patrick.net

Rin says

Yes, there's free market, in terms of supply, in the field of medicine. Here's my solution,

I like your suggestion, but there isn't a free market. The AMA cartel restricts the number of slots in medical school, and makes immigration difficult for doctors, and the prescription mandate prohibits people from buying their own medications without paying for permission first. Artificially constricted supply + artificially inflated demand = higher prices, i.e. higher revenue for the recipients and higher costs for everyone else. Our tax dollars at work, against our interests. Simply repealing the prescription requirement would reduce costs immediately. Your solution could also reduce costs and improve availability, but it would take longer. The two can be complementary.

curious2 says

but there isn't a free market

Sorry, my typo. Yes, there's no free market in medicine.

Yet, none of the Romneycare nor Obamacare wonks even mention it. Isn't that the reason why seeing a doctor in the US costs $200-$300 for a 10 min consultation vs $50 in other first world nations like Singapore or Japan?

curious2 says

Rin says

Yes, there's free market, in terms of supply, in the field of medicine. Here's my solution,

I like your suggestion, but there isn't a free market. The AMA cartel restricts the number of slots in medical school, and makes immigration difficult for doctors, and the prescription mandate prohibits people from buying their own medications without paying for permission first. Artificially constricted supply + artificially inflated demand = higher prices, i.e. higher revenue for the recipients and higher costs for everyone else. Our tax dollars at work, against our interests. Simply repealing the prescription requirement would reduce costs immediately. Your solution could also reduce costs and improve availability, but it would take longer. The two can be complementary.

More Curious2 bs.

Artificially constricted supply + artificially inflated demand = higher prices.
That's odd, the area's that have the highest number of doctors per capita have the highest cost. I've pointed this out time and again, but you never address it.

The AMA cartel:
So how does the AMA cartel keep up doctor's salaries in the rest of the first world? I'm doing some international medical recruiting and US salaries just aren't all that much higher than most of the first world. Don't bother posting the old cbo salary report that floats around, it's just not right. I have cv's on my desk right now and I know what these guys are making in Europe and Austolasia.

The AMA is doing immigration now? Pretty powerful organization.

Rin says

Yes, there's NO (typo, now fixed) free market, in terms of supply, in the field of medicine.

Both you and curious don't seem to comprehend the fact that the restriction is in residencies not medical schools. The number of residency slots funded by the states and medicare is the limiting factor. Please don't bother with the tired residency accreditation argument, it's just fiction.

Rin says

Here's my solution, if one can score a 30 or higher on the MCAT, he/she should be able to transfer into the clinical years of an MD program,

Not a bad solution but why use the mcat? It's not comprehensive or broad based enough to begin to be an evaluation. Why not allow anyone that can sit and pass the regular medical school exams for all pre clinical subjects to go directly into 3rd year? If they know the material then why not?

Why restrict this to medical school? You could apply this to all higher education. Anyone that just passes the tests in all the subjects could get their degree. Cut the cost of higher education to nothing.

Rin says

Most engineers and scientists simply do not have sustainable salaries of that amount

So why aren't engineers and scientists also overpaid in your mind? There is a severe constrictions on immigration of these people. Why shouldn't we have unlimited immigration of engineers and scientists? If there were unlimited immigration of engineers and scientist then the cost science and engineering would plummet to the point where we would be much more competative with the rest of the world. What's good for the goose is good for the gander.

bob2356 says

Artificially constricted supply + artificially inflated demand = higher prices.
That's odd, the area's that have the highest number of doctors per capita have the highest cost. I've pointed this out time and again, but you never address it.

You really don't seem to understand economics. Of course the areas with greatest demand (i.e., highest prices) attract the most supply. The supply is there because the demand is there. If you were a doctor choosing where to live and work, would you choose the place where you can make twice as much $, or half as much? If you are going to open up a bait shop, would you put it near a lake where people go fishing or would you put it in a desert that has no water and no fish? Supply follows demand.

bob2356 says

The AMA is doing immigration now? Pretty powerful organization.

The AMA represents only 12% of doctors, but is hugely active in lobbying. Ronald Reagan used to work for the AMA, fighting against the enactment of Medicare. AMA lobbying drives policy for the express purpose of increasing revenue for the AMA members and the AMA itself. You can read more here if you like:

http://politicalcorrection.org/factcheck/200906110008

bob2356 says

Why shouldn't we have unlimited immigration of engineers and scientists? If there were unlimited immigration of engineers and scientist then the cost science and engineering would plummet to the point where we would be much more competative [sic] with the rest of the world. What's good for the goose is good for the gander.

