US spends most on health care but has worst health outcomes
wesh.com
wesh.com
I'm generally a very conservative person. But even I am for government funded healthcare. Who in the hell is against it? I've not met a single person completely against it, mostly just people against people abusing emergency rooms.
Certain big media and politicians are against it, saying we have the best in the world and often pointing at waiting lists in other places. My last gastro had a 7 month waitlist. What in the hell am I paying a fortune for every paycheck, then?
“Oh, yeah, if someone has that cancer and they’re under 45 it’s an auto-reject from me. Just too unlikely for them to have it” was one message that’s stuck with me. You (or your company) pays thousands of dollars a year (or more) to an insurance company to cover you for when the worst things happen—and despite you or your doctors trying to get your shit together, somebody chilling 1500 miles away skims your report and auto-declines any form of coverage just because it seems unlikely. Then it’s an uphill battle of trying to not only battle your illness and your daily life, but a company that has employees with worse judgement than an AI thrown together by some dude on Twitter in a weekend.
It’s disgusting to think about.
It could also be malfeasance, but I doubt that is happening on a systemic level at the big health insurance companies. They benefit from more healthcare spending, so I do not see why they would want to tamp down on necessary expenses.
Read about how doctors and patients talk about Medicaid, Medicare or Tricare. If you say they're popular I'd agree with you - but you need to see what people say when they're asked if they like their own private insurance; generally that's popular too. Most people like whatever health insurance they have most of the time because insurance only pinches in edge cases - not when I'm healthy and only in the subset of sick case called "I want a treatment that my insurance won't pay for." Those cases are always going to happen and sometimes it will be for legitimate reasons.
Roughly half the country is against it! And ironically, it's often because they want "choice" in their medical care, despite the fact that health insurance is tied to your employment and you barely have any choices under your control anyway -- you go with the clinic or hospital that takes your plan, and you go with the doctor that's available.
The article linked below has it at 60/40. But that's just a simple yes/no survey. When you probe the 40, they are mostly for it too, just with extreme reservations. Talk to some. It's definitely not an 'I got mine, let everyone else die' as is painted.
https://thehill.com/policy/healthcare/3826215-57-percent-sup...
I don't believe, even given revised data above, that even 1/3 are against it. I'd estimate less than 1/5 are against it no matter what. The remainder has doubts and conditions, a given considering how awful government projects usually go. If I thought healthcare would be run like the DMV, I'd vote against it too.
If Americans had any international perspective at all it would be much harder to keep that fiction alive, but Americas generally are completely ignorant of how people live outside the us, and not interested in finding out.
The media promotes all of these myths, with the eventual goal of a complete government takeover of health care.
We can add one bonus myth here too: the idea that the US healthcare system leaves people to die if they have no money and no insurance. Nope! If you show up at any emergency room, they cannot refuse treatment. And of course, getting insurance for the poor or lower-middle class is easier than ever due to Obamacare.
So while it's far from a perfect system, it's a lot better than the media paints it as. And the government alternatives are not utopian. See https://www.theguardian.com/society/2022/mar/02/private-heal...
In any case, people die waiting for service with single-payer healthcare as well. Before you try to reform the system, try to understand how the system actually works rather than just repeating talking points.
As far as healthcare reform goes there's nothing particularly complicated about having a multi-billion dollar industry sieve funds that could be better spent on actual healthcare providers. There is also the minor issue of America's medical bankruptcy rates compared against literally every other industrialized nation on the planet, and the small matter of us having both the most expensive (by a wide margin) and one of the least effective healthcare systems of any 1st world country. Again, what the fuck are you stanning over there?
No advantages whatsoever? That would be a plausible argument if Canadians didn't seek treatment in the US in record numbers, growing by over 20% a year.
The amount of Canadians who visit the United States has increased dramatically over the last 10 years, many of which seek services which are simply not available at all in Canada -- such as specialist cancer treatment.
The NHS in the UK, commonly cited as the golden child of government-run healthcare, has the longest wait lists ever with tens of thousands waiting over a year. [2] NHS spending has increased over 6.5% yearly since 2010, with even more massive increases planned for 2024-25.
With the massive NHS spending, UK's nurses and doctors are treated like slave cattle. They earn less than 1/3rd of their US counterparts. This indicates administrative incompetence, skyrocketing middle management, waste and fraud.
