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

Great Debates
21

[QUOTE=Usram]
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.
[/QUOTE]

I can see why you might think that the UK might have more doctors in a market driven system, but a couple of points:
[ul]
[li]We aren’t talking about some risky, untried experiment. The NHS has been up and running for over half a century.[/li][li]Though you may be right about higher salaries attracting more people, doctors here still earn a huge amount, and getting into medical school is intensely competitive. And there are no complaints about the overall quality of doctors, as far as I’m aware. We are not running short on quality medics.[/li][/ul]

Why do I think it matters what I think a maximum salary is? Firstly because this is a forum for debate. Secondly, because I am a voter and taxpayer in a publicly-funded system. I have an opinion on a sensible wage for a doctor, in the same way as I have an opinion on a sensible wage for a soldier or police officer. So take your snarky tone elsewhere. :rolleyes:

I should have been clearer in the OP. I think that, on a 3.5 day contract system, a doctor should earn no more than $300,000 from the publicly-funded work that they do. What they do privately is none of my business.

zhongguorenmin

22

If you really want to consider having socialised healthcare, then you must also be prepared for the consequencies.

The healthcare system will become politicised, it will mean politicians appointing their placemen, and in the current US climate, that means idiots who actually know very little about healthcare and whose sole qualification is the ability to suck up to the leadership.

We in the UK tried that with Maggie Thatcher when she tried to make steps to de-nationalising healthcare, lets just say that it introduced a very expensive layer of managers, and produced very little in the way of useful outcomes, we are still having to deal with that legacy. The threat to our healthcare system that Thatcher posed is one significant, but not the only, reason she was removed from power.

Once you do have socialised medicine, you will also find it turns into a right of expectation, woe betide any politician who threatens it or screws it up.

Citizens generally like socialised healthcare, but it is very expensive, the system of sourcing healthcare services could be state funded treatment with private practiioners, through a mixture or private/nationlised, all the way to having a unified and single state suppiler of healthcare services, there are advantages and disadvantages to any system selected.

Next, you will need to work out how to pay for it, income tax will certainly have to rise, but there is one benefit, because it affect the politicians who will have an incentive to keep costs low, or keep value high in order to control taxation.

The financing of a national health service also has it problems, because resources are always limited and invidious choices have to be made, taxpayers will not provide a blank cheque which means costs of drugs will determine treatment instead of need.

How will you deal with those who work in the black economy, becuase realistically, this will become a big political issue, illegals who come to the US, pay little or no tax, but expect to have free medical treatment, it happens in the UK to a fairly limited extent, but in the US it would probably be a greater issue.

It would have a couple of huge advantages for workers, becuase they would become more employment mobile, instead of being tied down with certain employers due to the medical insurance, this in turn may well allow companies lower direct costs though indirect ones would rise.

There is likely to be a current huge unmet need for treatment, this has happened in most places where private medicine has been socialised, and it would take quite a few years to bring this demand down.

There is no reason to enforce compulsory state medicine, people should be free to insure themselves if they feel that is the best way to spend their money.

In the long run Socialised Healthcare does appear to cost less per capita, or GDP or whatever measure you choose, but then the quality of care is crucial too, for those who have the resources to obtain healthcare in the US, it would appear socialised healthcare is averaging quality downwards, but for those without cover its going to be a huge step up.

23

http://ezraklein.typepad.com/blog/2005/07/malpractice_in_.html
The malpractice as a problem is hugely exaggerated as a force in health cost. It is not.

24

[QUOTE=zhongguorenmin]
I take your George Bush point - but every other rich country does it fine, and comes out ahead of the US.
[/quote]

I don’t think so. Do any rich countries have “socialized” medicine? I mean really socialized, not in the caricature sense that some on the right mean when they use that term.

must…resist…Katrina…joke

That would actually be fine by me. But the US government is rather unusual in that it’s not a parliamentary style of democracy. When we elect a joker like Bush, we’re stuck with him for at least 4 years.

I like what’s happening now at the state level. Several states are taking on the issue, and we can see which approach works best for our style of government and our culture. My own state, CA, has a population and an economy that rivals most European countries. So I don’t see the need to have 1 single solution in the US, and if smaller states want to pool their efforts, then they’re free to do so. That does add some level of complexity in that a person moving from one state to another has deal with transitioning from one system to another, but that’s true of a lot of things.

25

[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]
zhongguorenmin
[/QUOTE]

I am enjoying the comments so far…

I haven’t seen anything of substance that supports your contention that socializing medicine in the US will solve either of the above two problems, though.

On the inequitable front: every US physician I’ve met is very frustrated with this. We are a titchy bit reluctant to assume the Feds can make it equitable without sacrificing quality, anymore than they have made schooling equitable for instance. We don’t want to trade the current system for one that is equitably lousy. Also, I think there are some broad restrictions in the UK to help ration expensive procedures. I may be completely wrong about this; I do not follow it. But historically that has not sold well as a policy in the US.