Nice turnaround, it shows that you write from the perspective of deriving your income from a medical practice. Many people do advocate for more immigration visas for engineers and scientists, partly because much of that work gets outsourced otherwise, but American government doesn't spend $1T/yr inflating demand for engineering and science (alas). Politicians artificially inflate the cost of medical care, then use that as an excuse to raise costs even further. That doesn't happen in engineering and science.

I respect doctors' erudition and am happy to see them prosper. I do not respect AMA and PhRMA and AHA and AHIP using government to turn America into a feedlot, where people are exploited like cattle in an overpriced system. Prior to the prescription mandate, doctors earned both $ and respect by providing expertise to people who wanted and needed it. Now, too many doctors sell permission to buy what's advertised on TV, and American public policy is re-oriented towards promoting that. Nothing similar has occurred in engineering or science.

curious2 says

You really don't seem to understand economics. Of course the areas with greatest demand (i.e., highest prices) attract the most supply.

I keep saying per capita, but you don't seem to grasp it. The area's with the greatest number of doctors PER CAPITA , ie, the greatest supply per patient, have the highest medical costs. So your solution to medical costs is to further raise the number of doctors per capita.

curious2 says

but American government doesn't spend $1T/yr inflating demand for engineering and science (alas)

Ok I'll bite, how exactly does government inflate demand for medical care? Americans go to doctors less than any of the other first world countries. How is it that government is getting people to see the seek medical care that wouldn't go otherwise? People go to doctors because they are sick, not because they have nothing else to do.

Please don't post a bunch of irrelevant links, actually explain in your own words the process of how this is done. You haven't managed to do that yet.

curious2 says

Prior to the prescription mandate, doctors earned both $ and respect by providing expertise to people who wanted and needed it.

Which prescription mandate are you talking about? The customs act of 1820, the import drugs act of 1848, the wiley act of 1906, Federal Food, Drug, and Cosmetic Act, of 1938, drug amendments act of 1962, medical and therapudic devices act of 1972, infant formula act of 1979?

I'll guess food, drug, and cosmetic act of 1938 since that was the one that set up what became the fda and regulated the sales of medical drugs. Medical expertise in the 30's pretty severely limited. Lifespan was something like 39. Gee I wonder if all those doctors selling permission ever since had anything to do with doubling life span?

curious2 says

Nice turnaround, it shows that you write from the perspective of deriving your income from a medical practice.

The health care system in the US is totally screwed which is why I'm not involved in it and I have no financial stake of any kind in it at all. But your perceptions of why and who is responsible are so at odds with the reality of the situation I can't even grasp what you are talking about half of the time. I notice you have never bothered to enlighten me on the source of your expertise. From all your strident somewhat bitter posturing I would guess some type of malpractice lawyer or consumer advocate. Or perhaps someone who didn't get into medical school.

I thought that the way to do it was to go to medical college and do your internship in some other country (like a third world country). Then come back to earn the exaggerated salaries.

bob2356 says

Lifespan was something like 39. Gee I wonder if all those doctors selling permission ever since had anything to do with doubling life span?

The first five presidents of the United States lived a median of 82 years, with no access to modern medicine. Today, the average American dies sooner than that. Education remains the best predictor of longevity; money and health insurance pale in comparison. Clean potable water helps too: plumbers have saved more lives than doctors. That isn't a knock against doctors, it is merely a fact that modern medicine is not the primary cause of increased life span.

bob2356 says

how exactly does government inflate demand for medical care?

Where to begin counting the ways? Fee-for-service Medicare and Medicaid are two examples. The tax subsidy for employer-sponsored medical insurance is another. RomneyCare in Massachusetts, soon to become national as ObamneyCare, figures prominently in the Presidential debates. How can you not have noticed any of these things?

You recognize the role of DTC ads on TV in driving excess demand for pills, but you don't seem to acknowledge the role of government cost shifting. If the people who fall for those TV ads weren't subsidized by government-mandated cost shifting, i.e. if their demand weren't artificially inflated by subsidies, their personal budgets and resistance to overpaying would result in fewer people buying that stuff. The purpose of the ads is to create demand, and the subsidies inflate it further.

bob2356 says

Which prescription mandate are you talking about?