[1] https://fee.org/articles/america-outperforms-canada-in-surge...
Yes! It needs more. Glad to have cleared that up.
> Also curious how you square "outperforming" ...
This is the conclusion of the study in the article you're commenting on
UK is outpacing France's spending increases by 2,066%. How does the UK need over 20x more spending increases than its close neighbor, exactly?
https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
Besides, in 2019, the difference was 4% on a per capita basis -- according to World Bank figures. [1] [2] Probably reflecting the massive difference in spending increases.
Given the NHS' planned spending increases from now until 2025, it is very likely the UK will overtake France altogether. NHS spending plans to 2025 that are already agreed outpace inflation by 6 billion pounds.
[1] https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locat...
[2] https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD?locat...
The Financial Times has published stark data showing persistent underinvestment when Conservatives are in power, compared with peer countries.
> of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
> As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017.
https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
Health care inflation is significantly higher than the retail price index. The population is aging - older people consume far more health resources than younger people.
https://www.kingsfund.org.uk/audio-video/key-facts-figures-n...
TBH I think most of the recent spending has been in management, rather than where it actually needs to be, so that doesn't help.
As mentioned, outperforming here is a relative benchmark vs the US, as stated in the article.
Canada is almost unique among developed countries with government healthcare in that it doesn't also have a parallel private medical system for those who can afford to pay for it. So naturally rich Canadians will often pay for private healthcare in the US.
I'm originally Canadian but have lived in Australia for the past 10+ years (in Melbourne). We've never had any issues getting medical appointments with local doctors (usually "bulk billed" so we pay nothing or a very nominal amount for the appointment). But we also have private medical insurance, which is required above a certain age (30 something), that we use occasionally for specialist appointments. But even then the out-of-pocket fee is something like $70 which is fine.
Unlike Canada, AFAIK most countries in Europe (e.g., Sweden, France, Spain, Germany) have parallel private medical care, so Canada really is unusual in that respect.
Except for government clowns, the ones that still claim Brexit was a splendid idea, and people with vested interests absolutely nobody claims that.
At least not since 2008 and austerity when the Tories started wanton destruction of the NHS.
There's a massive drive to private healthcare for those that can afford it and the rest is welcome to eat shit.
Or to wait 25 hours for an ambulance while lying on the floor with s broken hip.[0]
[0] https://www.independent.co.uk/news/health/ambulance-wait-wal...
The real fundamental problem I think is that the US healthcare system is primarily run for profit, and not for the health of the people. Both by insurance companies (who strongly resist paying), and by hospitals and other healthcare providers (who love to spring unexpected costs on you). That's the primary difference between the US and Dutch systems.
Fine-ish. For example some medications are not available because the insurance companies decided they would pay only for the cheapest generics and then only the lowest prices of anyone. For some reason this means that manufacturers decide to only supply to the Netherlands when they have ample supply.
Also there are the inefficiencies of the insurance companies who are for profit entities that spend large ammounts of money on their executive teams and ad campaigns to convince people to switch their policy to a difference insurer.
But obviously any system that involves for-profit companies with executives and shareholders is going to siphon some money out of the system. I don't doubt socialised healthcare systems are fundamentally cheaper, and if done well, at least equal in quality. I'm just saying it's not just the privatised nature that's crippling the US system; it's certainly not helping, but it's aggravated by being a particularly poorly implemented privatised system that's entirely about profit and doesn't really care about the people it's supposed to help.
And let's not fool ourselves; there are also wrong ways to do socialised healthcare. I do think socialised is generally better, but you always have to look critically at all the parts of the system.
Stuff that basically everyone needs to deal with should be out of pocket with tranparent ahead-of-time pricing. Doctors and occasional specialists, non-exotic meds, normal chronic conditions, etc. State covers/helps it if you can't (means testing with sliding scale, no cliff). Paying for stuff kinda sucks, but less so than brutal waste pulled out of your paycheck or taxes.
Financially major issues could be covered by private insurance or some government plan.
Vaccines subsidized by feds.
Invincibles aren't such a huge problem that we need to twist the whole system around for people who can pay but don't.
Done.
Are you suggesting that universal systems are more wasteful? Wouldn't that imply that a simple natural experiment of total healthcare spending vs average health outcomes should show a benefit to private over universal/tax funded?
Figure out why a hospital can charge you $25 for an aspirin, and start there. If you just let the state pay that $25, yes your taxes are being wasted.
https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...