On the inefficient front: I totally agree. However I’m not sure the inefficiency hurts the economy, because I do not understand economics. I just look at it as a mechanism of redistributing money. If one thinks the drug/insurance/health corporations are making a killing, just buy their stock and get in on the action…

I am completely confused about your point on the “entitlement crunch.” Those ARE our nationalized medicine programs. If they are a problem, how is nationalizing the rest going to help? Socializing all medicine does not remove the need for medicare; it just extends it to the entire population.

I don’t have the sense that the British have torts affecting them to the extent we do. For the average physician here (and physicians control about 80% of the total health spend to the extent that they order everything, including hospitalizations and testing) the effect of tort concerns far exceeds anything that formal studies ever report. It is so pervasive that we just accept it as a background reason for all sorts of things.

Finally, while I recognize this is not a debate about the quality of care, do you have a sense of how many people who have a choice choose to get care in one country v the other? Are wealthy US citizens flocking to Britain for really decent care, or vice versa? Is Britain creating new procedures and medicines and innovative care at a pace that meets or exceeds ours? Is their medical reputation better than their dental reputation, for instance? :wink: (Just kidding. That was Mike Myers; not me.)

26

[QUOTE=Dominic Mulligan]
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.
[/QUOTE]

It doesn’t have to jibe with the reality in Britain. The U.K. is not the U.S.

It’s honestly not even a matter of doctor’s being purely economical per se.

In the U.S. for many specialties (osteopathic, dermatology, opthalmology, immunology, etc) the doctor is effectively a small business owner. They operate out of an office space in a larger office building, sometimes with many independent doctors having office spaces inside, or they operate in their own free-standing buildings, sometimes their practice is in partnership with another doctor or maybe two or three other doctors. But essentially, they are very much like a guy who owns a butcher shop, except they make more money by virtue of their product (their expertise and medical training) being more valuable than the butcher’s (preparation and sale of meat.)

Doctor’s in this setting typically make more than the doctors who work at an emergency room and would almost certainly make way more than a doctor employed by government. Even if they wanted to spend 3.5 days/week working for the NHS, they realistically could not. To maintain private practice you can’t get away with only being able to see patients 1.5 days out of the week. A private practice physician has to build up trust and clients over time, and only being able to see people on a very restricted number of days would incredibly hamper that.

27

[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).
[/QUOTE]

Why not? That sounds better to me, and most countries do it that way right? Besides, this would be much less of a shock to the system.

28

[QUOTE=Martin Hyde]
It doesn’t have to jibe with the reality in Britain. The U.K. is not the U.S.

[/QUOTE]

What do you think the situation was like in the UK before the NHS was created? Do you not think that British doctors also had private practices?

The situation in the UK is not like the situation in the US precisely because we’ve instituted a nationalised health system.

29

Many of the GPs in the UK are in effect Health franchises, the local GP may well own their local practice.

Funding is allocated from the regional health budget, this is done with targets and with consideration given to the number of patients, the age of patients and the types of ilnessess they have.

Many UK citizens do not know this, but as far as they are concerned, GP practice is free at point of use.

Some GPs find that the work is hard and hours are long, but financially they are very well to do.

Quite a lot of GPs in recent years have chosen to give up their own practice, and instead take up a fully National Health Service pratice which covers their previous patients - this then makes them employees instead of small business owners and gives them a lot more time off, pay is very nearly equal to before but there is far less risk, and they have the benefit of having more support staff that they do not have to finance themselves.

I would imagine if the US were to operate state healthcare, then GPs would retain the option to run their own practices, in effect businesses, but over time you would see practices in densely populated areas slowly move over to employed GPs, as it is much less hassle for them with very little loss of income.

30

[QUOTE=zhongguorenmin]
Why do I think it matters what I think a maximum salary is? Firstly because this is a forum for debate. Secondly, because I am a voter and taxpayer in a publicly-/wellsystem. I have an opinion on a sensible wage for a doctor, in the same way as I have an opinion on a sensible wage for a soldier or police officer. So take your snarky tone elsewhere. :rolleyes:
[/QUOTE]

I apologise for offending you. I didn’t mean that you were not entitled to an opinion. I meant that your opinion about appropriate salaries for doctors is of no consequence, in itself. The amount that doctors earn ought to be a matter for the people who employ them.

I don’t understand why healthcare is treated differently in Britain than other demand/supply stuff. If it’s because “poor people shouldn’t die just because they’re poor”, you still have to face up to supply/demand. The idea that a socialised system is fairer is a fantasy. Instead of rich people getting the best surgeons, well-connected people get them. And they’re generally the same people. There’s nothing we can do about this, without changing the whole basis of human interaction.

31

[QUOTE=zhongguorenmin]
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
[/QUOTE]

How much does medical school actually cost in the UK? How much of that does the student need to pay themselves? Also in the US medical school lasts four years and is usually preceeded by four years of university. It only 5-6 years in the UK and directly follows secondary school.