1951. Although you don't want links, I'll post one anyway:

http://www.jstor.org/discover/10.2307/725214?uid=3739560&uid=2129&uid=2&uid=70&uid=4&uid=3739256&sid=21101318409901

I will also not respond to your continued efforts to shift from substantive debate to an ad hominem food fight. You write of your personal experience married to a doctor, and in fact I believe that part of what you say. On the Internet though, anyone can pretend to be anything; Marcus pretends to be a math teacher. Valid arguments depend on their own merits and reference to objective data, so I will not go along with your efforts to replace source links with ad hominem attacks.

Maybe you don't like links because your claims about The New Yorker got so conspicuously disproved.

bob2356 says

I keep saying per capita, but you don't seem to grasp it. The area's with the greatest number of doctors PER CAPITA , ie, the greatest supply per patient, have the highest medical costs.

You keep saying "area's." You don't seem to grasp that the plural of area is areas. But that isn't the point. The point is you also don't seem to grasp causation. As I said, supply meets demand. Where people are spending a lot on medical care, they bid up prices, and more doctors arrive, i.e. the supply rises to meet the demand. If you look at Rodeo Drive, you can observe many high-end retailers. They locate there because there is demand there. If those same stores re-located to a place with less demand, e.g. Fresno, they wouldn't be able to charge the same prices. This is economics 101.

Sorry but you people don't know SQUAT. I'm an engineer and my wife is a doctor. She is FAR from overpaid. She makes about $200k as a family practice doctor. Her taxes, malpractice insurance an other related expenses take a healthy chunk of that. In addition she works about 60-70 hours a week. When she is on call she might work 12 days in a row without any time off. 20% of that time is spent on the phone fighting with insurance companies trying to either get paid or get patients the medicine or tests they need or filling out copious amounts of paper work so she can get paid. We get calls all hours of the day and night. She can hardly take a day off.
Factor in all the time she works and I probably make more than her. I work 4.5 days a week get 4 weeks vacation time a year and make less than 1/2 what she makes. I'll take my job over her's any day of the week. Sorry but you people just haven't got clue.

All those that "don't know SQUAT", soopercommuter is always available to answer any questions.

Sooper -- I understand. If possible, your wife might think of working in an urgent care facility, where you're never on call and your hours are fixed. Might make a bit less, but not by much.

Doctors are just the next head-on-the-block after teachers and postal workers, put there by billionaires and vulture capitalists to distract any negative attention to themselves.

Rin says

I think it's time that we stop the lies and admit the truth, doctors are simply overpaid.

Nah. Once you go to college, then Med school, then residency followed by all the shit you have to do just to start out... then pay the fees, the overhead, the insurance, the staff... dedicate your life including after hours, etc to caring for people and dealing with insurance... well, then we'll talk.

People become physicians for many different reasons - the time & energy they pour into their lives, often resulting in divorce or a very understanding spouse who learns to live without them much of the time... Bankers and other people make a hell of a lot more and don't have to worry about killing people

Doctors aren't perfect, but they earn every dime. If they were all in it for the money, they'd be in the high price side of the profession.

My brother in law who works in Medical billing business in NY, was belly aching about Medicare prices and how Doctors are turning them away because they are underpaid.
To which I replied...
"Mike nuttin for nutti, but the day I see Doctors going home to trailer parks, I'll chime in along with you. But until then..."

elliemae says

People become physicians for many different reasons

You mean like, money, compensation, cash, and the ability to get laid easier?

sorry.

Astronomically stupid idea.

> 30 on MCAT and 3rd yr? You have NO idea what medical school is like, thus you don't know what the first 2 yrs are missing. It's not just biochem, physiology. all of 2nd year is pathophysiology. you don't even know what you don't know.

you are obviously just jealous of physicians as you couldn't get into med school

The problem is not the doctor getting a good pay. The overall medical care costs too much in US.

When I got sick in Germany recently, a cost to visit doctor's office was less than $30 without the insurance. The copay for my health insurance was already at $20, so I didn't even bother claiming it. Now, I want to know why it costs so much even to see a doctor here in US. I am assuming the doctors in Germany are getting as much as their counterparts in US. And the quality of care is pretty much the same.

