RE: SOCIALIZED HEALTHCARE or welcome to the NATIONAL POTLUCK - Coming from a German tongue
Hi again,
During my lifetime I developed a sense for facts and learned not to pay to much attention to words only.
To your statement:
"I have spent a lot of time around doctors (I won't speak for hospitals) - I wouldn't blame this on their professional judgement; they are victims of the current system too - they do an overwhelming share of the work and our usually the last ones to get paid."
Let me wipe off my tears and ask:
Just using my common sense and by looking around I see that every doctor I know owns several real estate properties, usually collects gold coins and has 2 $100.000+ cars in his drive way?
The average income of a physician in the US is $200.000
I wish that people that are gifted with intelligence would use it to help others and contribute to a solution, instead of defending the "wrongness" with words, ignoring the actions and facts.
I have no problem with people getting compensated well, but regarding health care, there is a line that needs to be drawn.
Physician salaries vary - some specialists and subspecialists make far more than primary care or general practices. Additionally, I think you are missing that the average doctor in the United States leaves medical school with nearly $200,000.00 in student loans. On top of that, if they are independent - i.e., not employed by an HMO or health system/hospital, they have to cover their own overhead (employee salaries), medical malpractice insurance, corporate insurance, etc... The doctor that takes care of your kids and mine when they have the flu or what-not is not living large as you describe (on average that is); rather, they are comfortably upper middle class. That is a nice place to be, but they are not living the rap music video life as you insinuate in your post.
That some physicians make so much more than others is on account of supply and demand and because of how medical insurers - including the exalted government - compensate for health care. They compensate - more often than - by service rendered, not by meeting some cost threshold of value metric. Additionally, most providers do not work under capitated models where there is a single global payment for a patient. That reality leads to those who provide the most acute and costly services being compensated the most. That is slowly starting to change with value-based payments, but it isn't anywhere near substantially changing the distribution of physician compensation.
One more item - I don't understand the complaints about physician compensation to begin with. It is rather illogical when you look at what percentage of health care spending in United States even goes to physicians (and the overhead described above still needs to be removed from that to discover their profit). I would encourage you to look at some of the links below to see some background on the breakdown on healthcare spending in the US. This is a more complex issue than x makes too much money. Costs in the US have a lot to do with parties (hospitals, testing centers, pharmaceutical companies, etc...), and we simply spend more because we are relatively less healthy than other peer nations. Additionally, we have other social determinants that cause expensive care settings - ERs for example - to become a cross between a primary care practice and a social services agency.
If the government became the only insurer tomorrow and covered everyone at Medicare rates (Bernie's Medicare for all), that would not, in any way, fix this issue. This is more complex than who is the provider of insurance.
Additionally, why shouldn't people who provide objectively valued services (for example neurosurgeons and oncologists) be compensated very well. They have extremely high risk and stressful jobs that require substantial debt and time (in addition to a level of intelligence in at least the top 15 percent or so). Also, they get sued a lot, many have to run or co-manage their business. Their jobs literally extend peoples' lives and fill a valuable need in society. That seems like a good reason to compensated very well. I am not seeing these people are perfect; I am just saying that most of the complaining about their compensation is grounded in less than factual information or anecdotes that irritate people. Important debates ought to be grounded in evidence.
Note: Some information on physician compensation, cost breakdowns for health spending, etc... can be found here:
http://www.commonwealthfund.org/publications/press-releases/2015/oct/us-spends-more-on-health-care-than-other-nations
https://economix.blogs.nytimes.com/2008/11/14/do-doctors-salaries-drive-up-health-care-costs/
https://economix.blogs.nytimes.com/2008/11/14/do-doctors-salaries-drive-up-health-care-costs/
http://www.healthcarefinancenews.com/news/physician-compensation-among-lowest-western-nations
I'll just answer this one:
"Additionally, why shouldn't people who provide objectively valued services (for example neurosurgeons and oncologists) be compensated very well. They have extremely high risk and stressful jobs that require substantial debt and time."
How about the risks a fireman, a cop or a soldier takes.
The fire department is socialized and works exceptionally well. So does the military. Talk about the risks and the stress those people take.
Maybe somebody else wants to chime in.
I think you missed that the number of people with either the skills or desire to go through the time and take on the debt to be a specialized medical professional is smaller - significantly smaller - than the number of people that are willing to enlist, become a fireman, or be a police officer. Also, police officers and firemen are well-compensated when you count in the costs of their public pensions, health benefits, overtime, etc... Those are highly paid working class jobs. I won't speak for the military.
I am honestly confused about the premises that you are using to come up with which professions are worthy of a certain salary. In your ideal world, who ought to be the arbiter of compensation?