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Comment by davikr | Hacker News Reader

Consider most physicians are hundreds of thousands of dollars down in education debt and have been training in healthcare settings for almost a whole decade, and that significant time has been invested in a previous undergraduate course and to pass the MCAT. I think they are paid accordingly for their investment, and only 8% of that healthcare spending [1] accounts for physician personnel salary.

What is most baffling to me, as someone who isn't from America, is how expensive even the most basic tests are.

A CT or MRI (which are admittedly expensive machines) scan shouldn't cost >$1000, and it probably doesn't anywhere else in the planet.

[1]: https://www.npr.org/sections/money/2019/03/12/702500408/are-...

> Baker estimates that the salaries of the roughly one million doctors in the U.S. account for about eight percent of total healthcare spending.

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I spent 11 years at university and came out with a medical degree and a couple of others for ~100k AUD, whilst also receiving government assistance whilst studying. The for profit education sector and price inelastic nature of demand have a lot to answer to

Unfortunately, it's a matter of where you get it done. Getting literally anything done at a hospital is highway robbery. That said, i get two MRIs a year at not a hospital and it's a couple hundred dollars, not a a couple thousand. It's not cheap, but it's a about 1K expense twice a year, which you can budget for.

I feel like this is the crux of the US's issue. We have medical care deserts and for many people the hospital is the only way to get something taken care of. This is where the US is different from many other wealthy nations. We really don't get economies of scale at all. We have cities, but a lot of our major cities juet have nothing like the population of other nation's major cities.

> i get two MRIs a year

If I may ask a personal question, why?

In Canada the typical MRI waitlist time is several months outside of emergent issues. You could go privately but it's tougher than you think to pay for this, as it's not well integrated with the public system and your family GP (if you have one). I guess I'm saying, cost is definitely one factor but our exclusive public-only system has got problems too

Canada has extremely few physicians, like USA. For healthcare to work well you probably need to reform your system to get more physicians, I don't think any system works well when you have too few physicians. You can see the countries with good public healthcare has twice as many doctors as Canada and USA does.

https://en.wikipedia.org/wiki/List_of_countries_and_dependen...

> We have cities, but a lot of our major cities juet have nothing like the population of other nation's major cities.

I don’t think this is it. European cities aren’t that big compared to American ones. So Spokane is larger than Geneva. The problem is there isn’t much in terms of healthcare between Spokane, Boise, and Minneapolis.

That's only if you look at the population of the named cities themselves rather than the population of the city plus the surrounding populates areas.

In Geneva's case, it is composed of several different named cities/towns/etc and those taken together are bigger than Spokane plus the municipalities that comprise its urban area.

Spokane metro is 579k. Geneva metro population is 633k. So Geneva metro has slightly more people than Spokane metro. Of course, the metro areas are wall to wall (so Geneva metro is adjacent to Lausanne metro) but they both have their own healthcare systems and aren’t gaining much more from scale than American metros.

And Spokane is a small case. There is nothing comparable to the Seattle metro in Switzerland. The closest you get is Paris in France or Milan in Italy.

On the chance this may be helpful, I recently used Radiology Assist [0] to self-pay for two 3-Tesla MRIs. Each MRI cost $375 - total - and included a radiology report and a copy of the MRI images. I have health insurance. It was cheaper to just pay for it myself. Also, Radiology Assist was able to get me in on the exact day and time I wanted, on short notice.

I have no connection to the company other than as a satisfied customer.

[0] https://radiologyassist.com/

>> Well, physicians have to be paid accordingly for their time and financial investment... Baker estimates that the salaries of the roughly one million doctors in the U.S. account for about eight percent of total healthcare spending.

This is exactly the attitude as to how American costs are out of control. If American healthcare budget was halved (which is still much more per person than other nations), then physician salaries would be 16% of the total. If American healthcare budget was a quarter of its current total (in line with many other nations spending), then physician pay would be 1/3 (32%) of the entire spend!

Clearly, if American healthcare is going to see a 1/2 or even 3/4 cost cut as the proponents of universal/single payer healthcare predict, then physician pay must take a similarly massive cut.

Just as you can find reasons why physicians cannot take a pay cut, so too can every slice of the pie claim that their slice is valid and uncuttable.

isn't it pretty reasonable for physician pay to be a really large percentage of healthcare? expertise isn't cheap.

If it's reasonable AND doable than why don't physicians in the fabled successful single payer systems get paid more?

Why does just about every doctor in every universal system make dramatically less than their American counterpart? Is their expertise worth less?

Even now becoming a doctor is a dubious financial trade off in the states. Medical school and residency is going to take a huge toll, you’ll be underwater a long time before that $350k comes in. However, a SWE can make that without such an investment and without such a crazy work life. So now reduce that to $200k but with all the same medical school debt and stress requirements.

A lot of areas already have trouble attracting doctors at all because they can’t compete with the money offered by bigger richer cities. If you want cheaper doctors, something else will have to give, or supply will just plummet.

> Well, physicians have to be paid accordingly for their time and financial investment

Most of those doctors European doctors probably got their degree with almost no tuition paid. If I wanted to become a doctor I could start now, and finish in 5 years with zero debt. It wouldn't be an "investment" in any more than my own time and effort.

But I think this shows that the healthcare is just one part of a large interconnected system of things. It's not easy to change into a french or UK or scandinavian healthcare model with great savings if doctors expect to make $300k/year because they made an investment. So single payer universal healthcare might need more doctors and nurses trained with tax money? But when I go to a university to get my tax-funded MD, that university is most likely a public institution too. You wouldn't have a university taking a huge cut of that money.

5 years? You wish!

Residency is just a normal job in most countries. It isn't a hazing period like in USA.

OK I'd be a "physician" within 5 years (if I didn't fail). A "doctor" would be after a couple of more years, but those years are done working, with a salary, and the rest of the staff still calls you 'doctor'. Just like there are no unpaid internships for attractive jobs in law or finance, there also aren't any unpaid or extremely underpaid healthcare jobs.

On the other hand: a US resident dr makes what, $60k? That's comparable to European doctors. I wouldn't make $100k for quite a few years. The first "residency" period here would proabably be more like $50k or even less. But with zero debt that doesn't sound horrible.

> Well, physicians have to be paid accordingly for their time and financial investment. Consider most are hundreds of thousands down in education debt and have been in training for almost a decade

> What is most baffling to me, as someone who isn't from America, is how expensive even the most basic tests are.

If you understand the former, then why is the latter baffling?

The cost of any tests includes labour...

But even very expensive labour does not explain the costs of the US system.

Why not? It seems to explain a large part of the difference.

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