Doctors on Salary
Yves has an post on the health bill that got passed last night. I found the part about the one clinic with salaried doctors interesting.
I found the comment at the end silly:
I suspect Frank is right on the pay issue, but for the wrong reasons. I am always staggered when I hear of law school and business school graduates being in debt to the tune of $100,000, even $200,000. I have no idea what the level for MDs is, but I imagine it is even worse.
And you cannot discharge student debt in a bankruptcy. You have no choice but to pay it (or I suppose flee the US or go underground, there are always extreme options). So the fee for service model may remain intact despite the fact that it produces poor outcomes for society as a whole because the current generation of doctors needs high incomes to so they can service their debts.
When the current system crashes, and I don't see how it keeps going as it is. What is happening in health care is utter unsustainable. People have invested in enormously in grossly mismanaged health insurance plans that will likely go bankrupt as those currently insured age and require more health services. As the report said, the young and health are opting out. I can see people also migrating to where health services are affordable. When I was in Costa Rica I met a woman who got her laser eye surgery done there, and she worked in the health care system in the US. So, she was certainly more qualified to evaluate the quality of service. She got the procedure done for 25c on the dollar compared to what it would have cost her at home. Indeed, the vacation and the procedure together cost her less then just the procedure in the US.
The need of doctors to service debt isn't going to be the driving factor for their wages, people's inability to pay and the enormous subsidy of healthy people paying for existing procedures under insurance policies and which leave grossly inadequate reserves is going to catch up to itself and health care will be different.