Nationalised medicine- would it be good for the US economy. Doctors should earn less.

Great Debates
1

Let’s take the following two facts:
[ul]
[li]The US health system is inequitable and inefficient - 16% of GDP instead of the UK’s 8%, for example.[/li]
[li]The US if facing an ‘entitlement crunch’ on medicare and social security in the medium term.[/li][/ul]

My contention:
Socialised medicine would help with both these problems.

For the first - even if the American NHS still costs 16% of GDP, it should insure everyone. So America will still have an incredibly expensive health system, but at least it would be less inequitable. And with such massive levels of spending, it should be possible to obviate the most common complaint about the NHS - long waits for non-urgent procedures.

But secondly, by giving everyone decent healthcare, it would remove the need for medicare (the funding for which could be absorbed into the NHS), and increase access to preventative medicine, hopefully reducing overall health spending and having fewer poor people dependent on SS.

These would seem to me to be benefits that come just from this reorganisation.

But in order to seriously cut back on spending, it seems to me that one incredibly politically unattractive solution is required: doctors should be paid less. I think it is unjustifiable, in a public system, for a doctor to earn more than $300,000.

Though of course, like in the UK, they would be free to earn more by doing private work in their spare time. This private work could be done during the time many doctors currently devote to charitable free clinics - which would be unnecessary under the NHS. Like in Britain, ‘going private’ would not get a patient a better quality of care, rather shorter waits and a more polished service.

Thoughts?

zhongguorenmin

2

I think tort reform is a lot bigger part of the problem than Doctor’s salaries.

3

[QUOTE=zhongguorenmin]
I think it is unjustifiable, in a public system, for a doctor to earn more than $300,000.

Though of course, like in the UK, they would be free to earn more by doing private work in their spare time. This private work could be done during the time many doctors currently devote to charitable free clinics - which would be unnecessary under the NHS.
[/QUOTE]
I assume you are not saying that doctors should be prevented from earning >$300K, just that they would not be paid more than that by the government. They could then earn however much more they could in private practice. Correct me if I am mistaken here.

IOW, the incentive would be for them to work as much as possible in the private sector, and as little as possible in the NHS.

The first question to ask is, of course, how many doctors are earning more than $300K, and thus how much will it save?

The first figures I happened across seem to indicate, not many, and not much, respectively. So you might want to adjust your salary caps downwards.

Regards,
Shodan

4

America is the only westernized country in the world without national health care. We pay more, a lot more for health care than other countries and don’t receive the best care for it. It is a national shame that people go without needed care due to a lack of money. I worked at a hospital for a number of years and saw many people turned away. I also saw some that fell under the emergency service short changed. Money seems to be everything. My daughter works at a cancer care center and they treat people without insurance, the only center in town that does. The problem is not so much the doctors but the insurance companies. They hold billions of dollars in health care insurance money making millions off of it and will pay huge amounts to keep their cash flowing. We are a sick people, and the disease is money whoring. Only when the American people get really fed up with the system will it change. I know several doctors that would welcome national health care.

5

It’s not the doctors that drives up the cost of medicine, it is the insurance companies. They are an unnecessary siphon of resources that stands between the doctor and patient. Single payer universal health insurance would eliminate all the costs created by the insurance companies.

6

Note that I am not advocating a single-payer system (where doctors are ‘independent contractors’ and get paid as they currently are, but in bulk from the government insurance program).

I would advocate a system more like the UK NHS - the doctors are salaried employees of the NHS. For consultants (the most senior doctors) it works something like: the consultant is paid a certain salary for working 3.5 days per week for the NHS, and is free to spend the remaining time doing private work, golf or whatever.

This would avoid the problem of consultants ditching lots of NHS patients and only taking more lucrative private ones (a risk under ‘single payer’), unless of course the salaried terms are so unattractive it’s better to go entirely private.

zhongguorenmin

7

[QUOTE=zhongguorenmin]

But in order to seriously cut back on spending, it seems to me that one incredibly politically unattractive solution is required: doctors should be paid less. I think it is unjustifiable, in a public system, for a doctor to earn more than $300,000.

[/QUOTE]

Jeez, I tend to dislike MDs, dealing with them in my job all the time. But, who exactly do you think is going to invest the better part of a decade in education as well as go several hundred thousand dollars in debt, all in the prime of one’s earning years, if there is no financial benefit on the other side? Your plan would have an MD shortage in no time.

