5 ms·

Why would you want it nation wide? Even if you “support it”, I’d much rather watch the implications from the various experiments across states. Then we can sel

Why would you want it nation wide? Even if you “support it”, I’d much rather watch the implications from the various experiments across states. Then we can select the best option. Personally, I’d like to see some states ban healthcare outright. Others have full coverage and everything in between. Then wait 10 years and we can see the results. I strongly suspect there would be states willing to do this.

tenpies 4y ago
Exactly. US salaries for healthcare are the best on the planet, period. The comparison (and to be fair, this is a very high level) paints an extremely clear picture: United States $313,000 Germany $163,000 United Kingdom $138,000 France $108,000 Per: https://www.worldatlas.com/articles/countries-with-highest-paid-doctors.html https://www.worldatlas.com/articles/countries-with-highest-p... So yes, I absolutely want to see how many physicians stick around if you tell them "your salary will now be half and we're maxing our your workload". Alternatively, I want to see how long the State's finances last if they say "we'll pay the national market rate for your services and we're now maxing our your workload". And even then I don't want 10 years, I want a generation or two. Even pre-COVID we had multiple surveys indicating that 60-70% of doctors would not recommend becoming a doctor. I want to see how that number changes as States run their experiments.
- throwaway2214 4y ago
  > "your salary will now be half and we're maxing our your workload" should be fine if they pay their student loans no? isnt that the main reason the salaries are so high? cost of living + debt
  - rhexs 4y ago
    Paying off 200K in debt with a 300K minimum salary is pretty trivial unless you immediately qualify for a 4 million dollar mortgage, buy a BMW, then get divorced six times after med school.
  - TuringNYC 4y ago
    cost of living isnt the reason for high salaries in Medicines. Unlike tech, salaries in medicine increase as you go to rural and/or underserved areas. It is driven by supply/demand and quality of life in urban vs rural areas.
    - bdzr 4y ago
      Sort of, the supply of physicians is artificially limited by the AMA - which dictates how many physicians there are. That keeps the cost of physicians nice and high.
      - TuringNYC 4y ago
        100% agree but note that the AMA's limits are at a national level. So the [very high] base salaries are indeed driven by scarcity (as dictated by medical boards.) However the local scarcity is not driven by the AMA (note the salaries just get even higher! in remote locales as the local scarcity compounds atop national scarcity.)
  - heavyset_go 4y ago
    > isnt that the main reason the salaries are so high? It's because the NIH limits the amounts of medical residencies in the country, and to become a doctor with a license to practice, you must have completed residency somewhere. The amount of doctors in the US are kept at low numbers because of this.
    - lettergram 4y ago
      I thought it was the AMA, but yeah I know about this and agree. This is the real problem
      - heavyset_go 4y ago
        AMA lobbies but doesn't decide how residencies are funded.
    - holden_nelson 4y ago
      I didn’t know that. Why does the NIH limit the number of residencies?
      - lettergram 4y ago
        Imagine you were working in an industry where you got to decide the number of people you can let in behind you. The option almost everyone picks is “no one”. Keep supply of your services low and increasing demand means more money for you.
      - chillacy 4y ago
        Professional organizations have stronger incentives to increase their compensation through restricting supply instead of decreasing their compensation to help their customers. The AMA is actually doing a great job at this recently compared to the ABA, where there have been too many lawyers graduating recently for insane salaries except at the top.
      - sarpeedo 4y ago
        Medicare funds medical residency (not the NIH and not the AMA). The 1997 balanced budget act passed by congress limited the expansion of new medical residency training. [0] https://www.npr.org/2018/03/09/592333771/severe-shortage-of-psychiatrists-exacerbated-by-lack-of-federal-funding https://www.npr.org/2018/03/09/592333771/severe-shortage-of-...
