and other clinical staff (nurses, physicians' assistants, etc.). In the aggregate, the latter account for about half, or in other words, roughly equal to what doctors in total pull in. As that article notes, this also doesn't mean that all of that money goes to the physicians themselves. Some portion is taken by the practices and groups that employ them, and a huge chunk of physicians' take-home pay is allocated towards business expenses[0]. For the context of the original article, only MDs are relevant, not what NPs, RNs, and so forth make. [0] Unlike software developers, who generally have their business expenses covered by their employer, physicians are typically expected to cover all of theirs out-of-pocket, which means that the seemingly-high salaries that you often see listed aren't directly comparable to salaries in many other fields, where the out-of-pocket expense are much lower.

blang 8y ago

Changing how compensation is structured, would probably be the most effective way to discourage things that might not be needed.

acomar 8y ago

Doctor's pay is not the driving factor behind increasing medical bills... administrative expenses at providers in insurance, opaque and arcane cost structures negotiated as deals between providers and insurance companies, and record profits at both insurance companies and providers point to a system that's cannibalizing itself. This will do nothing to costs even if implemented universally as it does nothing to address the actual causes of rising medical expenses.

karmajunkie 8y ago
There's no single bogeyman behind rising medical costs but it's ridiculous to say that provider compensation has nothing to do with it. The single biggest driver, IMHO, is fee for service and medical supplies, but every aspect of the medical industry plays some role.
beat 8y ago
I'm convinced that it's the cost structure, implemented by many-to-many negotiation between providers and insurers, that drives the uniquely high cost of the US health care system. (Unique as in twice as much per capita as the rest of the industrialized world.) Japan's system is structurally very similar to ours - employer-provided private insurance - with one key difference. In Japan, pricing for all medical goods/services are set by a government agency, with an eye to keeping the industry functional/profitable while keeping costs under control. There are no "networks". Everyone knows what it's going to cost, everywhere.
- chimeracoder 8y ago
  > I'm convinced that it's the cost structure, implemented by many-to-many negotiation between providers and insurers, that drives the uniquely high cost of the US health care system. (Unique as in twice as much per capita as the rest of the industrialized world.) Japan's system is structurally very similar to ours - employer-provided private insurance - with one key difference. In Japan, pricing for all medical goods/services are set by a government agency, with an eye to keeping the industry functional/profitable while keeping costs under control. There are no "networks". Everyone knows what it's going to cost, everywhere. In the US, Medicare pays for 40% of the market, and they set prices unilaterally. In addition to providers are legally required to charge private insurers more, Medicare has no mandate to keep the industry profitable, and in fact their reimbursement rates are about 7% lower than COGS. In other words, providers are (in the aggregate) losing money on Medicare patients on a per-patient basis, even before they account for overhead (building maintenance, staff wages, etc.). Medicare knows this and admits as much - not just in their annual reports, but because they actually have a number of different stipend programs that provide extra money to providers who see a lot of Medicare patients, because otherwise they would literally go bankrupt and close their practices (ie, if they don't see enough privately-insured patients to be able to make up the gap, they will go out of business). Medicare is, actually, the biggest beneficiary of price opacity in the American healthcare system today, but that opacity is not going anywhere.

pastor_elm 8y ago

why would doctors willingly give up making extra hundreds of thousands of dollars?

robotresearcher 8y ago
Why would a university willingly give up millions of dollars in tuition? Some people and institutions optimize for other things once they have enough money. Alas, this couldn’t have a large effect on health costs anyway, since costs are dominated by things other than doctor pay.
- karmajunkie 8y ago
  They're not giving it up—it's being paid by the interest on a rather large endowment.
  - naveen99 8y ago
    They are giving up interest on a rather large endowment.
    - stevenwoo 8y ago
      From the article they are 450 million into a roughly estimated 700 million needed to fund this new initiative.
    - amdavidson 8y ago
      An endowment that wouldnt exist except for the free tuition.
      - robotresearcher 8y ago
        Part of this money could only have been raised by a free tuition program. But many top med schools have somehow accrued huge endowments without offering free tuition. So that part may not be enormous. It’s an awesome program for these students.

mabbo 8y ago

Why would it? Hospitals in America aren't actually a free market. You cannot choose not to buy, and in emergency situations you can't actually compare prices between sellers. Hospitals charge whatever they can get away with and insurance companies get a discount because they have some leverage- but you and I don't. All this would really do is help lower the medical providers costs. Likely it will give them additional funding to lobby against socialized health care.

mbostleman 8y ago
Generally speaking, when exactly can you compare prices in a non-emergency situation? I have gotten to the point that every time I see my doctor, I ask for the costs because I enjoy the awkward and ultimately unanswerable question and I like bringing the problem to the surface rather than pretending it doesn't exist.
- ksdale 8y ago
  It's truly ridiculous how hard it is for hospitals to answer this question sometimes. We've occasionally received the answer that they won't know the price until after the appointment because they won't know which code to charge until they've provided service. Then you ask what the cost of the likely codes are and they still have no idea.
  - mbostleman 8y ago
    Right. There's too many levels of abstraction. It's like trying to find the implementing code and all you keep finding is interfaces.
- deleted 8y ago
  [deleted]
- pandler 8y ago
  The cost of what? The end-user cost that you’re billed or their costs to provide the service?

mbostleman 8y ago

If the subsidies are private it would be a great way to solve the "free education" for everyone promise that is gaining traction (I'm assuming education will also be pitched as a right if it hasn't already). But as long as health is not a free market, then the price isn't going to necessarily go up or down in response to costs. The price will continue to be function of political power and monopolistic practices as it is now.

jxf 8y ago

Doctors have very little influence on the overall cost of care, especially where drugs are concerned. Do you think that when Mylan raises the price of EpiPens from $50 to $500 that it's a market-based decision, for example? No; that's just an exercise of monopoly power.