Every family basically pays an $8k ‘poll tax’ under the U.S. health system | Hacker News Reader

Every family basically pays an $8k ‘poll tax’ under the U.S. health system

washingtonpost.com

38 pointspseudolus18 comments

I love the article's parenthetical explanation of its click-bait headline. In the U.S., "poll tax" usually refers to voting taxes used to disenfranchise black people. U.S. writers on tax issues thus generally refer to "head taxes" or use the Constitution's term "capitation."

It can cost a million dollars to become a doctor in the US. Less if you go to public schools and pinch pennies during your time at school but still half a million or more.

Doctors earn high salaries because if they didn’t we wouldn’t be able to convince kids to become doctors. We already have a severe shortage of geriatric doctors because kids don’t want to enter the field and get paid Medicare rates after accumulating a mountain of debt.

No easy solutions. We have built this problem up over many decades and it will take many painful decades to unwind it all.

Make becoming a doctor cheaper?

Teaching isn't inherently expensive - you can do an online e-learning based system with online tests for 90% of the course content. This whole idea of having prestigious universities with limited class sizes to maintain exclusivity isn't helping the nation.

That’s not an easy solution. Entire economies revolve around education costs. Not to mention there are tens of thousands of doctors that already paid the sky high costs. What do we do with them?

This problem is deeply entrenched into the American economy. Tentacles everywhere. Nothing exists in isolation that can be easily and painlessly fixed with the flick of a pen.

You don’t do anything for them, you let time and the market sort things out rather than trying to engineer any kind of solution.

Just decrease the cost of becoming and practicing as a doctor and you’ll eventually get more doctors who will have to compete, and thus decrease their own fees.

What are the relevant costs? How many of them are imposed by the government?

Or make it easier to pull doctors in specific fields from countries where cost disease isn't hitting training so hard.

Or allow nurses or other trained, experienced personnel to take on more duties.

Or innovate on efficiency and find ways to use and train technicians or teams thereof to perform specific procedures.

Doctors earn high salaries for several reasons - one of which is that they have a strong "union" that is deeply involved in regulating the supply of doctors and their specific responsibilities.

I'm not even sure the current situation genuinely benefits doctors themselves anymore since so many seem to be chronically overworked.

I strongly suspect the main reason is that the AMA limits the supply of doctors. The U.S. has 40% fewer physicians per capita than Germany (and a much less healthy populace).

> Doctors earn high salaries because if they didn’t we wouldn’t be able to convince kids to become doctors.

Are you arguing the reason we can't have more doctor's is because not enough people want to be doctor's? Have you looked at medical school acceptance rates?

> No easy solutions. We have built this problem up over many decades and it will take many painful decades to unwind it all.

There are plenty of easy solutions. Stop requiring a college degree for medical school. Increase the number of medical school slots. Increase how much nurse practitioners can do. But the is fighting all of them tooth and nail.

>Are you arguing the reason we can't have more doctor's is because not enough people want to be doctor's? Have you looked at medical school acceptance rates?

No that is not what I was arguing. Becoming a doctor is prohibitively expensive but being a doctor pays handsomely. If cost and salary were "normalized" nothing would change but it is impossible to just change one of the two. Thus my argument is that we can't just pay doctors less unless we also make becoming a doctor cheaper.

>There are plenty of easy solutions. Stop requiring a college degree for medical school. Increase the number of medical school slots. Increase how much nurse practitioners can do. But the is fighting all of them tooth and nail.

Easy to say, difficult to do. You can't just instantly suck money out of areas of the economy. Things take time to adjust.

Tuition for public medical schools in Texas is close to ~$18,000 a year but they still get paid very well. Doctor's get paid well because there is a shortage due to restrictive licensing, not because it's expensive to become a doctor.

You're right that it is politically difficult. I just meant it was easy in that the solutions are obvious and don't require hard trade offs.

pay wall.

Here you go: https://outline.com/nHcEqX

Seems the article has confused cause and effect. US health care costs haven't caused poor health. Poor health has caused US health care costs.

40% of American adults are obese. Obesity causes heart disease, stroke, diabetes, and cancer. Diseases raise a person's health care costs. Costs do not make that person obese.

It's also not a head tax, because healthy people don't pay it. Obese people need to accept personal responsibility for their condition and stop trying to leech off the system.

It's very rare to hear someone say "I won't eat this burrito - I won't be able to afford the diabetes treatment in 50 years".

Do burritos increase your risk of contracting diabetes?

It's much worse than this.

Dr: "Stop eating burritos and soda or you will need insulin"

Average Joe: "Ok just give me insulin."

Type 2 is largely reversible by diet and exercise. But people would rather just eat burritos and be sick.

The article does not say that health care costs cause poor health. It says that we have poor health in spite of our high health care costs.

Also, you stated that poor health is the cause of high US health care costs and that's not true, either. It's one of the many conctributors.

Also also, healthy people do pay it if they have health insurance and/or pay taxes that contribute to Medicare/Medicaid.

I agree that obesity is a problem though. I also believe that many of these articles about the American healthcare system falsely attribute poorer health to our healthcare system rather than at least partially attributing it to unhealthy lifestyles.

> The article does not say that health care costs cause poor health. It says that we have poor health in spite of our high health care costs.

I think the way it's presented in the article ("health outcomes") strongly implies that healthcare quality in the US is not as good as other countries with lower costs.

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