
Do American doctors get paid too much?  - peter123
http://www.slate.com/id/2227965/
======
splat
I'm surprised that the article doesn't mention the effect that the AMA has had
on the medical community. The article points out that in France and the UK one
aspiring doctors go to medical school for free immemdiately after high school,
whereas in the US aspiring doctors go to a university before going to medical
school and must pay tuition for both (not to mention the residency period
afterward). This is a consequence of rules put in place by the AMA (which, in
turn, are backed up by legislation). The AMA has ensured that doctors in the
US tend to be quite good, but it has also restricted the supply. The result is
that cheap, lower-quality doctors are forbidden from entering the marketplace.
In many cases, this is good -- I wouldn't want to undergo open-heart surgery
with a low-quality doctor. But if I break my arm, do I really need to see a
doctor who has had over 10 years of training? I would likely be just as well
off seeing a doctor who is not quite as good and has had only a few years of
training.

As a consequence of the AMA, patients are forced to see extremely well-trained
doctors even for routine procedures. In many cases, this is just overkill. But
the net effect is reduction in the supply of doctors, and an increase in their
salaries.

~~~
oldgregg
SPOT ON. The AMA is an unconstitutional cartel that punishes the poor. All the
changes they are talking about are total bullshit until this issue is
addressed.

And what about prescriptions? The vast majority of drugs are safer than a
bottle of Nyquil, but oh, we have to protect you so you have to make a doctors
visit for some freaking allegra. Prescriptions need to come to an end unless
it's a highly addictive or dangerous (class II?).

You can't let the "experts" dictate what is best for all those "dumb citizens"
when they stand to dramatically benefit from fear-mongering. It's elitist
idiocy. It's the same reason why I'm highly skeptical of most global warming
policy. Maybe we have global warming, but we have no idea if we can even stop
it to begin with-- so hell, let's just let the "experts" make stuff up
("change your light bulbs!")... while we dump tons of money into funding
research projects. Dumb.

~~~
Locke1689
What the hell are you talking about? Unconstitutional? The AMA is a
professional association. A _private_ professional association. The
Constitution enumerates the powers of the federal and state governments and
certainly doesn't have anything to say about the AMA...

 _You can't let the "experts" dictate what is best for all those "dumb
citizens" when they stand to dramatically benefit from fear-mongering. It's
elitist idiocy. It's the same reason why I'm highly skeptical of most global
warming policy. Maybe we have global warming, but we have no idea if we can
even stop it to begin with-- so hell, let's just let the "experts" make stuff
up ("change your light bulbs!")... while we dump tons of money into funding
research projects. Dumb._

Ahh... Ok... Global warming skeptic: this makes so much more sense. It's clear
you have no idea what you're talking about and, more to the point, are
_certainly_ not qualified to make any kind of judgment on "the vast majority
of drugs." Please come back with some actual data next time.

------
brown
Yes, they do.

In my opinion, the biggest cause of this is the artificial caps on the number
of doctors graduated every year. Only a small fraction of qualified med school
applicants are accepted each year. (In my idealism) more doctors would create
more of a free market. The market would find ways to identify high quality
doctors who deserve $1m a year, but there would also be the $200k/yr doctors
for normal middle class and $50k doctors for low income areas.

The cynic would say it's because the medical community is being protectionist.
The conservative would say it's those pesky liberals worrying too much about
our safety. The doctors I've worked with speculate it's because of the
"priest" like status that doctors have historically held in society.

For hackers... well, let's just say there's a lot of money to be made in
medical software. Doctors value their time very much and are willing to pay
silly amounts of money for modest efficiency improvements. Most hackers are
scared away from medical software because of concerns of excess regulation and
complexity. That's a fair concern, but that doesn't mean there's still not
good opportunities.

~~~
tokenadult
Economist Martin Feldstein found out a long time ago that increasing the
supply of doctors just increases the share of national income that all doctors
enjoy, and still results in high incomes for each doctor, because doctors
refer to other doctors.

The United States has a higher supply of medical doctors per capita than most
countries, and those doctors make a good living.

After edit: Here's a link to a follow-up paper by that economist on the issue
of physician income:

<http://lingli.ccer.edu.cn/he2007/ref/1014/reply.pdf>

------
falsestprophet
Has anyone seen an adequately objective breakdown of United States health care
costs?

 _edit_ Here is the best I can find:
[http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=6...](http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358)

~~~
baran
This McKinsey report shows the best breakdown of costs that I have seen:

[http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_he...](http://www.mckinsey.com/mgi/rp/healthcare/accounting_cost_healthcare.asp)

------
barrkel
Well, the AMA appears to use an almost Marxist model of labour supply:

> Apparently the American Medical Association has a board that calculates
> something called "relative value units", or RVUs. These attempt to measure
> how difficult a given procedure is for the physician [...] We have a name
> for setting prices this way. It's called the "labour theory of value", and
> it was invented by a guy named Karl Marx.

[http://www.economist.com/blogs/democracyinamerica/2009/09/ma...](http://www.economist.com/blogs/democracyinamerica/2009/09/maybe_medicare_really_is_commu.cfm)

<http://www.slate.com/id/2227082/>

------
motoko
Do technology startup founders get paid too much?

And: if you think doctors do get paid too much? What are you going to do about
it? Offer to pay less? That would be reasonable, but do you pay your doctor?

------
baran
Dont forget about medical malpractice. This insurance has gone through the
roof in the last 10-15 years, many times dramatically eating into doctors
salaries.

Also remember doctors have peoples lives in their hands. I dont understand how
people could think they are overpaid.

~~~
asciilifeform
> doctors have peoples lives in their hands

And so do bus drivers.

------
ars
> According to Reinhardt, doctors' take-home pay (that is, income minus
> expenses) amounts to only about 1 percent of overall health care spending,
> or about $26 billion.

This doesn't make any sense whatsoever. So where is all that money going?

> That's a drop in the ocean compared with overhead for insurance companies,
> billing expenses for doctors' offices, and advertising for drug companies.

There is absolutely no way those things add up to 99% of medical expenses.

In every field most of the money goes to pay people. So who is making the
money? Is Reinhardt excluding specialists perhaps?

~~~
ams6110
He left out a lot of other stuff. Hospital rooms. Nurses, lab technicians, all
the other staff at the hospital/clinic/doctor's office. Other overhead (office
rent, equipment leases) on and on.

Liability insurance premiums for malpractice insurance. A _huge_ cost. Enough
to drive doctors away from some specialties, such as obstetrics.

There's some overhead in insurance company billing operations, but I've not
seen any good evidence that the government can do it for less.

~~~
Locke1689
I was curious, so I asked my dad what it was on average. He said that it was
about $30,000-$40,000 per year per doctor, but that is highly dependent on the
specialty. For surgeons, probably close to $100,000 a year, while probably
close to nothing for psychiatrists.

------
isaacgarcia
It's a free market - leave it alone. If anyone wants to be a doctor - go to
school for 12 years. No one is stopping you.

The article also fails to address the ridiculous cost of malpractice insurance
that doctors must carry (for obvious reasons).

~~~
fnid
It's the exact opposite of a free market. The supply of doctors is limited.
The ability for people to care for their own health is limited by the FDA and
prescriptions. Lots of very good candidates for medical school are eliminated
from the physician pool by the AMA every year due to the availability of med
school seats, which currently is around 11,000 per year.

Doctors limit the supply of doctors. When DeBeers does this in the diamond
industry it's considered illegal.

~~~
tokenadult
See my other reply.

<http://news.ycombinator.com/item?id=816755>