If anything MD salaries are unjustifiably low on average, particularly in the early career.

8

Doctors’ salaries are the least of our concerns.

If I were to make one change in the present healthcare system–aside from universal insurance not linked to employment-- I would reduce the amount of money spent on expensive treatments that accomplish nothing. And I would put more focus on figuring out what treatments are effective for most people in a particular situation.

I heard on NPR some time ago that compared to countries with Socialized Medicine, the US spends a lot more money per capita on the elderly and pre-mature babies, without getting better outcomes. In countries where there is some sort of rationing of say MRI machines, the people likely to get the most benefit from having an MRI get them, but a lot of elderly with knee pain don’t. This is because most MRIs on elderly knees don’t actually provide any information for better treatment, they just make the patient feel like something was accomplished. Similar things happen with very sick and pre-mature babies.

Now, as Americans, we feel entitled to the best possible care, and we don’t care how much it costs. So between entitlement and a disconnect between who pays for care and who recieves the treatmet, and a strong dislike of the rationing that often comes with socialized medicine, we, as a group, throw huge amounts of money at providing care for very sick babies and elderly. And yet, we don’t get better outcomes. We need to work on this problem, if we want to decrease the overall cost of providing medicines.

9

[QUOTE=zhongguorenmin]
Note that I am not advocating a single-payer system (where doctors are ‘independent contractors’ and get paid as they currently are, but in bulk from the government insurance program).

I would advocate a system more like the UK NHS - the doctors are salaried employees of the NHS. For consultants (the most senior doctors) it works something like: the consultant is paid a certain salary for working 3.5 days per week for the NHS, and is free to spend the remaining time doing private work, golf or whatever.

This would avoid the problem of consultants ditching lots of NHS patients and only taking more lucrative private ones (a risk under ‘single payer’), unless of course the salaried terms are so unattractive it’s better to go entirely private.

zhongguorenmin
[/QUOTE]

I’m not sure how this system would fix perceived problems in the U.S. system. Salaries will be what they will be, people won’t spend 3.5 days per week working for the NHS when they can almost certainly make more money in private practice.

10

Eureka is right. If patient satisfaction were not an issue, I could probably eliminate a third to a half of the diagnostic studies I order and still have exactly the same outcomes–and I’m often criticized for being too conservative with tests.

But patients want the expensive tests, doctors like ordering them because it’s easier than thinking, and insurance companies pay for them. There’s really no incentive anywhere to control costs. The tests I order in a day cost several times what I make in a day.

I hate to say it, but if you cut doctors’ salaries by that much, doctors would leave the profession in droves. Even those who truly love it are frequently tempted to get out and find something less stressful or time consuming, and the money is the only thing keeping them around.

I’d probably be on board for a single-payer or even a truly nationalized system if it were done right, which would include maintaining doctors’ salaries pretty close to where they are. I think it could be done, but I don’t trust our government to do it right.

11

[QUOTE=zhongguorenmin]
Let’s take the following two facts:
[ul]
[li]The US health system is inequitable and inefficient - 16% of GDP instead of the UK’s 8%, for example.[/li]
[li]The US if facing an ‘entitlement crunch’ on medicare and social security in the medium term.[/li][/ul]

My contention:
Socialised medicine would help with both these problems.

For the first - even if the American NHS still costs 16% of GDP, it should insure everyone. So America will still have an incredibly expensive health system, but at least it would be less inequitable. And with such massive levels of spending, it should be possible to obviate the most common complaint about the NHS - long waits for non-urgent procedures.

But secondly, by giving everyone decent healthcare, it would remove the need for medicare (the funding for which could be absorbed into the NHS), and increase access to preventative medicine, hopefully reducing overall health spending and having fewer poor people dependent on SS.

These would seem to me to be benefits that come just from this reorganisation.

But in order to seriously cut back on spending, it seems to me that one incredibly politically unattractive solution is required: doctors should be paid less. I think it is unjustifiable, in a public system, for a doctor to earn more than $300,000.

Though of course, like in the UK, they would be free to earn more by doing private work in their spare time. This private work could be done during the time many doctors currently devote to charitable free clinics - which would be unnecessary under the NHS. Like in Britain, ‘going private’ would not get a patient a better quality of care, rather shorter waits and a more polished service.