Obesity vs overweight (the former is surely a better predictor of health outcomes anyway) aside, we’re definitely higher than comparable nations, but I wouldn’t say significantly so.
Even the link you provided says that the US would fit among the Arab countries, but would be a major outlier in Europe. There are people with bellies here, BMI > 30, but the "unable to walk without a motorized wheelchair" category is rare.
I live in the Czech Republic, a notorious beer-guzzling nation that was never known for being slim. But the kind of obscene, ballooning fatness that is ubiquitous in the US was never seen here until, say, 2015. Unfortunately I slowly see it slowly emerging among the youth, probably the ones who live on the fastfood diet.
(Fast food used to be relatively expensive compared to Czech salaries, so people wouldn't gorge on it everyday, but this has changed and now it one of the cheaper options out there.)
Having said all that, I happen to know there's a school of thought that many (if not most) of the health issues supposedly "caused" by being overweight are largely an artifact of health professionals being so focused on their patients' weight that they fail to diagnose other health issues early on, or that patients no longer feel comfortable speaking to their doctors etc. The fact that the stats on diabetes/stroke/heart failure etc. correlate so strongly with obesity across such a large range of countries, even those where apparently "fat shaming" isn't a thing, leads me to be somewhat skeptical of that POV.
You also can't reform it if you aren't going to touch the pharmaceutical industry. There are medicines that cost $3K a month here that cost $0.50 in Africa for the same dosage. I can understand that the US is funding the military to a ridiculous degree to maintain its global hegemony... but I can't understand why voters think it's a good idea to allow pharmaceutical manufacturers to gouge the crap out of people.
Nothing about medical care is a traditional manufacturer / consumer relationship. I'd rather nationalize the pharma companies and all medical patents for medicines or devices which are sold more than a factor of 5x in the US over its lowest price.
> many doctors and nurses who would also be incensed if you told them that they had to take less pay EVEN IF you also immediately eliminated all their education debts
If the reduction in current value of their lifetime pay is greater than the value of their education debts, why wouldn’t they be incensed? I would be as well, as would most people.
Not if the government nationalizes the pharmaceutical industry and treats it like NASA, which it should have done a LONG time ago.
> If the reduction in current value of their lifetime pay is greater than the value of their education debts, why wouldn’t they be incensed? I would be as well, as would most people.
Hospitals are overworking medical staff. The average nursing shift is 12 hours long. Most surgeons are putting in 60+ hours a week. The number of medical staff needs to increase and their work hours need to be normalized as much as possible. We've allowed medical associations to artificially gatekeep the populations of staff for no damned good reason.
I'm European but there are major issues with waiting times, terribly low wages, strikes, ambulance provision, etc. in almost every country I've lived in.
Overall I think public healthcare is well worth it - in theory you can save a lot with one central purchaser, and even moreso if the government was willing to do drug discovery and production directly too.
But it is difficult to ensure future governments don't ruin it. It's kind of like why the unemployment funds and minimum wage negotiations being in the hands of trade unions instead of the government has worked out better in Sweden.
Not sure about the wages and strikes though. But considering the fact that our neighbor doctor is a member of a yacht club, and the landlord who is another doctor had invested in a bunch of apartments that he lost the track of them, I guess they are fine.
> But even I am for government funded healthcare. Who in the hell is against it?
Both of the countries I've lived in have carried out health-related reforms (one a really big reform — almost half of hospital beds were closed, the other a much smaller reform). The people who lost income didn't matter for the success or failure of either reform.
You're basically saying that there are lobbyists and that's an insurmountable obstacle, and throwing your hands up in the air. You're not, for example, trying to learn how the countries that executed reforms successfully did so.
EDIT: You could easily find a list online of the top ten health systems. Learning about the reforms carried out by each of those in the past 30 years requires effort, but it's really not impossible.
It's possible to learn how these things were done, or it's possible to just give up and say it's politically difficult.
I suspect change will only come once the existing tensions towards healthcare expenses boil to an outrage. Talk to anyone in the US though, they will complain about their healthcare!
There is a big overlap with those people and the people that ultimately make decisions affecting whether that system exists though.
I don't think so. The medical personnel are way too stressed. You having money does not change that the people that will see you suffer in an inhuman system.
