4 ms·

That forum is amazing! Thanks for the primary source! That said, two quibbles/questions: Those same threads have logins like "indebt4life" and "kids2feed", w

That forum is amazing! Thanks for the primary source! That said, two quibbles/questions: Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. In other words, and benefits of gatekeeping accrue to the school and hospital complex more than the individual practirioners. Separately, what's the breakdown of specialist labor costs vs drugs and equipment? My experience has been that the crazy bills are for stuff , not people.

jopsen 7y ago
> My experience has been that the crazy bills are for stuff , not people. That could just be an accounting trick, since you're more willing to pay for stuff than people. (On topic: obviously, there's many reasons for costs, doctors isn't the only one)
AnthonyMouse 7y ago
> Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. It's gatekeeping that causes that. There are complex procedures that require a decade of medical training and simpler ones that don't. If you take the doctor with the extensive training and have them do only the complex procedures, it's easy to justify paying them mid six figure salaries that cover their costs. But if you have regulations that require that same doctor to spend three quarters of their time doing simple procedures that could reasonably be done by a PA or a nurse, the average value of their services drops and they have a harder time commanding a salary that can pay for their schooling and insurance.
m0zg 7y ago
It's not just the cost of training. In the US there's implicit expectation that becoming a doctor is a way to become wealthy, similar in earning potential to becoming a lawyer. There's no such expectation in most other countries which are often used in arguments for how socialized medicine "costs less". Their doctors make a fraction of what US doctors do, so of course it "costs less". Right now in the US you'd be "socializing" the expectation that a doctor should make $300K+ a year, with a very weak upper bound. Which I'm not going to say real good ones shouldn't, but good ones, in my personal experience, are few and far between. This is something we'd need to deal with before forcing taxpayers to pay for these inflated expectations at gunpoint, _if_ we decide to go the "single payer" route. ACA, ironically, did nothing at all to address the _affordability_ side of things. If I'm forced to give up a good chunk of my income for "free" healthcare, I'd be categorically not interested in paying for yet another beach house some surgeon wants to buy. Just like all problems involving human motivations, this is a tough one to solve. It's so tough, in fact, that I think the most realistic path forward is gradual automation of everything that can be automated, though technological means, such that we only use doctors where a robot or a computer can't do the job. Someone needs to start another Theranos, but do it for real this time.
- lotsofpulp 7y ago
  There better be a $300k+ payday at the end of a doctor’s training, otherwise I don’t see how the gauntlet they get put through is worth sacrificing their best years (20s and early 30s).
  - fountainofage 7y ago
    The thinking is also that the gauntlet is just plain wrong, so that would go away as well once their cartel (AMA) loses its power.
  - m0zg 7y ago
    Maybe the gauntlet would be less severe if there wasn't such a massive pot of gold at the end of this particular rainbow. Much of it is just hazing and weeding out of the "unworthy". But that's sort of orthogonal to the problem I'm discussing. The cost structure that enables "low cost" socialized medicine in other countries is just not there, and it's not going to be there in this country in the foreseeable future. Given this, all this talk about "medicare for all" etc, is just electoral pandering and nothing else. It's not doable without turning the whole system into a money black hole that's even worse than what we have now.
  - ZhuanXia 7y ago
    If you are trying to make free market arguments for doctors salaries come on. The doctors guild restricts supply through the state. No free market here.
    - lotsofpulp 7y ago
      I’m saying with the current requirements of becoming a doctor, a very high pay is needed to incentivize smart people who have options to choose to become a doctor.
rayiner 7y ago
US drug spending accounts for about 11% of total healthcare spending.
- vkou 7y ago
  When you get a $700 for two pills of ibuprofen, and five minutes of a doctor's time, what percentage of that bill was the ibuprofen?
  - lotsofpulp 7y ago
    The OP didn’t write that the doctor provided ibuprofen, the $700 was just for the doctor’s time.
mherdeg 7y ago
> Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. In other words, and benefits of gatekeeping accrue to the school and hospital complex more than the individual practirioners. This really depends on the forums you read. If you hang out on the whitecoatinvestor forums you'll see that there are plenty of folks who are getting by just fine on their $600k annual salaries and may even be retiring early. Reading those forums it's clear that there are challenges (not buying a doctor house, avoiding loan debt, budgeting like a resident even once you're in your real earning years) but there are plenty of opportunities, in some disciplines, to be happy with an eight-figure lifetime earnings and a balanced lifestyle.
hakfoo 7y ago
We see a lot of people trying to justify medical salaries due to the cost of education and malpractice insurance, but an integrated program could work around that. We should treat it like the infantry. If you want to drive a tank and blow up people, you don't apply to a college and get a Doctorate in Blowing People Up. You don't buy insurance to cover if you blow up the wrong people. You join the army. I'd like to see health care reform inspired by military structure. A high-schooler eager to get into medicine joins the Health Corps, and gets their education covered in exchange for n years of working in state-run facilities. There's strongly restricted legal recourse if the Health Corps hospital cuts off the wrong foot-- here's $500 and a really nice wooden peg. As a self-contained system, I could also imagine it working around some of the structure that's restricting the industry. I'm picturing programmes to advance in both through direct study and training, and where appropriate "field promotions" (think of the 20-year term nurse who knows more than most of the doctors from experience, but will never be able to escape their position without expensive and onerous formal training/certification)
- lallysingh 7y ago
  Would that end up also being single payer?
  - radicalbyte 7y ago
    If you wanted to do it cost effectively, yes. I have experience of single player (UK) and private insurance based but properly managed by the government (NL) and can tell you that single player is much cheaper to run. When I moved to NL about 15 years ago the UK was spending the same per capita on the NHS as The Netherlands spent from the central government to cover the shortfall to the insurers. In 2019 there isn't as much difference: a significant amount of providers in the UK have been privatised which increased costs whilst at the same time the NHS budgets have been systemically strangled in real terms - something like annual 2% budget increases against annual 15% cost increases thanks to demographics and lifestyle choices. So in short: single payer is great but the second the Republicans (or whatever the "don't tax the rich" party is at the time) get to touch it they'll ruin it.
- 7y ago

