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With my skillset (software engineer) I can easily pull low six figures. And I'm confident that doctors provide more value than I do. I'm pretty sure I've never

With my skillset (software engineer) I can easily pull low six figures. And I'm confident that doctors provide more value than I do. I'm pretty sure I've never saved anyone's life. So I have zero problem paying doctors 2 or 3 times my pay, which is about what you're saying they get paid. Health insurance CEOs make, in some cases, literally hundreds of times my salary, while literally killing people for profit. I'm going to go out on a limb and say you've misidentified the problem. Now, certainly bringing down the cost of medical education, and allowing people with less education (i.e. nurse practitioners) to do more, would both help lower the cost of healthcare. But if we're talking about who we should consider "the enemy", it's certainly not doctors. The entire raison d'être of capitalism is that it's supposedly meritocratic. Are you really claiming that curing illness and sometimes saving people's lives isn't meritable?

leetcrew 7y ago
not sure what kind of work you do, but if you make tools that save people time and you have many users, it could add up to many lifetimes not spent on some menial task. not quite the same, but I would argue that helping many people allocate their time towards activities they actually value is just as important as saving individual lives.
- EpicEng 7y ago
  >I would argue that helping many people allocate their time towards activities they actually value is just as important as saving individual lives. I think you'd pretty easily get trounced making that argument. People would much rather be alive to do something less efficiently than to... not be alive at all. This argument is a bit insane to me.
  - leetcrew 7y ago
    think about the people you care about. would you rather live more years or spend more time with them over a shorter life? what would they prefer? it's an inherently subjective question, and I don't think the answer is obvious. I certainly don't think one of the answers is "insane".
    - EpicEng 7y ago
      Why are you assuming that I would spend less time with e.g. my wife if she were less efficient in performing some menial task? It would take her longer _to complete_, but that doesn't mean she wouldn't still quit working at 5. Besides, most of the software we write is pretty inconsequential as far as most people are concerned.
      - leetcrew 7y ago
        > Why are you assuming that I would spend less time with e.g. my wife if she were less efficient in performing some menial task? because "helping many people allocate their time towards activities they actually value" was an important premise I stated in the post you originally replied to? I deliberately excluded stuff that merely improves productivity at work (although not everyone is fortunate enough to have a job where they can just leave at five if the work isn't done).
        EpicEng 7y ago
        Then you're going to have to give me some examples. All in all I think doctors and medical scientists are more important to the world than the vast majority of us (since we have to make it an either/or for the sake of argument), so get specific.
        leetcrew 7y ago
        I for one am quite grateful to the engineers who implement electronic automatic billing. when I was a kid, it seemed like my dad spent a lot of time sorting through mail and writing/mailing individual checks for services. now it's automatically billed to the credit card, the credit card gets autopaid from checking, and he just has to make sure there's enough in his checking at the end of the month. that's not a huge amount of time and thought saved, but it's not nothing either. there's a lot of this stuff that we take advantage of in our lives without really noticing, I think.
        7y ago
- kerkeslager 7y ago
  I'm a freelancer, so I've worked on a lot of stuff. I charge a reduced rate to nonprofits, which has gotten me some genuinely rewarding work, and my software has also had some small part in keeping innocent people out of jail. So I really have no regrets about my career, at least not from a "was what I did meritable?" standpoint. I don't feel like my comment is asking anybody to make me feel better about what I've done with my life. :) But I'm still going to stand firm on my stance that a doctor, even if they only save a few lives in their career, is providing a more valuable service than I am. There's just no way the time I've saved people has added up to even a few lifetimes. If we look at the software industry as a whole, it's just very obvious. We're an industry that likes to think we're saving the world, but the reality is that the results of software have been a very mixed bag. Facebook, for example, is pretty much just bad, and there isn't a major company out there that I wouldn't look at as being in some grey area, where it's hard to tell if they are a net positive or negative.
civilian 7y ago
It's a bit much to say individual doctors are the enemy. (I have friends & family who are doctors!) But their organizations are. The AMA severely restricts the number of doctors trained each year. There are more qualified candidates for medical school than they accept-- which is also why there are so many extra hoops medical school candidates are jumping through in order to get in. It's a classic licensing scheme to restrict competition. Doctors may not be the enemy, but they are financially benefitting from their monopolistic practices, and it is reducing quality of care for Americans.
screye 7y ago
I think engineers really underestimate the value of their work. An engineer's impact on a single person might be low, but at scale, it can add up to a lot. As noble as being a doctor is, their individual contributions can never scale beyond a few people. While I am at it, can someone explain why being a doctor needs a person to go through 4 years of undergrad in field completely useless in their domain ? > The entire raison d'être of capitalism is that it's supposedly meritocratic Not it is not. It may be sold to us like that, but it is more like : "Those who succeed in Capitalism, do so only by the means of their merit....and the infinite privilege or luck that might have instead put them there. "
- kerkeslager 7y ago
  > An engineer's impact on a single person might be low, but at scale, it can add up to a lot. > As noble as being a doctor is, their individual contributions can never scale beyond a few people. Nonsense. If you only scale into saving hundreds of users a few minutes each, you're maybe approaching one lifetime, and that's assuming that your time saving actually improves those users' lives. The vast majority of engineers don't scale beyond that. Meanwhile, some doctors absolutely make contributions that scale, such as finding cures or vaccines, preventing spread of infectious diseases, or discovering ways to detect diseases earlier. Looking at percentages of world population, the black death killed more people than any of the FAANG companies have users, and that's only one of the diseases cured by the discovery of penicillin. If antibiotics resulting from penicillin didn't exist, it's quite reasonable to guess that more people would die of bacterial infections than FAANG has users. The smallpox vaccine? A test for detecting HIV? Quarantining the Ebola outbreaks? Each of these saved millions of lives. And let's not forget that the highest-scale engineers are pretty hit or miss as far as whether the way their work touches lives is even positive. Big pharma isn't innocent, but I don't think anyone would argue we should get rid of them entirely. In contrast, it's pretty unambiguous that the world would be better off without Facebook, and each of the AANG companies has some pretty large negative effects on i.e. small businesses, worker rights, attention, privacy. In short, you're just comparing the highest-scale engineers to the lowest-scale doctors, and assuming that what engineers are doing is as positive as what doctors do.