Even apart from money, how on earth is it possible that the people who should know more better than anyone else the effects of stress and lack of sleep let doctors work in far too long shifts? How does the existence of 24 hour shifts make any sense?
The system has a lot more problems than just money.
Just one example link: https://bcmj.org/articles/sleep-deprivation-among-physicians
It's not just the US: https://www.theguardian.com/society/2022/jan/17/nhs-doctors-...
Also always interesting to read: https://old.reddit.com/r/medicine/
The US isn't the only country with a partisan, ideological driven political landscape but it is probably the loudest. Ideologues on the right are able to pander to their base by equating any healthcare reform as socialist, substandard, death panel creating and an affront to freedom. People will accept a bad deal if they think it is the right deal.
Healthcare companies benefit so much that they are one of the biggest lobbying industries in the US, spending $690 million a year on lobbying (quick Google result, so pinch of salt). The changes they want are those that will profit them more, so it benefit them to feed the ideologues.
In my view, there are a lot of trivial and important changes that could make US healthcare cheaper, better and more available. As long as I don't specify any further details, everyone can agree with me.
Bring it into the political discourse. And vote.
The U.S. has the highest rate of people with multiple chronic health conditions... and the highest obesity rate...
I think they are seriously missing something. Obesity is related in part to our built environment and car-centric lives forced on us to a large degree by our built environment. Pollution may be a root cause of multiple chronic conditions.
Just beefing up our health care system likely isn't sufficient.
Trying to fight that in a democracy will take a long, long time.
Do they like it or have they simply never had any choice in the matter and have never experienced anything else? The extremely high housing prices in the few dense walkable places seems to imply there is more demand than supply for such developments, so at least some prefer them.
Paved earth isn't a bad thing if you're opposed to car-centric lifestyles. Dense cities (like Manhattan NYC) are nothing but pavement outside the parks, but that's what you need if you want a walkable lifestyle. Lots of earth and grass everywhere means everything is so far apart you need to drive.
I wonder if anyone has done an analysis comparing different nations and their per-capita road infrastructure maintenance costs. The US has to be the worst at this, and surely is a big drag on the economy.
The healthcare industry isn't the only one that needs a massive, aggressive check in the US.
a) The USA pays more for drugs than the rest of the world does. b) private health insurance is really inefficient. c) The US doesn’t do public and preventative health very well. d) The US wastes money overtreating rich people and undertreating poor people more than other countries. e) The US does a bunch of expensive and more importantly counterproductive end-of-life care than other countries. f) The US pays its doctors more than other countries because the supply is artificially restricted and governments don’t push back like they do elsewhere.
* A big chunk of the money goes to private insurance, never materializing into “health”.
* Health centers being run as a business, not a national necessity (like roads or the military)
* An obscurity in health practice pricing that would be illegal in any other activity.
> In a population of 1000 perhaps 10 will get a Really Bad Health Issue that requires Really Expensive Treatment that costs 100. So those 1000 people pool their resources up and each pays 0.1 so that if they happen to be one of the unfortunate 10 they are covered. Given that this is a shared risk for those 1000 people, the higher possible entity (the state) is put in charge.
It seems the Americans thinking starts the other way around:
> Anything public is awful and should be avoided at all costs. I'd better take my chances with a private entity (even if that means grouping with another 100 people instead of 1000, and that the private entity takes one cut, so we end up paying 2 each instead of 0.1) because the alternative is just awful.
... But then they are fine with having a very well publicly-funded military and police departments.
And yes, since national defense and law enforcement are desirable services that can't be provided by a competitive market, we are fine with the government providing those specific services in a constitutionally-limited way. That preference is actually more ideologically consistent than your preference to socialize our healthcare system unless you're going to advocate for abandoning capitalism entirely.
That makes no sense. It will be one person. Not a tenth. And also if that was true the private insurance would raise their quota to 1.9. And then deny treatment to that unfortunate person anyway because it’s cheaper to pay a lawyer to litigate the expensive cases than to pay them.
Your last bit makes no sense to me at all. It is clear that health care is desirable, and can’t be provided by a competitive market. The richest country in the world can’t pull it off. You lose much more people per week to health care unavailability than to wars. From the point of view of mere efficiency of capital it makes no sense.
And are talking as if there was no proof that socialized care works in other countries. It’s right there if you’re willing to look for it.