Re-reading the OP and the comments, I think the averages conceal a deeper problem. The problem isn't doctors on average being overpaid or underpaid, it's the structure with perverse incentives that overpay bad practice and underpay good practice. Picture the careful surgeon who says honestly to a patient, "Sorry, I can't help you with surgery, there is nothing better for your old knee than ordinary ibuprofen, aspirin, or naproxen sodium." The disappointed patient goes across the street for a second opinion, and encounters a butcher who says "Hey I can replace that knee TODAY! You'll LOVE your BRAND NEW KNEE!" The butcher gets paid thousands of $$$, the careful surgeon gets nothing, and both pay the same malpractice premium so when the knee replacement turns out to be crippling the cost is shared equally between them. Government artificially inflates the demand for pills and procedures, enriching butchers and poisoners, while honest practitioners struggle to make a living or go out of business. The honest practitioner knows that whole categories of pills (e.g. SSRIs) and procedures (e.g. most knee replacements) are worse than useless, but to quote Sophocles, "How sad is wisdom when it brings no profit to the wise."

I am assuming the doctors in Germany are getting as much as their counterparts in US.
A PBS documentary I saw a couple of years ago showed doctors in Germany on strike. I'm assuming they make less than their US counterparts.

Update: A family doctor in Germany makes about two-thirds as much as he or she would in America. (Then again, German doctors pay much less for malpractice insurance, and many attend medical school for free.)

elliemae says

Bankers and other people make a hell of a lot more and don't have to worry about killing people

Bankers should worry about that, but they don't.

Rin says

Simple, doctors are overpaid

No way. You don't understand the effort doctors put in their profession. It is not a easy job. If you put yourself in their shoes then you will understand how difficult their job is.

Just Imagine yourself how difficult it is when you tell the patients family now its time to pack up and remove the oxygen. How much stress a doctor takes.

While Rin's suggestion makes sense it won't reduce prices by much.

1. Two medical years at school, two to three residency years, and two+ years of specialisation are very abusive. The stress is incomparable to one PHD students or Post-Doc scientists experience. (disclosure: my son is in his medical years now after finishing his PhD in biology/medical research)

Physicians will still come out with lots of debt and will need some compensation for these long and very difficult years of their life. I don't think any other country has such an abusive rite of doctors initiation.

2. The culture that promotes frivolous law suits will not go away. The malpractice insurance won't be any lower.

However, Rin's idea may work well, combined with government scholarships provided for an obligation to repay it with certain number of free care hours. In turn the free care recipients should sign up on a waiver of any legal litigations and the government should enforce such waivers.
(That does not mean malpractice will go unpunished, it means patient will not be paid any proceeds of malpractice law suites in such cases. Physicians may still lose their licenses in case of a proven malpractice.)
Second, such scholarships should be provided based solely on the academic success of the applicants not on any social/economic status, like gender, race, income etc. The goal of such a program should be getting as many as possible most talented doctors, not solving any social injustices.

Nobody says

The problem is not the doctor getting a good pay. The overall medical care costs too much in US.

When I got sick in Germany recently, a cost to visit doctor's office was less than $30 without the insurance. The copay for my health insurance was already at $20, so I didn't even bother claiming it. Now, I want to know why it costs so much even to see a doctor here in US. I am assuming the doctors in Germany are getting as much as their counterparts in US. And the quality of care is pretty much the same.

No they don't make as much but they are happy being middle-class to upper middle-class (and getting laid). It is true that due to student loan costs you start out much in the red in the US, but this is due to the generally broken system. That being said, there is a lot of other things to be fixed that may yield better results before taking on the doctors, but it is no secret that doctors in Europe (or almost anywhere else) are equally happy earning significantly less than their US counterparts.

Most Dr's are not overpaid. The biggest chunk of healthcare dollars extracted from the system, which does contribute ANYTHING positive to anyones health, are insurance companies administration fees and overhead. This is why social medicine countries, and our US Veterans Affairs can deliver excellent care at about half the cost. The other problem is simply how health care is administered in this country, which again, is largely influenced by Insurance Companies. Here is a short article from Harvard Review that I believe outlines a related problem in a succinct manner. Namely, spending healthcare dollars where it does the most good. We don't measure enough to even know where to do this because of competing capitalist pressures that funnel dollars not to the most effective procedures/best practices or Drs, etc, but rather to what makes people the most money. http://hbr.org/2011/09/how-to-solve-the-cost-crisis-in-health-care/ar/1

an excerpt;

"the fundamental value problem: how to deliver improved outcomes at a lower total cost.