tptacek 7y ago
I don't understand the axioms you're trying to draw on to derive just compensation for physicians. Why not just look at the worldwide market? Compare US physicians to those in other countries; we pay ours drastically more, and we are not generally more satisfied with the care we receive.
- kerkeslager 7y ago
  If we look at the worldwide market, health insurance CEOs salaries stand out even more starkly.
  - tptacek 7y ago
    It's not clear to me what CEO salaries have to do with anything. Zero them out, and how much money has the American family saved? I haven't done the math, but I presume it's pennies, if that.
    - kerkeslager 7y ago
      To do that math effectively, you'd have to look at which parts of a health insurance company's structure are essentially waste caused by health insurance being private, and zero all that, and I'd presume that's a large portion of premiums. The CEOs are just the most obvious example.
      - tptacek 7y ago
        I don't have to do very complicated math to add up (or even wildly overestimate) compensation for CEOs, zero them, and see what that saves. I don't like that CEOs make that much money either, but why would I waste time on them? They're not the problem.
        kerkeslager 7y ago
        I'm saying that a doctor's contribution to society is a lot more than a health insurance CEO's and yet that is not reflected in their salary. It wouldn't surprise me if doctor pay was a larger factor in healthcare costs. But doctor pay is an inherent cost of healthcare, and while we can certainly lower their pay, it's not entirely clear to me what a fair pay would be. Health insurance CEOs, and indeed most of what a health insurance company does, are not only not inherent costs, but active blights on the healthcare system. A fair pay would be zero, with fines for literally killing people. So they're much higher priorities than doctors for the axe.
TuringNYC 7y ago
>> With my skillset (software engineer) I can easily pull low six figures. And I'm confident that doctors provide more value than I do. I'm pretty sure I've never saved anyone's life. So I have zero problem paying doctors 2 or 3 times my pay, which is about what you're saying they get paid. There are many problems comparing software pay to healthcare pay. - A large portion of software jobs are in the Bay Area, you are not being paid for your software job, you are being paid a giant CoL premium that gets taken away by landowners. Doctors on the other hand have jobs available all across the country and need not live in super-expensive areas. Further, their pay usually goes UP as they go to less expensive areas . - Medical salaries/jobs are not cyclical and do not suddenly disappear in droves as tech jobs did in 2001-2003 (countrywide) / 2008-2009 (NY+). With tech jobs, your low six figure pay is also paying you a hazard premium which i'm hoping youre saving for the next down cycle. - Many software engineers will tell you about age discrimination -- supposedly it gets harder and harder to find a job as you age. It is an unlicensed field, so there is theoretically unlimited supply. Further, there isnt a cartel-like mechanism (i.e., AMA and residency programs) to constrict supply. Thus, you are like a less extreme football player -- you make low six figures and then you pleateau or go down over time. Doctors make more with experience and there is no age discrimination that is spoken of. Depending on how many workers get imported on any given year, there are 300-500% more tech workers imported (e.g., with H1b) than all medical school graduates per year: https://www.aamc.org/data-reports/students-residents/interactive-data/2018-facts-applicants-and-matriculants-data https://www.aamc.org/data-reports/students-residents/interac... There are near zero imported medical specialists in the US. There are imported primary care workers, but those arent where the big billings are coming from. There is literally no downward pressure on medical salaries like there is in the US for tech.
- kerkeslager 7y ago
  Okay. So maybe the multiplier of my salary to get a doctor's salary is 5 or 6 instead of 2 or 3. The multiplier of my salary to get a health insurance CEO's salary is also now, what, 200 or 300 instead of 100?
  - TuringNYC 7y ago
shsjxjbsbs 7y ago
There are way more doctors than CEOs. If you’re gonna claim that CEO pay is a more significant factor than doctor pay you should do the math on that.
- kerkeslager 7y ago
  I'm saying that a doctor's contribution to society is a lot more than a health insurance CEO's and yet that is not reflected in their salary. It wouldn't surprise me if doctor pay was a larger factor in healthcare costs. But doctor salaries are an inherent cost of healthcare, and while we can certainly lower their salaries, it's not entirely clear to me what a fair salary would be. Health insurance CEOs, and indeed most of what a health insurance company does, are not only not inherent costs, but active blights on the healthcare system. A fair salary would be zero, with fines for literally killing people. So they're much higher priorities than doctors for the axe.
  - lotsofpulp 7y ago
    You are welcome to figure out a way to allocate society’s resources in a way that results in everyone having access to healthcare without the use insurance companies and actuaries. As far as I can tell, there does not exist a sufficient quantity of healthcare supply to meet the demand, hence the high prices. Without increasing the supply of healthcare, the conversation is moot.
vharuck 7y ago
Your logic will work if you put a price tag on a healthy and enjoyable life. Which is basically impossible for somebody to do for themself, because that's most people's goal in how they use money. If somebody said, "The value of a healthy and enjoyable life for me or my loved one is $X," that'd mean they wouldn't spend their money if it cost over $X. Which is a ridiculous idea, and we've all seen it play out where people or their families shell out most of their wealth for the chance of living another month. The only two ways I can see around this are: 1. Have an objective evaluator of life (maybe even accounting for differences in each person's value to society, if you really want to be accurate and don't mind the mobs with pitchforks). 2. Drop the idea of including health in the regular economy. Not totally possible, but public healthcare might be close enough.