Thoughts?

zhongguorenmin
[/QUOTE]

FWIW I was a practicing ED physician in the US for 25 years. I’m now a traveling salesman. So I’m close to the field but changes wouldn’t directly affect me.

Physician income is very high. It isn’t quite the bed of roses you might think, though. I started my earning career at about the age of 30, because of the length of time it takes to train. I finished paying off my Med School debts at 40. These days kids have even more debt; a couple hundred thousand is not unusual. My first salary (early 80’s) was 45k, topping out at about 250k when I quit. Currently ED physicians are near the top of the salary heap. The average primary care MD is in the 80-160K/yr range. For those that don’t start out rich you really have to wait til you are about 40 or so to feel like you are getting ahead. For one thing the current taxing system in the US is heavily weighted toward income and not wealth so you find yourself squarely in the middle of high direct taxation plus high indirect taxation (“I am sorry sir; your income is just too high to deduct those college expenses. And your income is also too high to get any break on the expenses…”) Of course more money is always better than less money, so I realize nobody’s crying for us docs.

A few other points:

Physician income is not the major cause for the high cost of healthcare. Those causes are legion.

There is a feeling among physicians that you will get what you pay for. Make being a physician just another salaried job and you are not going to get the cream of candidates. The year I applied I had 99/99/99/97 percentile ranks on the four MCAT categories and two of five Med Schools I applied to still wait-listed me. One has to take into consideration that high physician compensation needs to be compared to what that person’s earning power would have been had they been out in the business world with a 5 year head start. These are not folks who would otherwise be making telemarketing calls for a living.

I have no idea if socialized medicine would be good for the economy. One question that probably needs to be addressed is whether it would be good for medicine. I have long since ceased having very positive opinions about large social programs, particularly the ones that remove personal incentive for excellence. On the other hand, I am distressed at the waste across all of medicine and the dissociation between the cost of care and the quality of care.

It’s also a little odd that many patients who complain in general about the high cost of care want no expense spared for themselves. They want glistening high-tech facilities. They love the baby grand playing soft music in a marble lobby. They want no test spared; no possibility unexplored; no orphan drug unfunded; no cost/benefit weighed; no errors tolerated; no cutback on staffing.

They may feel abstractly your physician makes too much money. When it comes to the doctors taking care of their heart attack, they only care about one thing: are they the very best?

Sorta like me when I flying. I am definitely happier when the captain is the very best, even if he’s costing the airline 250k/year.

12

[QUOTE=China Guy]
I think tort reform is a lot bigger part of the problem than Doctor’s salaries.
[/QUOTE]

http://www.consumerlaw.com/medical.html
Harvard study says 80,000 people killed by poor medical care yearly and less than 2 percent seek damages. In Hawaii the insurance companies pay less than half of what they charge the doctors in fees.
It is not the litigation but the excessive malpractice fees insurance companies charge.

13

[QUOTE=gonzomax]
http://www.consumerlaw.com/medical.html
Harvard study says 80,000 people killed by poor medical care yearly and less than 2 percent seek damages. In Hawaii the insurance companies pay less than half of what they charge the doctors in fees.
It is not the litigation but the excessive malpractice fees insurance companies charge.
[/QUOTE]

From your cite:

"Approximately 80,000 people die in the United States each year due **partly **to medical malpractice (based on an extensive study entitled “Patients, Doctors and Lawyers: Medical Injury, Malpractice Litigation, and Patient Compensation in New York,” published by the Harvard Medical Practice Study in 1990, a report to the State of New York). "

(bolding mine)

Can you tell me what the “partly” means? I’m not being snarky, but that is a pretty strange word in that sentence. I could honestly claim that 80,000 people are killed every year in the U.S. “partly” due to attacks by bears.

14

[QUOTE=Martin Hyde]
I’m not sure how this system would fix perceived problems in the U.S. system. Salaries will be what they will be, people won’t spend 3.5 days per week working for the NHS when they can almost certainly make more money in private practice.
[/QUOTE]

How does that even jibe with the reality in Britain? We still have a private health care network (the likes of BUPA etc.) in the UK, too.