32

[QUOTE=Usram]
I apologise for offending you. I didn’t mean that you were not entitled to an opinion. I meant that your opinion about appropriate salaries for doctors is of no consequence, in itself. The amount that doctors earn ought to be a matter for the people who employ them.

I don’t understand why healthcare is treated differently in Britain than other demand/supply stuff. If it’s because “poor people shouldn’t die just because they’re poor”, you still have to face up to supply/demand. The idea that a socialised system is fairer is a fantasy. Instead of rich people getting the best surgeons, well-connected people get them. And they’re generally the same people. There’s nothing we can do about this, without changing the whole basis of human interaction.
[/QUOTE]

No (non-momentary) offence taken! :slight_smile:

I am certainly not well-connected, and because of the severity of my case, when I had open heart surgery in April I was referred to the best guy in the country for this procedure (allegedly one of the two best in the world, the other is supposedly some guy in Canada).

It was a re-do aortic root replacement, for those keeping score, and his stats are supposedly well ahead of almost anyone else for this procedure.

I know the plural of anecdote is not data, but do you have any evidence that the best-connected people get the best surgeons? Unless one is a very difficult or specialised case, it is usually determined by which region you live in.

zhongguorenmin

33

Comparing the training and education of UK medical doctors and US ones is probalby not going to work all that well.

The choice of the words ‘secondary school’ is misleading, and becoming a doctor in the UK may well not be the same as a US one.

Doctors having only 4-5 years would almost certainly be called junior doctors, these have not yet decided their specialisation and have a huge amount of further education to do.

Junior doctors having completed this stage of their training have to then apply for appointments which will include the next stage of their training

It will take someone at least 12 years to reach consultant level and nine years to reach GP level in the UK, it often takes very much more than that depending upon the exact specialism.

http://www.nhscareers.nhs.uk/details/Default.aspx?Id=561

The US medical practitioner will probably take similar amount of time to achive the same levels, the stages may appear to have differant terms applied, and specialisms may well be chosen at differant stages.

34

From what I can reason, the benefits aren’t very good for socialized medicine. So far I can see

  1. people without health insurance will have health care, and
  2. the total out of pocket expenses for health care might be lower for people who already have insurance.

I’ll argue against 1, because those without health insurance are generally the poor and uneducated. These people are also chronically unlikely to go to the doctor regularly even if they have insurance. One of the major issues Wal Mart has with its employees and health care is that they spend such a large amount of money on emergency room visits that could have been prevented through regular doctor visits. I have no reason to believe poor people would go to the doctor more if it was socialized, since poor people who already have health insurance don’t go.

Number 2 isn’t really proven, either. Compare your insurance costs and doctor visit premiums vs. the tax increase necessary to sustain socialized health care, and I bet it comes up pretty close to equal. I guess a tax supported socialized health care system might take some of the burden of health care from the middle and lower class, and place it on the upper class, but I’m not convinced that it’ll actually leave me (or anyone else) with more money in their pocket for the same standard of health care they can get today.

On the other hand, I can see a lot of bad things resulting from socialized health care. Socialized health care means nationalized drug companies, and nationalized drug companies mean that there isn’t any financial incentive to develop better drugs.

There would be less incentive to improve a lot of other things, too, like medical technology. Who’s going to develop new medical tech if they can’t sell it to the highest bidder? Money is a great incentive for innovation, and when you remove that concept from medicine you end up borrowing whatever innovations have been developed by other countries.

35

Exactly! That’s why most countries don’t have socialized medicine, they have socialized health insurance.

36

[QUOTE=zhongguorenmin]
I know the plural of anecdote is not data, but do you have any evidence that the best-connected people get the best surgeons?
[/QUOTE]

East Germany?

37

Sorry but that comment about nationalised drug companies is just plain flat out wrong.

Socialised healthcare does not mean nationalised drug companies at all, where on earth would you get that idea ?

It’s not true in the UK, its not true in the Western world and in any case drugs companies are largely multinationals, and have serious leverage along with patents to ensure that novel treatments can generate revenue.

There are foundations that carry out drugs research, but that is a far cry from being nationalised.

One problem is that profit driven drug companies, will go for maximum mark up, it is not in their interest to look into cheap effective treatments.

It was something of a farce the story about stomach ulcers and Helicobacter pylori.
The drug companies went for treating the symptoms which made lots of long term profit.

It turned out that treating the infection costs far far less, but the drug companies hadn’t looked into that, there was not the potential income stream available so they didn’t research it.

38

[QUOTE=Usram]
East Germany?
[/QUOTE]

Is that the best you can do?

zhongguorenmin

39

[QUOTE=Mosier]

On the other hand, I can see a lot of bad things resulting from socialized health care. Socialized health care means nationalized drug companies, …

[/QUOTE]

Pure nonsense.

40

[QUOTE=zhongguorenmin]
Is that the best you can do?
[/QUOTE]

The point is, healthcare allocation has to be determined by some means or another, and if you think it is determined by anything other than selfish reasons, you are deluding yourself. Therefore, it is best to be upfront about it and treat it like any other desirable good.