leetcrew 7y ago

not sure what kind of work you do, but if you make tools that save people time and you have many users, it could add up to many lifetimes not spent on some menial task. not quite the same, but I would argue that helping many people allocate their time towards activities they actually value is just as important as saving individual lives.

EpicEng 7y ago
>I would argue that helping many people allocate their time towards activities they actually value is just as important as saving individual lives. I think you'd pretty easily get trounced making that argument. People would much rather be alive to do something less efficiently than to... not be alive at all. This argument is a bit insane to me.
- leetcrew 7y ago
  think about the people you care about. would you rather live more years or spend more time with them over a shorter life? what would they prefer? it's an inherently subjective question, and I don't think the answer is obvious. I certainly don't think one of the answers is "insane".
  - EpicEng 7y ago
    Why are you assuming that I would spend less time with e.g. my wife if she were less efficient in performing some menial task? It would take her longer _to complete_, but that doesn't mean she wouldn't still quit working at 5. Besides, most of the software we write is pretty inconsequential as far as most people are concerned.
    - leetcrew 7y ago
      > Why are you assuming that I would spend less time with e.g. my wife if she were less efficient in performing some menial task? because "helping many people allocate their time towards activities they actually value" was an important premise I stated in the post you originally replied to? I deliberately excluded stuff that merely improves productivity at work (although not everyone is fortunate enough to have a job where they can just leave at five if the work isn't done).
      - EpicEng 7y ago
        Then you're going to have to give me some examples. All in all I think doctors and medical scientists are more important to the world than the vast majority of us (since we have to make it an either/or for the sake of argument), so get specific.
        leetcrew 7y ago
        I for one am quite grateful to the engineers who implement electronic automatic billing. when I was a kid, it seemed like my dad spent a lot of time sorting through mail and writing/mailing individual checks for services. now it's automatically billed to the credit card, the credit card gets autopaid from checking, and he just has to make sure there's enough in his checking at the end of the month. that's not a huge amount of time and thought saved, but it's not nothing either. there's a lot of this stuff that we take advantage of in our lives without really noticing, I think.
        7y ago
kerkeslager 7y ago
I'm a freelancer, so I've worked on a lot of stuff. I charge a reduced rate to nonprofits, which has gotten me some genuinely rewarding work, and my software has also had some small part in keeping innocent people out of jail. So I really have no regrets about my career, at least not from a "was what I did meritable?" standpoint. I don't feel like my comment is asking anybody to make me feel better about what I've done with my life. :) But I'm still going to stand firm on my stance that a doctor, even if they only save a few lives in their career, is providing a more valuable service than I am. There's just no way the time I've saved people has added up to even a few lifetimes. If we look at the software industry as a whole, it's just very obvious. We're an industry that likes to think we're saving the world, but the reality is that the results of software have been a very mixed bag. Facebook, for example, is pretty much just bad, and there isn't a major company out there that I wouldn't look at as being in some grey area, where it's hard to tell if they are a net positive or negative.

