# Access to medical care or "Do you really want a doctor who can't afford a Ferrari?" **URL:** \ **Category:** In My Humble Opinion\ **Created:** [May 8, 2017, 5:23am UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115 "2017-05-08T05:23:41Z")\ **Posts on this page:** 14\ **Page:** 5
**Author:** ![Ruken](https://avatars.discourse-cdn.com/v4/letter/r/f475e1/32.png) [@Ruken](https://boards.straightdope.com/u/Ruken)\ **Post date:** [May 9, 2017, 7:04pm UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/81 "2017-05-09T19:04:36Z")
> [@constanze](#): > > Replacing “expensive car” with “expensive boat” doesn’t change the main argument: if your doctor is more interested in making money in order to buy espensive stuff, then how do you know he won’t choose the most expensive treatment, instead of a cheaper one that’s better for you? Or just bill you for completly unneccessary procedures? In an efficient market this would be less of an issue. But we don’t have that, so you don’t know. I expect it probably happens. I asked an assistant at a sleep clinic how many people leave _without_ a prescription for a CPAP. “Oh, almost nobody.” :dubious: ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [May 9, 2017, 8:10pm UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/82 "2017-05-09T20:10:28Z")
> [@PatrickLondon](#): > > Ferrari or not, you would be hard put to it to find many doctors in the UK who think the NHS should be replaced with a for-profit system (nor, come to that, that many who’d prefer a state-regulated insurance+co-pay system as on the Continent). “The Continent” has multiple systems, including several which in no way resemble that one. ---
**Author:** ![Jophiel](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jophiel/32/66_2.png) [@Jophiel](https://boards.straightdope.com/u/Jophiel)\ **Post date:** [May 9, 2017, 8:38pm UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/83 "2017-05-09T20:38:56Z")
> [@Ruken](#): > > I wonder if credibility exhibits a Doppler effect. At least we’re getting our lulz this afternoon. Does anyone else miss that “my post is my cite” guy? This is IMHO, not GD nor GQ. While I strive to be accurate and credible, I don’t feel any onus to get into a “You can’t cite that 100% to my acceptance then it doesn’t count” debate. As I said, if you want to believe that threats and pressure of unionization didn’t affect Walmart’s decision, I’m fine with that. I think you’re very wrong but I’m fine with you being very wrong if the alternative is a tedious “that doesn’t count!” volley. ---
**Author:** ![Derleth](https://avatars.discourse-cdn.com/v4/letter/d/b9e5f3/32.png) [@Derleth](https://boards.straightdope.com/u/Derleth)\ **Post date:** [May 9, 2017, 8:46pm UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/84 "2017-05-09T20:46:17Z")
> [@Ruken](#): > > In an efficient market this would be less of an issue. Efficient markets rely on both parties having the same information; information asymmetries create a [market for lemons](https://en.wikipedia.org/wiki/The_Market_for_Lemons), with “lemon” as in “bad car nobody wants, but the dealer can fill the transmission with sawdust and sell you anyway” because you don’t know about the sawdust or the 30k mile “eccentricity” that model develops or… Regulations mitigate this, by forcing the _real_ lemons off the market and by making side effect information available. Unless you’re buying supplements or alternative medicine, which is wholly unregulated and therefore [full of lemons](http://scienceblogs.com/insolence/2012/07/02/dietary-supplements-scary-substances-manufactured-under-scary-conditions/). My point is, though, the doctor is an MD for a reason and you’re not, for the converse of the same reason. There’s always an element of trust in getting expert assistance, which you cannot do away with simply by doing your own research (because you might stumble upon a Null or a Weil or a Wakefield and end up with a head full of bullshit), so there can never be an efficient market for healthcare. > [@](#): > > I asked an assistant at a sleep clinic how many people leave _without_ a prescription for a CPAP. “Oh, almost nobody.” :dubious: Holy mother of biased samples. ---