- rootusrootus 4y ago
  This will be a tough problem to solve. We could start by eliminating the AMA.
- slothtrop 4y ago
  > want to see how many physicians stick around Why would they bother to leave? Physician salaries might still very well be highest in the world.
- sarpeedo 4y ago
  I see this argument made often on HN. I would imagine if we compared software engineering salaries in these same countries you would see that similarly software engineers in the US are also "overpaid". Software United States of America $95,879 United Kingdom $68,664 = 72% USA Germany $61,390 = 64% USA France $47,617 = 50% USA Medicine United States of America $313,000 United Kingdom $138,000 = 44% USA Germany $163,000 = 52% USA France $108,000 = 35% USA (I believe the software salaries I've sourced are somewhat conservative) [0] https://www.codingame.com/work/blog/find-developers/average-software-engineer-salaries-top-paying-countries/ https://www.codingame.com/work/blog/find-developers/average-...
duncan-donuts 4y ago
Ban healthcare? Like make it illegal to receive care or are you saying have no concept of health insurance and everything is out of pocket?
deleted 4y ago
[deleted]
arcbyte 4y ago
Yep. I vehemently oppose federal Healthcare initiatives but im very receptive to state options.
codefreeordie 4y ago
presumably, you don't actually mean "ban healthcare" so much as some version of "prohibit government spending on healthcare" or somesuch? I'm pretty sure there's actually no constituency for outlawing the practice of medicine. Or maybe you're actually the misanthrope that I sometimes pretend to be?
airstrike 4y ago
This argument makes no sense. If you're really interested in "selecting the best option", there can always be a federal option complementing state "experiments".
vdnkh 4y ago
> Personally, I’d like to see some states ban healthcare outright. Others have full coverage and everything in between. Then wait 10 years and we can see the results. I strongly suspect there would be states willing to do this. This is the most HN comment I've ever seen
- kbenson 4y ago
  I'm not even sure what they mean by ban "healthcare" (insurance, doctors, hospitals?), and I can't decide if that makes me agree with you more or less.
  - lettergram 4y ago
    I meant health insurance, but gonna just leave it lol
    - kbenson 4y ago
      I figured, but with the "Most HN comment" meme and Poe's law providing context, it can be hard to be sure someone isn't suggesting something a bit more... extreme. :)
      - lettergram 4y ago
        Lol first time my thoughts on banning health insurance is the less extreme option haha... For reference, the idea is to optimize for public good. Banning insurance would drop fees dramatically because people would get less unnecessary work done. At the same time, hospitals and others would be willing to offer loans provided you could pay it off. This would drive down costs to the point even the poor can get some decent medical treatment. Any gaps can be made by non-profits, religious organizations and the like (similar to planned parenthood). Not perfect, but makes healthcare abundant and cheap.
        vdnkh 4y ago
        > This would drive down costs to the point even the poor can get some decent medical treatment Or we could just offer free healthcare without relying on unfettered capitalism to "work". >unnecessary work With capitalism as the driving force, anything unprofitable becomes unnecessary. Probably goes without saying, but focusing on profitability likely won't drive the best healthcare outcomes.
kbenson 4y ago
> Why would you want it nation wide? They didn't say they did, they said we're closer to having a legitimate discussion. But to answer your question, if it's better, we might want it nationwide for similar reasons we have a national minimum wage and national child labor laws. For some things making sure there's a lower bound that everyone can rely on is a large part of the benefit, so inconsistent rules across the nation don't allow for a large portion of the benefit to be realized. Whether this is one of those cases is something we'll hopefully get some more data on.
slothtrop 4y ago
You need only peer across the globe. Take your pick between Germany, Singapore, Norway, etc.