civilian 7y ago

It's a bit much to say individual doctors are the enemy. (I have friends & family who are doctors!) But their organizations are. The AMA severely restricts the number of doctors trained each year. There are more qualified candidates for medical school than they accept-- which is also why there are so many extra hoops medical school candidates are jumping through in order to get in. It's a classic licensing scheme to restrict competition. Doctors may not be the enemy, but they are financially benefitting from their monopolistic practices, and it is reducing quality of care for Americans.

screye 7y ago

I think engineers really underestimate the value of their work. An engineer's impact on a single person might be low, but at scale, it can add up to a lot. As noble as being a doctor is, their individual contributions can never scale beyond a few people. While I am at it, can someone explain why being a doctor needs a person to go through 4 years of undergrad in field completely useless in their domain ? > The entire raison d'être of capitalism is that it's supposedly meritocratic Not it is not. It may be sold to us like that, but it is more like : "Those who succeed in Capitalism, do so only by the means of their merit....and the infinite privilege or luck that might have instead put them there. "

kerkeslager 7y ago
> An engineer's impact on a single person might be low, but at scale, it can add up to a lot. > As noble as being a doctor is, their individual contributions can never scale beyond a few people. Nonsense. If you only scale into saving hundreds of users a few minutes each, you're maybe approaching one lifetime, and that's assuming that your time saving actually improves those users' lives. The vast majority of engineers don't scale beyond that. Meanwhile, some doctors absolutely make contributions that scale, such as finding cures or vaccines, preventing spread of infectious diseases, or discovering ways to detect diseases earlier. Looking at percentages of world population, the black death killed more people than any of the FAANG companies have users, and that's only one of the diseases cured by the discovery of penicillin. If antibiotics resulting from penicillin didn't exist, it's quite reasonable to guess that more people would die of bacterial infections than FAANG has users. The smallpox vaccine? A test for detecting HIV? Quarantining the Ebola outbreaks? Each of these saved millions of lives. And let's not forget that the highest-scale engineers are pretty hit or miss as far as whether the way their work touches lives is even positive. Big pharma isn't innocent, but I don't think anyone would argue we should get rid of them entirely. In contrast, it's pretty unambiguous that the world would be better off without Facebook, and each of the AANG companies has some pretty large negative effects on i.e. small businesses, worker rights, attention, privacy. In short, you're just comparing the highest-scale engineers to the lowest-scale doctors, and assuming that what engineers are doing is as positive as what doctors do.

tptacek 7y ago

I don't understand the axioms you're trying to draw on to derive just compensation for physicians. Why not just look at the worldwide market? Compare US physicians to those in other countries; we pay ours drastically more, and we are not generally more satisfied with the care we receive.