Fortunately, we can change this state of affairs. And the remedy does not require medical science breakthroughs or top-down governmental regulation. It simply requires a new way to accurately measure costs and compare them with outcomes. Our approach makes patients and their conditions—not departmental units, procedures, or services—the fundamental unit of analysis for measuring costs and outcomes".

"Fortunately, we can change this state of affairs. And the remedy does not require medical science breakthroughs or top-down governmental regulation. It simply requires a new way to accurately measure costs and compare them with outcomes. Our approach makes patients and their conditions—not departmental units, procedures, or services—the fundamental unit of analysis for measuring costs and outcomes"

That makes entirely too much sense. You must be un-American or something.

crazydesi says

ust Imagine yourself how difficult it is when you tell the patients family now its time to pack up and remove the oxygen. How much stress a doctor takes.

I would find that to be pretty easy. Perhaps APOCALYPSEFUCK and I should be doctors?

Rin says

You can earn over $200K, as a doctor, in places like Des Moines Iowa, nevermind the big coastal cities.

This is because no one wants to live there. The less desirable the city the more incentive needed to attract doctors. Some places are as high as $350K.

Doctors work hard for years and incur a lot of debt to get where they're at. They made sacrifices for years to now make a lot of money, while your lazy ass sat on a couch or went to brunch with your friends every Sunday.

Get a clue.

nw888 says

Doctors work hard for years and incur a lot of debt to get where they're at. They made sacrifices for years to now make a lot of money, while your lazy ass sat on a couch or went to brunch with your friends every Sunday.

Get a clue.

That's like saying people that worked two minimum wage jobs for 8 years, deserve 300K a year, just because.

CaptainShuddup says

That's like saying people that worked two minimum wage jobs for 8 years, deserve 300K a year, just because.

No not really. If they developed the skills to save lives during that time, then yes they certainly do.

If the distortions of insurance and subsidy were removed, supply and demand would show who is overpaid and who isn't. I suspect that current distortions result in good doctors being currently underpaid, while butchers and poisoners are overpaid. But currently it's almost impossible even to get a price quote from a doctor, because everything is distorted by insurance.

curious2 says

bob2356 says

how exactly does government inflate demand for medical care?

Where to begin counting the ways? Fee-for-service Medicare and Medicaid are two examples. The tax subsidy for employer-sponsored medical insurance is another. RomneyCare in Massachusetts, soon to become national as ObamneyCare, figures prominently in the Presidential debates. How can you not have noticed any of these things?

You recognize the role of DTC ads on TV in driving excess demand for pills, but you don't seem to acknowledge the role of government cost shifting. If the people who fall for those TV ads weren't subsidized by government-mandated cost shifting, i.e. if their demand weren't artificially inflated by subsidies, their personal budgets and resistance to overpaying would result in fewer people buying that stuff. The purpose of the ads is to create demand, and the subsidies inflate it further.

I love what passes for logic in your world. I honestly can't discern what you are trying to say. So you are saying the medicare/medicaid fee for service model is a giant front for selling more DTC drugs? So is your 1trilllion "subsidy" to "inflate" demand for health care or DTC drugs? WTF are you saying?

Fact, Americans visit doctors the least of any first world country, so the US system has the LOWEST demand. Fact the cost of health care in the rest of the first world is around half of the cost of health care in America despite higher demand in other places. Fact the rest of the first world has public health care at no or nominal cost to the patient so that means 100% cost shifting.

So how does 100% government cost shifting in the rest of the first world result in half the cost? By your logic costs should be much higher than the US. Simple question. Just a simple explanation in your own words please. Want to run econ 101 past me again?

curious2 says

You keep saying "area's." You don't seem to grasp that the plural of area is areas. But that isn't the point. The point is you also don't seem to grasp causation. As I said, supply meets demand. Where people are spending a lot on medical care, they bid up prices, and more doctors arrive, i.e. the supply rises to meet the demand.

No, you just don't know anything about the economics of medical practice. There isn't any more "demand" in any given population. The same percentage of people get sick no matter what. What happens when there are too many doctors in an area is they boost the number of tests, referrals, and visits to keep up income. The missing part of your equation that you don't grasp is the cost of health care and what doctors earn isn't interlocked. Salaries are much lower in area's with lots of doctors even though costs are much higher. Doctors in the upper midwest earn something like 25% more than their counterparts in NY or Florida. Some of the highest paying jobs are in places like Kansas and Wyoming. My wife looked at a job in Eastern Maine that offered almost double what she was earning in Portland Oregon for a lot less hours. Hell, Roseburg Or which is about 2 hours south of Portland was offering almost 50% higher. The catch is you have to live in Eastern Maine or Roseburg. Sorry to confuse your ideology with more facts.

nw888 says

If they developed the skills to save lives during that time

Oh the Doctors are GOD complex I see.
I bet you also are one of those believe it is the malpractice law suits that is solely responsible for high costs, followed by people with their contagious diabetes?