tenpies 4y ago

Exactly. US salaries for healthcare are the best on the planet, period. The comparison (and to be fair, this is a very high level) paints an extremely clear picture: United States $313,000 Germany $163,000 United Kingdom $138,000 France $108,000 Per: https://www.worldatlas.com/articles/countries-with-highest-paid-doctors.html https://www.worldatlas.com/articles/countries-with-highest-p... So yes, I absolutely want to see how many physicians stick around if you tell them "your salary will now be half and we're maxing our your workload". Alternatively, I want to see how long the State's finances last if they say "we'll pay the national market rate for your services and we're now maxing our your workload". And even then I don't want 10 years, I want a generation or two. Even pre-COVID we had multiple surveys indicating that 60-70% of doctors would not recommend becoming a doctor. I want to see how that number changes as States run their experiments.

throwaway2214 4y ago
> "your salary will now be half and we're maxing our your workload" should be fine if they pay their student loans no? isnt that the main reason the salaries are so high? cost of living + debt
- rhexs 4y ago
  Paying off 200K in debt with a 300K minimum salary is pretty trivial unless you immediately qualify for a 4 million dollar mortgage, buy a BMW, then get divorced six times after med school.
- TuringNYC 4y ago
  cost of living isnt the reason for high salaries in Medicines. Unlike tech, salaries in medicine increase as you go to rural and/or underserved areas. It is driven by supply/demand and quality of life in urban vs rural areas.
  - bdzr 4y ago
    Sort of, the supply of physicians is artificially limited by the AMA - which dictates how many physicians there are. That keeps the cost of physicians nice and high.
    - TuringNYC 4y ago
      100% agree but note that the AMA's limits are at a national level. So the [very high] base salaries are indeed driven by scarcity (as dictated by medical boards.) However the local scarcity is not driven by the AMA (note the salaries just get even higher! in remote locales as the local scarcity compounds atop national scarcity.)
- heavyset_go 4y ago
  > isnt that the main reason the salaries are so high? It's because the NIH limits the amounts of medical residencies in the country, and to become a doctor with a license to practice, you must have completed residency somewhere. The amount of doctors in the US are kept at low numbers because of this.
  - lettergram 4y ago
    I thought it was the AMA, but yeah I know about this and agree. This is the real problem
    - heavyset_go 4y ago
      AMA lobbies but doesn't decide how residencies are funded.
  - holden_nelson 4y ago
    I didn’t know that. Why does the NIH limit the number of residencies?
    - lettergram 4y ago
      Imagine you were working in an industry where you got to decide the number of people you can let in behind you. The option almost everyone picks is “no one”. Keep supply of your services low and increasing demand means more money for you.
    - chillacy 4y ago
      Professional organizations have stronger incentives to increase their compensation through restricting supply instead of decreasing their compensation to help their customers. The AMA is actually doing a great job at this recently compared to the ABA, where there have been too many lawyers graduating recently for insane salaries except at the top.
    - sarpeedo 4y ago
      Medicare funds medical residency (not the NIH and not the AMA). The 1997 balanced budget act passed by congress limited the expansion of new medical residency training. [0] https://www.npr.org/2018/03/09/592333771/severe-shortage-of-psychiatrists-exacerbated-by-lack-of-federal-funding https://www.npr.org/2018/03/09/592333771/severe-shortage-of-...
rootusrootus 4y ago
This will be a tough problem to solve. We could start by eliminating the AMA.
slothtrop 4y ago
> want to see how many physicians stick around Why would they bother to leave? Physician salaries might still very well be highest in the world.
sarpeedo 4y ago
I see this argument made often on HN. I would imagine if we compared software engineering salaries in these same countries you would see that similarly software engineers in the US are also "overpaid". Software United States of America $95,879 United Kingdom $68,664 = 72% USA Germany $61,390 = 64% USA France $47,617 = 50% USA Medicine United States of America $313,000 United Kingdom $138,000 = 44% USA Germany $163,000 = 52% USA France $108,000 = 35% USA (I believe the software salaries I've sourced are somewhat conservative) [0] https://www.codingame.com/work/blog/find-developers/average-software-engineer-salaries-top-paying-countries/ https://www.codingame.com/work/blog/find-developers/average-...

duncan-donuts 4y ago

Ban healthcare? Like make it illegal to receive care or are you saying have no concept of health insurance and everything is out of pocket?

deleted 4y ago

[deleted]

arcbyte 4y ago

Yep. I vehemently oppose federal Healthcare initiatives but im very receptive to state options.

codefreeordie 4y ago

presumably, you don't actually mean "ban healthcare" so much as some version of "prohibit government spending on healthcare" or somesuch? I'm pretty sure there's actually no constituency for outlawing the practice of medicine. Or maybe you're actually the misanthrope that I sometimes pretend to be?

airstrike 4y ago

This argument makes no sense. If you're really interested in "selecting the best option", there can always be a federal option complementing state "experiments".

vdnkh 4y ago

> Personally, I’d like to see some states ban healthcare outright. Others have full coverage and everything in between. Then wait 10 years and we can see the results. I strongly suspect there would be states willing to do this. This is the most HN comment I've ever seen

kbenson 4y ago
I'm not even sure what they mean by ban "healthcare" (insurance, doctors, hospitals?), and I can't decide if that makes me agree with you more or less.
- lettergram 4y ago
  I meant health insurance, but gonna just leave it lol
  - kbenson 4y ago
    I figured, but with the "Most HN comment" meme and Poe's law providing context, it can be hard to be sure someone isn't suggesting something a bit more... extreme. :)
    - lettergram 4y ago
      Lol first time my thoughts on banning health insurance is the less extreme option haha... For reference, the idea is to optimize for public good. Banning insurance would drop fees dramatically because people would get less unnecessary work done. At the same time, hospitals and others would be willing to offer loans provided you could pay it off. This would drive down costs to the point even the poor can get some decent medical treatment. Any gaps can be made by non-profits, religious organizations and the like (similar to planned parenthood). Not perfect, but makes healthcare abundant and cheap.
      - vdnkh 4y ago
        > This would drive down costs to the point even the poor can get some decent medical treatment Or we could just offer free healthcare without relying on unfettered capitalism to "work". >unnecessary work With capitalism as the driving force, anything unprofitable becomes unnecessary. Probably goes without saying, but focusing on profitability likely won't drive the best healthcare outcomes.

kbenson 4y ago

> Why would you want it nation wide? They didn't say they did, they said we're closer to having a legitimate discussion. But to answer your question, if it's better, we might want it nationwide for similar reasons we have a national minimum wage and national child labor laws. For some things making sure there's a lower bound that everyone can rely on is a large part of the benefit, so inconsistent rules across the nation don't allow for a large portion of the benefit to be realized. Whether this is one of those cases is something we'll hopefully get some more data on.

slothtrop 4y ago

You need only peer across the globe. Take your pick between Germany, Singapore, Norway, etc.