jopsen 7y ago

> My experience has been that the crazy bills are for stuff , not people. That could just be an accounting trick, since you're more willing to pay for stuff than people. (On topic: obviously, there's many reasons for costs, doctors isn't the only one)

AnthonyMouse 7y ago

> Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. It's gatekeeping that causes that. There are complex procedures that require a decade of medical training and simpler ones that don't. If you take the doctor with the extensive training and have them do only the complex procedures, it's easy to justify paying them mid six figure salaries that cover their costs. But if you have regulations that require that same doctor to spend three quarters of their time doing simple procedures that could reasonably be done by a PA or a nurse, the average value of their services drops and they have a harder time commanding a salary that can pay for their schooling and insurance.

m0zg 7y ago

It's not just the cost of training. In the US there's implicit expectation that becoming a doctor is a way to become wealthy, similar in earning potential to becoming a lawyer. There's no such expectation in most other countries which are often used in arguments for how socialized medicine "costs less". Their doctors make a fraction of what US doctors do, so of course it "costs less". Right now in the US you'd be "socializing" the expectation that a doctor should make $300K+ a year, with a very weak upper bound. Which I'm not going to say real good ones shouldn't, but good ones, in my personal experience, are few and far between. This is something we'd need to deal with before forcing taxpayers to pay for these inflated expectations at gunpoint, _if_ we decide to go the "single payer" route. ACA, ironically, did nothing at all to address the _affordability_ side of things. If I'm forced to give up a good chunk of my income for "free" healthcare, I'd be categorically not interested in paying for yet another beach house some surgeon wants to buy. Just like all problems involving human motivations, this is a tough one to solve. It's so tough, in fact, that I think the most realistic path forward is gradual automation of everything that can be automated, though technological means, such that we only use doctors where a robot or a computer can't do the job. Someone needs to start another Theranos, but do it for real this time.

