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Comment by flerchin | Hacker News Reader

Doctors and nurses are paid too much in this country. Pharmaceuticals charge too much. Diagnostics are gold-plated.

There's no downward pressure on these prices except what the insurance companies can negotiate, and people don't like the insurance companies doing that when their health is on the line.

ie, It's a total market failure, and single payer would fix things, at the expense of all the profits of the 3 largest factors.

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If you want physician salaries to be lower, you need to lower the cost of becoming one. It's really as simple as that.

People like to make comparisons to physician salaries in other countries but ignore the fact that the education is significantly cheaper or even free in those countries.

Additionally, the US forces newly minted medical school graduates into a forced regime of working for 3-10 years at minimum wage to get qualified as a doctor (ie medical residency). During that time, their debt balloons from $300K+ to $500K+ because many residents can't afford anything more than minimum payments.

And if that wasn't bad enough, there are increasingly gap years built into the system to make you more competitive. This could be a Masters (and more debt) or practical experience after undergrad to get into medical school. There is an increasing need for a "research year" after medical school to get into competitive specialties.

So you might be 38 years old and have spent 20 years studying post-high school by the time you are earning those big bucks and you have to recoupe maybe $700k+ in debt.

There are negative societal outcomes for a high cost of education. Just like there are for housing. Yet people want to gatekeep both for some reason.

One of the upward pressures of physician salary is malpractice insurance.

Cosmetic surgeons I have heard pay about half their salary into malpractice insurance. I do not know how you fix the litigiousness of consumers - that is a cultural problem.

Doctors wages are not why costs are high

I'm not necessarily opposed to a single payer system, but it wouldn't fix those things unless it also imposes severe price controls. Fixing prices below the market price inevitably leads to supply shortages (i.e. longer queues). This is why we see affluent Canadians come to the USA as medical tourists to get MRIs here and skip the queue back home. On balance it might be better overall but let's be clear about the trade-offs.

While physicians in the US are paid much more than any other country, there's not a huge difference for nurses.

Nurses in the US make more than 2x what they're paid in the UK

Maybe we could make the case that medical school, malpractice insurance, administrative staff costs (e.g. to deal with insurance), etc. are too high. That's a more actionable way to look at it.

Edit: We should also pay attention to the power of the hospital lobby in keeping costs high.

Revoke the concept of a medical licence! Maybe charge $10k a year for one (so doctors are still registered, theres just no other barrier) and boom, now you can prescribe whatever you need. If that medical degree and residence program is really worth it then the market will price it in. Healthcare costs will fall drastically. Its the cartel of Doctors that keeps costs high, every medical decision gets made downstream of doctors. No doubt quality will fall in the cheap end, but the care per dollar will go way up.

You really want to live in a world where anyone with $10k can start prescribing medication? It'd be nice for the heroin dealer down the street, as the no longer have to worry about the cop. Just pay your yearly fee and start slinging Oxy. No downside to that, right

Licenced medical doctors under the current system will already prescribe you oxy (actually they moved into low socio-economic areas to sling dope, theres your upper class medical profession) so not sure what your attack is here

But they have to worry about the state medical board revoking their license. That at least moderates wanton opiate dispensing.

There can still be laws, code of conduct etc, eveil jaim time for ethics violators. Just dont restrict supply by only giving licences to people with medical degrees.

This is so retarded it must be satire

I assure you Im serious. I would like to know your actual thoughts why you think this way

I agree the supply needs unblocked. But there’s many steps to take before one so drastic. First off stop letting congress and the AMA dictate how many residences are offered, allow as many doctors study and become doctors as want to be.

>Doctors and nurses are paid too much in this country. Pharmaceuticals charge too much.

Be very careful what you wish for.

Japan has been suffering a chronic and severe shortage of doctors and other medical staff because pay is too low. More recently, certain medicines both prescription and off-the-shelf have been exhausted due to overdemand and undersupply from government-mandated low prices.

I’ve been looking for sources about the Japan doctor shortage, do you know of any that describe the cause as being low pay? I have heard about the medicine issues.

I have no links handy, but practically every report by NHK and other outlets all come to the same conclusion that medical workers are leaving the industry and newcomers (medical students) aren't coming in because the pay is too low for the intense workload required compared to almost every other industry (and the shortage leads to doctors putting in even more hours, causing a negative feedback loop).

The low pay in turn has been linked to hospitals running on essentially zero margin, so they can't pay more even if they wanted to. That in turn has been linked to Japan's national healthcare insurance system and other government mandates, with arguments everyone here has probably heard enough already.

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