**Author:** ![Ruken](https://avatars.discourse-cdn.com/v4/letter/r/f475e1/32.png) [@Ruken](https://boards.straightdope.com/u/Ruken)\ **Post date:** [May 9, 2017, 9:31pm UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/85 "2017-05-09T21:31:45Z")
> [@Derleth](#): > > Regulations mitigate this, by forcing the _real_ lemons off the market and by making side effect information available. Unless you’re buying supplements or alternative medicine, which is wholly unregulated and therefore [full of lemons](http://scienceblogs.com/insolence/2012/07/02/dietary-supplements-scary-substances-manufactured-under-scary-conditions/). My point is, though, the doctor is an MD for a reason and you’re not, for the converse of the same reason. There’s always an element of trust in getting expert assistance, which you cannot do away with simply by doing your own research (because you might stumble upon a Null or a Weil or a Wakefield and end up with a head full of bullshit), so there can never be an efficient market for healthcare. It may never be an efficient market but I wouldn’t attribute most of that to any undue complexity; it’s just medicine. But instead to features like hidden pricing, inability to shop for emergency care (because it’s an emergency), normal incentives not being in place due to how health insurance works (or doesn’t) here, etc. > [@Derleth](#): > > Holy mother of biased samples. This was during the lucrative apnea boom some years back. It sounds like insurers have caught on and put a harness on it. [Insurers Are Grumpy Over Booming Sleep Apnea Business : Shots - Health News : NPR](http://www.npr.org/sections/health-shots/2012/01/16/145182935/the-sleep-apnea-business-is-booming-and-insurers-arent-happy) ---
**Author:** ![Jophiel](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jophiel/32/66_2.png) [@Jophiel](https://boards.straightdope.com/u/Jophiel)\ **Post date:** [May 9, 2017, 9:46pm UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/86 "2017-05-09T21:46:53Z")
> [@puddleglum](#): > > How long does it take? From 1982-1990 the minimum wage did not go up at all. During that same time the total wages in the economy went up 70%. From 2004 to 2012 the minimum wage rose three times from 5.25 to 7.25 and total wages in the economy went up 30%. That is the exact opposite of what your model predicts. Wages for the working class [remained stagnant](http://www.epi.org/files/charts/img/718.png) during the 80s and didn’t climb until the mid-90s – starting a few years after we started increasing minimum wage, in fact. You are not only (bizarrely) cherry-picking a date range that includes the greatest economic collapse in the last 60-some years and saying “How come increased minimum wage didn’t grow this more”, but also including including all levels of pay including the huge upgrowth in salaries for the high upper class. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [May 9, 2017, 10:42pm UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/87 "2017-05-09T22:42:00Z")
> [@constanze](#): > > Replacing “expensive car” with “expensive boat” doesn’t change the main argument: if your doctor is more interested in making money in order to buy espensive stuff, then how do you know he won’t choose the most expensive treatment, instead of a cheaper one that’s better for you? Or just bill you for completly unneccessary procedures? Demonstrate to me that he will do these things. You are extrapolating a ridiculous level of information from an essentially meaningless data point. The author of the article is making a stupid assumption; the problem is that the opposite assumption is equally stupid. ---
**Author:** ![Isamu](https://avatars.discourse-cdn.com/v4/letter/i/7c8e57/32.png) [@Isamu](https://boards.straightdope.com/u/Isamu)\ **Post date:** [May 10, 2017, 12:37am UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/88 "2017-05-10T00:37:50Z")
> [@puddleglum](#): > > 33% of British ER doctors [have](http://www.telegraph.co.uk/news/health/news/11883559/A-third-of-AandE-doctors-leaving-NHS-to-work-abroad.html)left for Australia. Perhaps that just shows that if you educate people then they’re going to move to Australia. 😃 ---
**Author:** ![TokyoBayer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tokyobayer/32/13989_2.png) [@TokyoBayer](https://boards.straightdope.com/u/TokyoBayer)\ **Post date:** [May 10, 2017, 1:54am UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/89 "2017-05-10T01:54:27Z")
What a silly argument. “They are complaining because they don’t have bread” “Let them eat cake!” Of course someone who can afford an expensive doctor by paying cash has no sympathy, if not outright contempt for people who aren’t as affluent. However, most people are sensible enough to not say so directly. ---
