4 ms·

> In the end - the absolute best of everything is expensive. Very expensive. I doubt a system can afford to have that happen for everyone, It's not a question

> In the end - the absolute best of everything is expensive. Very expensive. I doubt a system can afford to have that happen for everyone, It's not a question of money. If there's one person who's acknowledged as "the best" at something, that puts a hard limit on the number of people who can hire "the best" for that thing in any particular time window. Paying more won't give that one expert more hours in their day.

bitmasher9 2y ago
It’s a matter of money in that we have a finite resource (one person’s time) and in-demand finite resources tend to have a high price. At a systems level someone pioneering surgery techniques should probably spend most of their time researching and teaching, with surgery being a small portion of their time used to maintain the practical knowledge needed to better teach/research.
thayne 2y ago
Indeed. And one downside of a private healthcare system is that people who don't need the very best, and would be fine with any competent doctor but have the means to pay for the best use up that time, and people who might legitimately need that additional expertise that don't have as much money can't get it.
DannyBee 2y ago
This is also true of course, but i'm using "best" more colloquially - let's assume it's top 10%. That would match the rough stratification of doctor salaries (accounting for specialization, etc). The average primary care family physician earns 350k in the us. The top 10% earn 1.3 million. The top 1% earn 4 million[1]. So enough people are hiring the best, or paying the best, to get a 4x difference and 10x difference in yearly pay. I chose family PCP's because it seemed more unlikely that the top family PCP should be worth 10x more than the average. Whereas in something like neurosurgery, maybe? It felt at least arguable. Happy to be shown i'm wrong here. In any case, it seems like this level of stratification would not exist if people weren't trying to get to see the "top" doctors all the time. [1] There are lots of different data sources, but they all roughly have the same relative stratification even if the exact numbers are different. Since the actual numbers don't really matter to the point i'm making, i didn't try harder. But i will say all the data I find seems a bit of a mess.

bitmasher9 2y ago

It’s a matter of money in that we have a finite resource (one person’s time) and in-demand finite resources tend to have a high price. At a systems level someone pioneering surgery techniques should probably spend most of their time researching and teaching, with surgery being a small portion of their time used to maintain the practical knowledge needed to better teach/research.

thayne 2y ago

Indeed. And one downside of a private healthcare system is that people who don't need the very best, and would be fine with any competent doctor but have the means to pay for the best use up that time, and people who might legitimately need that additional expertise that don't have as much money can't get it.

DannyBee 2y ago

This is also true of course, but i'm using "best" more colloquially - let's assume it's top 10%. That would match the rough stratification of doctor salaries (accounting for specialization, etc). The average primary care family physician earns 350k in the us. The top 10% earn 1.3 million. The top 1% earn 4 million[1]. So enough people are hiring the best, or paying the best, to get a 4x difference and 10x difference in yearly pay. I chose family PCP's because it seemed more unlikely that the top family PCP should be worth 10x more than the average. Whereas in something like neurosurgery, maybe? It felt at least arguable. Happy to be shown i'm wrong here. In any case, it seems like this level of stratification would not exist if people weren't trying to get to see the "top" doctors all the time. [1] There are lots of different data sources, but they all roughly have the same relative stratification even if the exact numbers are different. Since the actual numbers don't really matter to the point i'm making, i didn't try harder. But i will say all the data I find seems a bit of a mess.