kerkeslager 7y ago
If we look at the worldwide market, health insurance CEOs salaries stand out even more starkly.
- tptacek 7y ago
  It's not clear to me what CEO salaries have to do with anything. Zero them out, and how much money has the American family saved? I haven't done the math, but I presume it's pennies, if that.
  - kerkeslager 7y ago
    To do that math effectively, you'd have to look at which parts of a health insurance company's structure are essentially waste caused by health insurance being private, and zero all that, and I'd presume that's a large portion of premiums. The CEOs are just the most obvious example.
    - tptacek 7y ago
      I don't have to do very complicated math to add up (or even wildly overestimate) compensation for CEOs, zero them, and see what that saves. I don't like that CEOs make that much money either, but why would I waste time on them? They're not the problem.
      - kerkeslager 7y ago
        I'm saying that a doctor's contribution to society is a lot more than a health insurance CEO's and yet that is not reflected in their salary. It wouldn't surprise me if doctor pay was a larger factor in healthcare costs. But doctor pay is an inherent cost of healthcare, and while we can certainly lower their pay, it's not entirely clear to me what a fair pay would be. Health insurance CEOs, and indeed most of what a health insurance company does, are not only not inherent costs, but active blights on the healthcare system. A fair pay would be zero, with fines for literally killing people. So they're much higher priorities than doctors for the axe.

TuringNYC 7y ago

>> With my skillset (software engineer) I can easily pull low six figures. And I'm confident that doctors provide more value than I do. I'm pretty sure I've never saved anyone's life. So I have zero problem paying doctors 2 or 3 times my pay, which is about what you're saying they get paid. There are many problems comparing software pay to healthcare pay. - A large portion of software jobs are in the Bay Area, you are not being paid for your software job, you are being paid a giant CoL premium that gets taken away by landowners. Doctors on the other hand have jobs available all across the country and need not live in super-expensive areas. Further, their pay usually goes UP as they go to less expensive areas . - Medical salaries/jobs are not cyclical and do not suddenly disappear in droves as tech jobs did in 2001-2003 (countrywide) / 2008-2009 (NY+). With tech jobs, your low six figure pay is also paying you a hazard premium which i'm hoping youre saving for the next down cycle. - Many software engineers will tell you about age discrimination -- supposedly it gets harder and harder to find a job as you age. It is an unlicensed field, so there is theoretically unlimited supply. Further, there isnt a cartel-like mechanism (i.e., AMA and residency programs) to constrict supply. Thus, you are like a less extreme football player -- you make low six figures and then you pleateau or go down over time. Doctors make more with experience and there is no age discrimination that is spoken of. Depending on how many workers get imported on any given year, there are 300-500% more tech workers imported (e.g., with H1b) than all medical school graduates per year: https://www.aamc.org/data-reports/students-residents/interactive-data/2018-facts-applicants-and-matriculants-data https://www.aamc.org/data-reports/students-residents/interac... There are near zero imported medical specialists in the US. There are imported primary care workers, but those arent where the big billings are coming from. There is literally no downward pressure on medical salaries like there is in the US for tech.

kerkeslager 7y ago
Okay. So maybe the multiplier of my salary to get a doctor's salary is 5 or 6 instead of 2 or 3. The multiplier of my salary to get a health insurance CEO's salary is also now, what, 200 or 300 instead of 100?
- TuringNYC 7y ago

shsjxjbsbs 7y ago

There are way more doctors than CEOs. If you’re gonna claim that CEO pay is a more significant factor than doctor pay you should do the math on that.

kerkeslager 7y ago
I'm saying that a doctor's contribution to society is a lot more than a health insurance CEO's and yet that is not reflected in their salary. It wouldn't surprise me if doctor pay was a larger factor in healthcare costs. But doctor salaries are an inherent cost of healthcare, and while we can certainly lower their salaries, it's not entirely clear to me what a fair salary would be. Health insurance CEOs, and indeed most of what a health insurance company does, are not only not inherent costs, but active blights on the healthcare system. A fair salary would be zero, with fines for literally killing people. So they're much higher priorities than doctors for the axe.
- lotsofpulp 7y ago
  You are welcome to figure out a way to allocate society’s resources in a way that results in everyone having access to healthcare without the use insurance companies and actuaries. As far as I can tell, there does not exist a sufficient quantity of healthcare supply to meet the demand, hence the high prices. Without increasing the supply of healthcare, the conversation is moot.

vharuck 7y ago

Your logic will work if you put a price tag on a healthy and enjoyable life. Which is basically impossible for somebody to do for themself, because that's most people's goal in how they use money. If somebody said, "The value of a healthy and enjoyable life for me or my loved one is $X," that'd mean they wouldn't spend their money if it cost over $X. Which is a ridiculous idea, and we've all seen it play out where people or their families shell out most of their wealth for the chance of living another month. The only two ways I can see around this are: 1. Have an objective evaluator of life (maybe even accounting for differences in each person's value to society, if you really want to be accurate and don't mind the mobs with pitchforks). 2. Drop the idea of including health in the regular economy. Not totally possible, but public healthcare might be close enough.