There seems to be a lot of analysing from the viewpoint that doctors are purely economically rational agents in this thread i.e. they will always prefer to go for a job with a higher wage. This isn’t my experience with doctors at all, the vast majority of which go into the field because they want to make a real difference to people.

15

[QUOTE=gonzomax]
http://www.consumerlaw.com/medical.html
Harvard study says 80,000 people killed by poor medical care yearly and less than 2 percent seek damages. In Hawaii the insurance companies pay less than half of what they charge the doctors in fees.
It is not the litigation but the excessive malpractice fees insurance companies charge.
[/QUOTE]

Now I see it. That study is horsecrap.

They basically took all of the people who had died in a hospital, and reviewed their charts. They noted if any of them had been given what they considered to be suboptimal care. If they did, they then decided that that suboptimal care “partly” caused their death. A terminal cancer patient who was given what these reviewers considered to be not the best dose of chemotherapeutic would have counted toward that number regardless of whether he would have died from the cancer anyway.

http://jama.ama-assn.org/cgi/content/full/286/4/415

16

I think I heard something on NPR the other day that said that even in places where there is nationalised medicine doctors tend to be well off. They quoted one English or French doctor as saying that even with the system in that country he has a million-dollar estate. Can anyone verify this?

17

Does anyone know of a good, objective site that analyzes the cost of health care in the US broken down in a way where we can see what procedures are getting what % of the money spent? Basically fleshing out the idea that Eureka presented in his post, above. Every time someone points out that Americans pay more for health care than any other country, my first reaction is: so what? Without knowing exactly who is paying for what, that’s a meaningless statement.

But the other question I always wonder about when the idea of “nationalized medicine” comes up is why so many people on the left want to put George W. Bush in charge of their health care. As much as I’m all for reforming the system we have in the US (especially getting out of the crazy idea that employers should pay for it), the last thing I would want to do is “nationalize” or “socialize” it.

18

[QUOTE=Johnny L.A.]
I think I heard something on NPR the other day that said that even in places where there is nationalised medicine doctors tend to be well off. They quoted one English or French doctor as saying that even with the system in that country he has a million-dollar estate. Can anyone verify this?
[/QUOTE]

Yes, British doctors earn a lot. First year after graduating, probably £25k, and top consultants may earn £400k (including private work).

And the median? A GP (primary care) will probably make £80k, a consultant in a desirable speciality at least £200k.

zhongguorenmin

19

[QUOTE=John Mace]
Does anyone know of a good, objective site that analyzes the cost of health care in the US broken down in a way where we can see what procedures are getting what % of the money spent? Basically fleshing out the idea that Eureka presented in his post, above. Every time someone points out that Americans pay more for health care than any other country, my first reaction is: so what? Without knowing exactly who is paying for what, that’s a meaningless statement.

But the other question I always wonder about when the idea of “nationalized medicine” comes up is why so many people on the left want to put George W. Bush in charge of their health care. As much as I’m all for reforming the system we have in the US (especially getting out of the crazy idea that employers should pay for it), the last thing I would want to do is “nationalize” or “socialize” it.
[/QUOTE]

I don’t have a cite, but my impression is that Americans pay more for insurance overheads, and they have many more things like MRI scanners per head of population. These mostly go on wasteful investigations like those described by DoctorJ.

I take your George Bush point - but every other rich country does it fine, and comes out ahead of the US. Are you suggesting that the US government is uniquely incompetent? In that case I think it’s time for a root-and-branch revision of the country’s institutions, starting with the constitution.

zhongguorenmin

20

[QUOTE=Dominic Mulligan]
There seems to be a lot of analysing from the viewpoint that doctors are purely economically rational agents in this thread i.e. they will always prefer to go for a job with a higher wage. This isn’t my experience with doctors at all, the vast majority of which go into the field because they want to make a real difference to people.
[/QUOTE]

Surely that is in part because the economics of doctorhood are distorted by the presence of a state health service? You might expect that if Britain had market-driven healthcare, a lot of people who are now media executives and stockbrokers would have chosen medicine instead.

I don’t know why the OP thinks it matters what he or she thinks is an appropriate maximum salary for doctors. Unless we have a state-run centrally planned economy, various types of employ are going to be competing for able people. If doctors’ pay is artificially restricted, that will just result in fewer doctors, or less able doctors.