If your state agencies are poorly managed and you go private, that is a self-perpetuating cycle. Fewer people will use them, they will get budget cuts, and get worse. The solution is to revolt, strike, demand better, and help each other, even if they are poor.
Abandoning some aspects of capitalism is completely possible and rational.
Your lack of intuition about such a simple linear relationship should be extremely concerning to you. It suggests that you are approaching the question with an emotional attachment to a particular outcome that is blinding you to the extremely simple and intuitive correct answer.
There's a lot more to unpack here, but I don't have time to address it point by point. You are making a lot of assertions that seem much more reflective of left-wing ideology than actual conditions on the ground. You suggest that consumers demanding better is a solution to public systems that don't actually meet consumers needs, but the very nature of public goods ensures that no individual consumer will ever be in a position to make a demand that administrators will have to prioritize over competing demands from producers and public employees. The nature of democracy gives outsized influence public sector unions and interest groups that can then turn around and contribute a share of those benefits back to politicians campaigns. In contrast, a competitive market affords consumers to actually make demands with some weight behind them. A producer has to take a consumers demands into account lest that consumer simply take his business to a competing producer. The weight of the empirical evidence affirming this fundamental difference between public and private systems is completely overwhelming, and your resistance to the idea that capitalism is a far better system than socialism for the vast majority of goods suggests an emotional attachment to an ideology that has very intentionally been sold to the public in such a way as to make uncritical advocacy for that ideology very self-flattering to those very advocates.
I know that I didn't really address the middle part of your argument but let me assure you that those ideas are just as contrary to reality as any of the ideas that I chose to address. I might come back to those in a future post if I find myself with both the time and the inclination to do so.
In my example 10 people out of 1000 required the treatment. If it's 100 people, then 1 will need it. You must have misread.
> Your lack of intuition about such a simple linear relationship should be extremely concerning to you
That's very condescending and a bit ironic. I think you should apologize.
> much more reflective of left-wing ideology
"Left" means different things in different places. In my country, a big chunk of the people on the "right" feel the same way you feel about the army, but about healthcare. Which is that some things like life-threatening problems are too important to let personal gain interfere. More on that in a second.
> actual conditions on the ground
I am writing this from the ground. My son just got treated by our public health system twice this week - the last one today. (His pediatrician was on strike today, actually. That is a bit inconvenient for us but it is fine. It's not life or death). My sister in law got diagnosed with cancer and got treatment for it. This is reality that I am telling you is happening right now. Not a theoretical thing that I am imagining might work on a communist country. It exists, and it works.
For the life-threatening cases at least. It is not perfect - there's sometimes long waiting lists for non-life-threatening ones. That is where private health plays a role. Those who don't want to wait, or want a private room in the hospital, can pay for it.
But if you are poor and you get cancer you don't necessarily die. Your family doesn't have to beg in gofundme for your treatment, nor they are left bankrupt. Which is absolutely a reality in the US.
> The nature of democracy gives outsized influence public sector unions and interest groups that can then turn around and contribute a share of those benefits back to politicians campaigns. In contrast, a competitive market affords consumers to actually make demands with some weight behind them.
I prefer referring to people as people. Or, citizens, in the context of a country.
Perhaps that is where our difference of opinion comes from. I don't see a country as a business. So naturally its people are not "consumers". Poor people may not be able to consume much, but they are still people.
On buying public administrators: in my country, lobbying consists in "having meetings with politicians". It does not mean "giving presents" or "contributing to campaigns". That is called bribing, and is against the law. Again, not a perfect system by any means. There's plenty of corruption, as well as other problems. One of them, and one of the places where I do agree with you, is that that interest groups (especially those sponsored by the extremely wealthy) still have much more levers to pull than the average person.
Where I differ with you is in how to fix this. You propose that "people vote with their wallet". The problem with that is that the money that consumers use to vote with their wallet eventually goes into the pockets of the ones funding the interest groups that eventually make laws against them. This is a problem both in my country and in the US. It gets worse with inequality, which is getting worse everywhere, but especially in the US.
My proposed solution is simply that there's other things besides the consumer-producer relationship. This doesn't necessarily imply a communist regime or an anarchist revolution. It just means Europe, man.
But yeah, focus on purposely misinterpreting my arguments all you want. Have a nice day.
(Because the article is blocked in some regions.)
US does not spend on healthcare. It spends on people making profits from healthcare.