What good are those life saving skills, if they live on a clock and only dance if you can afford to call the tune?

Show up at a doctors office at closing time, and see how far you get, or don't have the money to cover your out of pocket expenses for insurance, let alone having no insurance and see how far you get.

I think you meant to say, "If they developed Skills to fleece people out of money that can afford to pay for their health." You make them sound like goddamn humanitarians. We should replace every Doctor in America with Indians from India that make less money than a teacher.

My wife saw five Doctors in the last two months, and it was the Doctor in the Emergency room that diagnosed her underlying condition that the previous 4 missed. We were paying out of pocket for their services and they did do a damn thing but stick a thermometer in her mouth and charged us for it. Meanwhile there was a mass in her cervix that these bastards strung us along for weeks at a time for appointment, that by the time we went to them, they informed us they weren't willing to perform the procedure the biopsy. Strung us along for two whole freaking months. Finally the doctor in the ER told her she had an infection, which he cured and referred her to a Doctor that performed the Mass removal the very next day. It turned out to be non cancerous thank god. Though we're waiting on the Biopsy results for 100% certainty.
Those other 4 doctors had her terrified and had it been more serious were running out valuable time by running her around for two months with appointments that they never kept.

In the meantime I have insurance that starts on November 1st but we weren't waiting two months for it to kick in.

And to give what I've been saying all along credit with 100% certainty, now I can say it is not a gut feeling. The whole episode was less than two months worth of Insurance premiums that I'll be paying started this pay check.

Once again it is cheaper to pay out of pocket for 90% of your medical needs than it is to be insured.

The funny thing is I remember the Liberals saying how people use the Emergency room as their own personal Primary Doctor, like that's a bad thing.

From my experience if I am ever in a position where my life may be in danger. I will never go to a Doctors office for treatment. I will go to the Emergency room, and follow up with the Doctor on premise they recommend the next day. Doctors in those offices in cheesy out of the way strip malls, are bunch of Ass-clowns that are there only because they feel they deserve to make GOBS of money because they "Sacraficed" for 8 years as you so shamelessly put it.

bob2356 says

No, you just don't know anything about the economics of medical practice. There isn't any more "demand" in any given population. The same percentage of people get sick no matter what. What happens when there are too many doctors in an area is they boost the number of tests, referrals, and visits to keep up income. The missing part of your equation that you don't grasp is the cost of health care and what doctors earn isn't interlocked. Salaries are much lower in area's with lots of doctors even though costs are much higher.

You seem to be getting upset and contradicting yourself, while ignoring what I and others have posted. Obviously costs and net income are not the same thing, insurance distortions being a major reason for that. Equally obviously, demand and the number of doctor visits are also not the same thing, visits are usually counted as an intersection of supply and demand. In one sentence you say there isn't more demand, then in the same paragraph you acknowledge doctors inflate demand by ordering up more tests (which are subsidized by government and insurance, inflating demand). Please, switch to decaf, read a bit about economics, and come back when you can cite some links. You never acknowledge when you're wrong, and when it's proven quite obviously you say you don't want to see any more links. I will not indulge your hunger for ad hominem food fights, nor your thirst for source-free shouting matches, so if those are all you want then you'll have to direct your attention towards someone else. If you want to discuss intelligently then please cite some actual source links, and quote somebody who knows that the plural of area is areas, rather than endlessly embarrassing yourself with your own words. You might be able to make some good points, but it's impossible to know because you slip so frequently into sarcasm and you almost never cite any sources.

"Why shouldn't we have unlimited immigration of engineers and scientists?"

Because all this means is we get flooded with Asian tech workers with fake degrees (I know they're fake because my wife's friend is one and she told us matter of factly that they fake the diploma and work experience. She helped my wife do the same!!!)