lotsofpulp 7y ago
There better be a $300k+ payday at the end of a doctor’s training, otherwise I don’t see how the gauntlet they get put through is worth sacrificing their best years (20s and early 30s).
- fountainofage 7y ago
  The thinking is also that the gauntlet is just plain wrong, so that would go away as well once their cartel (AMA) loses its power.
- m0zg 7y ago
  Maybe the gauntlet would be less severe if there wasn't such a massive pot of gold at the end of this particular rainbow. Much of it is just hazing and weeding out of the "unworthy". But that's sort of orthogonal to the problem I'm discussing. The cost structure that enables "low cost" socialized medicine in other countries is just not there, and it's not going to be there in this country in the foreseeable future. Given this, all this talk about "medicare for all" etc, is just electoral pandering and nothing else. It's not doable without turning the whole system into a money black hole that's even worse than what we have now.
- ZhuanXia 7y ago
  If you are trying to make free market arguments for doctors salaries come on. The doctors guild restricts supply through the state. No free market here.
  - lotsofpulp 7y ago
    I’m saying with the current requirements of becoming a doctor, a very high pay is needed to incentivize smart people who have options to choose to become a doctor.

rayiner 7y ago

US drug spending accounts for about 11% of total healthcare spending.

vkou 7y ago
When you get a $700 for two pills of ibuprofen, and five minutes of a doctor's time, what percentage of that bill was the ibuprofen?
- lotsofpulp 7y ago
  The OP didn’t write that the doctor provided ibuprofen, the $700 was just for the doctor’s time.

mherdeg 7y ago

> Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. In other words, and benefits of gatekeeping accrue to the school and hospital complex more than the individual practirioners. This really depends on the forums you read. If you hang out on the whitecoatinvestor forums you'll see that there are plenty of folks who are getting by just fine on their $600k annual salaries and may even be retiring early. Reading those forums it's clear that there are challenges (not buying a doctor house, avoiding loan debt, budgeting like a resident even once you're in your real earning years) but there are plenty of opportunities, in some disciplines, to be happy with an eight-figure lifetime earnings and a balanced lifestyle.

hakfoo 7y ago

We see a lot of people trying to justify medical salaries due to the cost of education and malpractice insurance, but an integrated program could work around that. We should treat it like the infantry. If you want to drive a tank and blow up people, you don't apply to a college and get a Doctorate in Blowing People Up. You don't buy insurance to cover if you blow up the wrong people. You join the army. I'd like to see health care reform inspired by military structure. A high-schooler eager to get into medicine joins the Health Corps, and gets their education covered in exchange for n years of working in state-run facilities. There's strongly restricted legal recourse if the Health Corps hospital cuts off the wrong foot-- here's $500 and a really nice wooden peg. As a self-contained system, I could also imagine it working around some of the structure that's restricting the industry. I'm picturing programmes to advance in both through direct study and training, and where appropriate "field promotions" (think of the 20-year term nurse who knows more than most of the doctors from experience, but will never be able to escape their position without expensive and onerous formal training/certification)

lallysingh 7y ago
Would that end up also being single payer?
- radicalbyte 7y ago
  If you wanted to do it cost effectively, yes. I have experience of single player (UK) and private insurance based but properly managed by the government (NL) and can tell you that single player is much cheaper to run. When I moved to NL about 15 years ago the UK was spending the same per capita on the NHS as The Netherlands spent from the central government to cover the shortfall to the insurers. In 2019 there isn't as much difference: a significant amount of providers in the UK have been privatised which increased costs whilst at the same time the NHS budgets have been systemically strangled in real terms - something like annual 2% budget increases against annual 15% cost increases thanks to demographics and lifestyle choices. So in short: single payer is great but the second the Republicans (or whatever the "don't tax the rich" party is at the time) get to touch it they'll ruin it.
7y ago