**Author:** ![msmith537](https://avatars.discourse-cdn.com/v4/letter/m/d9b06d/32.png) [@msmith537](https://boards.straightdope.com/u/msmith537)\ **Post date:** [May 10, 2017, 1:54am UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/90 "2017-05-10T01:54:50Z")
“Life is unfair” says every dickhead business major whose parents sent them to college, read Atlas Shrugged and fancies themselves as Hank Rearden based on their desire to snap necks and cash checks. Really the question is “if you are broke and get sick or injured, what is the minimum level of medical care you should expect in the wealthiest country on Earth?” ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [May 10, 2017, 12:34pm UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/91 "2017-05-10T12:34:30Z")
> [@puddleglum](#): > > If minimum wage was set to $50 dollars an hour, what would happen to the wages of heart surgeons? I think the idea is that if we removed the minimum wage, heart surgeons would have to work for $2 an hour. Regards, Shodan ---
**Author:** ![Derleth](https://avatars.discourse-cdn.com/v4/letter/d/b9e5f3/32.png) [@Derleth](https://boards.straightdope.com/u/Derleth)\ **Post date:** [May 10, 2017, 4:27pm UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/92 "2017-05-10T16:27:40Z")
> [@msmith537](#): > > Really the question is “if you are broke and get sick or injured, what is the minimum level of medical care you should expect in the wealthiest country on Earth?” The other question is, “How much pure wastage, how much deadweight loss, can we remove from the system by making medical care easier to access?” What isn’t understood is that the people who are opposed to UHC are the ones making the moral statement without regard for economics. They’re the ones advocating an economically illiterate position based on what they think is morally superior. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [May 10, 2017, 7:29pm UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/93 "2017-05-10T19:29:43Z")
> [@Jophiel](#): > > Wages for the working class [remained stagnant](http://www.epi.org/files/charts/img/718.png) during the 80s and didn’t climb until the mid-90s – starting a few years after we started increasing minimum wage, in fact. You are not only (bizarrely) cherry-picking a date range that includes the greatest economic collapse in the last 60-some years and saying “How come increased minimum wage didn’t grow this more”, but also including including all levels of pay including the huge upgrowth in salaries for the high upper class. The date range I picked was the largest increase in the minimum wage in US history. Since all salaries are based on minimum wage why does it matter if the salaries are for working class or upper class? ---
**Author:** ![Ruken](https://avatars.discourse-cdn.com/v4/letter/r/f475e1/32.png) [@Ruken](https://boards.straightdope.com/u/Ruken)\ **Post date:** [May 11, 2017, 1:16am UTC](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115/94 "2017-05-11T01:16:21Z")
EPI uses tricks like not counting all compensation, ignoring demographic changes, etc. to push their stagnation message. The myth doesn’t pass the sniff test; just look at life today vs 1980 or even earlier. To steal from Scott Winship, “To honestly believe that below the top 10 percent of earners there has been essentially no improvement in 45 years is to declare an extreme disconnection from the real world and a commitment to a negative interpretation of the American economy that is beyond parody.” And when we look at what people are actually taking home, CBO ([PDF](https://www.cbo.gov/sites/default/files/112th-congress-2011-2012/reports/10-25-householdincome0.pdf)) showed (Table 1) an increase of real median household income of 35% between 1979 and 2007. Re: demographic changes, EPI ignores low-paid new additions (young people, immigrants, the previously unemployed) and high-paid subtractions (retiring boomers) to the workforce, such that the apparent wage can decrease even if, on average, everyone with a job is doing better than before. E.g. [http://www.frbsf.org/economic-research/files/el2016-07.pdf](http://www.frbsf.org/economic-research/files/el2016-07.pdf) [Previous page](https://boards.straightdope.com/t/access-to-medical-care-or-do-you-really-want-a-doctor-who-cant-afford-a-ferrari/786115.md?page=4)