But, Europe is slowly getting there too.
The medical industry justifies their excess profits as necessary for supporting the "free market" in "generating innovation".
In reality:
1. Their "free market" is anything BUT a free market.
2. "Generating innovation" is not a substitute for generating positive health outcomes.
3. Their excess profits are primarily used for propaganda and bribery to justify their own existence and protect their racket.
Just look up the laws restricting Medicare from bargaining on medical care and prescription drugs to understand just how much of a racket this whole industry is. It is criminal in every way - aside from the written law, since the people who make the laws are co-conspirators in the scheme.
It's so much worse than the "most expensive" healthcare in the world. This nauseatingly overinflated healthcare is further subsidized by US taxpayer funds from the shit medical care and extortionate drug prices that Medicare is legally obligated to pay. It actually adds trillions to our Federal Deficit each year... so we get the worst health outcomes WHILE driving the US government into bankruptcy.
This whole system maximizes profits for a limited number of players at the expense of our doctors, our patients, the fiscal health of Medicare, and the future of our republic.
Improving the health system won't fix everything.
> Improving the health system won't fix everything.
Of course there's no silver bullet that will fix everything, but it's silly to think you can fix the outrageous costs of the healthcare system without fixing the healthcare system.
Lower barrier to entry. A lot of cities have no good infrastructure for outdoor biking.
I agree that the healthcare system needs fixing as well, in addition to making the country healthier by lifestyle.
Doctors aren't paid when you are healthy. How would you suggest fixing such a system? Because if you figure it out, there's a whole system of auto mechanics that could probably benefit from the solution.
Second, you've not only massively oversimplified, you have also made a false equivalence. Doctor's aren't the only ones getting paid, the CEOs take home billions, as do shareholders. If you think going to the hospital in the US is the same as taking a car to a garage in the US, then you are greatly mistaken. To equate the 2 is either unthinkingly glib or willfully disingenuous.
They are, here in my country.
I am healthy (AFAIK) my taxes are paying for doctors too.
Also, I am healthy (AFAIK) because I go to the doctor even when I am not sick to check on my health.
I already paid for it.
There are huge logical gaps in your statement.
1/ Being alive is a constant fight against diseases, aging and myriad other illness. 2/ In any reasonable population, there would be a percentage of people who need more medical care than others. 3/ Children and old people are more vulnerable. 4/ Given these above, the doctors cater to people who need the medical care. 5/ The world is not static. You can eat something bad and get sick. The doctors and by extent, the entire healthcare system is not a sterile environment to put people in.
Why not propose an alternate system where doctors can be proactive in asking people to take care of themselves - maybe like asking them to take a vaccine?
Doctors are paid to be doctors. And there is always a fraction of the population that aren't healthy. Just like you insinuate with your car mechanic analogy, it's probably a good idea to have a system that doesn't give doctors incentive to give patients more expensive treatment, and instead have incentives to reach good health outcomes.
Isn't it worst that doctors are paid if you are not healthy? Doesn't it create an incentive for them to prevent you from being completely healthy?
Anyway, most countries in Europe pay their doctors regardless of you health status and that money comes out directly of taxpayers' pockets whom most of them are 100% happy to make it that way
Like less than a third or even a quarter of US wages.
That's the real issue - they will never want to take a hit to living standards. It was possible in the UK because it was directly after the war and the Blitz had killed hundreds of thousands of people, and there was a real threat of communism.
Whereas the USA is nowhere that situation today. Things are going very well for the majority of people so drastic change would be very hard.
So what are they gonna do? Refuse to treat people and starve themselves to death? They'll be replaced by people willing to earn less and who probably care about the work they do rather than just caring about earning a fat paycheck - those exist, as other countries prove. Seems like a win to me.
Britain had all of these issues and it cost a lot of money.
There's also other issues - like the NHS doesn't cover circumcision unless there is medical need (this is not so controversial in the UK, but would be in the USA), and it does cover gender transition surgery, etc. (despite covering no other cosmetic surgery, and nowadays not covering dentistry or opticians) - all of these issues are controversial and difficult.
I'm not sure that comparing absolute amounts between countries makes a lot of sense. And doctors would still likely be in top 1% to 5% also in Europe.
It also doesn't cost them a million dollar to become a doctor.
And they don't have to work 80 hours a week.
Doctors in Europe are also easily in the top 5% earners.