Think about that the next time one of them is cutting open you or your loved one in an emergency room...

curious2 says

You seem to be getting upset and contradicting yourself, while ignoring what I and others have posted. Obviously costs and net income are not the same thing, insurance distortions being a major reason for that. In one sentence you say there isn't more demand, then in the same paragraph you acknowledge doctors inflate demand by ordering up more tests (which are subsidized by government and insurance, inflating demand

Patrick is moderator of this thread.).

I'm not the least bit upset. Are you actually a native english speaker? Ok, for the hair splitting amoung us I will rephrase it to say there isn't any more need, does that satisfy you? There isn't any more need, but because there are excess doctors PER CAPITA they create excess work to bill for. The excess supply of available doctors is creating the excess utilization not the other way around. Satisfied with that wording? There is no contradiction, and the article you keep citing says exactly the same thing. Try to remember that your original point was that if there were more doctors the cost of health care would fall yet here you are saying where there are more doctors the cost is higher. So which is it?

So why are costs so much lower in countries with 100% government paid for health care if government paid health care inflates demand? There should be unlimited demand in those countries as per your logic. This is not an ad hominem food fight just a simple question that keeps getting ignored.

curious2 says

You really don't seem to understand economi

Patrick is moderator of this thread.cs. Of course the areas with greatest demand (i.e., highest prices) attract the most supply. The supply is there because the demand is there. If you were a doctor choosing where to live and work, would you choose the place where you can make twice as much $, or half as much?

This is your quote correct? In your own convoluted way I think you are saying that doctors in high "demand" area's aka high health care cost area's aka area's where lots of doctors practice the doctors are making twice as much. Am I reading that correctly? I thought you said obviously "costs" (I am assuming you mean health care costs, it's not very clear) and net income were not the same thing above. I thought it was you who pointed out how much doctors could earn in Des Moines Which is it? Work on your own contradictions. Doctors earn considerably less money in area's with excess doctors than in area's with a shortage of doctors This is not an ad hominem food fight, just a simple statement of fact that contradicts your assertion that a shortage of doctors is driving the cost of health care.

bob2356 says

In your own convoluted way I think you are saying that doctors in high "demand" area's aka high health care cost area's aka area's where lots of doctors practice the doctors are making twice as much. Am I reading that correctly?

No. And you haven't cited any sources, nor learned to spell "areas".

bob2356 says

I thought it was you who pointed out how much doctors could earn in Des Moines Which is it?

That was Rin. A simple text search would have found it for you.

bob2356 says

Doctors earn considerably less money in area's with excess doctors than in area's with a shortage of doctors

If you were to spell "areas" correctly, that statement would be consistent with basic economics.

bob2356 says

your assertion that a shortage of doctors is driving the cost of health care.

I never asserted a shortage of doctors. But, it is also true that the AMA lobbies for licensing restrictions that constrict supply. Other factors also reduce supply, for example the insurance system that drives many doctors to retire early in frustration. That doesn't create a shortage per se but it does reduce supply, increasing prices.

bob2356 says

Are you actually a native english speaker?

Is that sarcasm again or another attempt to fish for ad hominem targets? You are the one who can't spell the plural "areas".

bob2356 says

The excess supply of available doctors is creating the excess utilization not the other way around. Satisfied with that wording?

No. A culture of entrepreneurial doctors taking advantage of artificially inflated demand by selling unnecessary and even harmful drugs and "services", while shielded from the consequences by "tort reform," is creating excess cost.

bob2356 says

So why are costs so much lower in countries with 100% government paid for health care if government paid health care inflates demand?

Finally, amid all of your sarcasm, you manage to ask an intelligent question that might lead to a useful result. If you did some research, you might find your answer. Those countries manage demand instead of merely subsidizing it, and they subsidize the supply of doctors with free education and in some instances lower barriers to entry. They also don't have the costs and distortions of profit-maximizing insurance companies. And they don't have DTC advertising of Rx drugs on TV driving demand. We have a lobby-driven lemon socialist system that maximizes revenues by victimizing patients, subsidizing everything from HFCS to dialysis while taxing vaccines. BTW, costs are even lower in Mexico, where most healthcare is not government paid.

I took a couple of days off for the hurricane and all hell breaks loose. curious2, thanks for the assist. Looks like you've got everything covered.

Ok, since there's already been a lot of upheaval, here's the Des Moines general medicine, GP, salary survey ...

(http://swz.salary.com/salarywizard/Physician-Family-Practice-Salary-Details-Des-Moines-IA.aspx?&hdcbxbonuse=on&isshowpiechart=false&isshowjobchart=false&isshowsalarydetailcharts=true&isshownextsteps=true&isshowcompanyfct=true&isshowaboutyou=true)

It's ~$171K/yr, not bad for a town where one can buy their home in a couple of years with that kind of salary. Certainly beats the $1M homes in Silicon Valley where one can work for years w/o being able to pay off the farm.

(http://homes.yahoo.com/Iowa/Des_Moines/1646-beaver-ave:fb53d6d435f93881515dd4b617b3156c)

and you can search around there, houses aren't expensive in the heartland.

Next for those who think that my IQ is low, I got an A- GPA in Applied Chemistry/Chemical Engineering, BS level, and a 34 MCAT score. I've taken quantitative courses in thermodynamics, transport phenomena, and reactor design/kinetics which are generally avoided by premeds trying to pad their GPA with 'soft' courses. I'm a jr partner at a hedge fund, having left pure engineering (then IT), for a monied profession. I'll be applying for medical school, once I've banked my first $2-3M, as I don't see being a money manager, as a meaningful profession, despite the high compensation. Yes, unlike others, I don't see money as the only goal in life. I don't mind working 3 days a week for $100K, which any moonlighting physician can do.

And yes, I'm aware that the MCAT isn't the USMLE and thus, only covers undergrad material in biology, general/organic chem, and gen physics, however, i don't believe that many normal science/engineering individuals, who score well on the MCAT, can't study courses which are based more upon memorization than quantitative problem solving like Anatomy, Physiology, Histology, Biochemistry, Embryology, Neuroanatomy, Pathology, Pharmacology, Microbiology, Immunology, etc, the 1st two years of medical school.

AMA-driven Limits on medical schools and thus medical students:

http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-salaries-so-high/

Limits on residency, blamed on Medicare but also driven by AMA (which opposed the enactment of Medicare, and influences the funding):

http://thechart.blogs.cnn.com/2012/03/16/why-your-waiter-has-an-m-d/

Barriers to entry restrict supply and increase prices.

But, there are also larger problems in the medical-industrial complex. Hospital and insurance executives much more overpaid than doctors. Increasingly, doctors find they can no longer practice on their own, and can only work as employees of hospitals and large corporations. The corporations overcharge for their services, but the doctors get only a fraction of that.

EBGuy says

A PBS documentary I saw a couple of years ago showed doctors in Germany on strike. I'm assuming they make less than their US counterparts.

Does that mean they are getting paid less? I don't base my assumption just based on one incident. Oh, and I don't assume the doctors over there are getting paid more, just because they are driving a Porche.

Nobody says

When I got sick in Germany recently, a cost to visit doctor's office was less than $30 without the insurance. The copay for my health insurance was already at $20, so I didn't even bother claiming it. Now, I want to know why it costs so much even to see a doctor here in US.

Much of it is the insurance. In Germany, you went without insurance and paid the actual cost. In America, the insurance companies negotiated with providers (doctors and hospitals) to be "in network" and part of the deal was the provider had to charge triple to everyone "out of network," passing along the actual cost as an "in network" insurance "copay." It got worse from there, as insurers began buying providers (hospitals and large corporate practice groups) outright. It started out like advertising, then became more like the mafia: you pay protection money to your insurance company for the privilege of being protected from the overcharges they put on everyone else. If you pay your insurance premium to the Gambinos, then they won't whack you, but if you suffer an emergency somewhere and John Gotti's crew or some other out-of-network provider gets ahold of you, you still get whacked. The whole thing has become so complicated and secretive that you can't even get an honest price quote from a doctor anymore, and part of that is because 70% of them are now employees of corporations whose pricing is beyond the doctor's control or even knowledge. It took years for the system to get messed up the way it is, but it is the logical result of various factions pursuing their own self-interest and using government to lock everyone into it. If you actually want to understand it, you'd have to spend a very long time reading about it, and it seems you haven't even followed the links on this thread because your question about salaries is answered in charts just one click away from what you're reading now. People don't read widely enough, which is one of the reasons why they become so thoroughly trapped and manipulated.

CaptainShuddup says

My wife saw five Doctors in the last two months, and it was the Doctor in the Emergency room that diagnosed her underlying condition that the previous 4 missed.

I'm sorry to hear that and hope all is okay. There are lazy and incompetent doctors out there that don't care about their jobs at all, and could care less about people. That being said, there are many out there (my wife included), that really care about people and devote their lives to medicine in order to help people.