One way to understand the possibilities for solving the US health care crisis is to take a better look at how people make career decisions.
I have a lot of doctors in my family and lots of friends who are doctors, so I'm reasonably familiar with the careers of doctors, and I'm astounded that we're not talking about paying less for health care.
Why do doctors need to make so much money? The non-financial rewards for being a doctor are larger than almost any other profession. Except teaching.
There's a reason we pay an almost non-living wage to teachers: It's rewarding and meaningful and you do not need tons of schooling to do it.
So okay, there's a shortage of teachers, but not by a lot. Because the trend today is to do meaningful work and work with civic duty. Teach for America is one of the most popular choices for college grads. So the salaries can't be that out of whack for the job.
Also, the Institute for the Study of Labor says, “When teachers were offered cash rewards for good performance (measured by factors like grades and parental feedback) student scores on national exams significantly declined.” So I don't think paying more to people with meaningful work actually gets a more meaningful performance from them.
Which means that it makes sense that we pay people for what the market demands. And we could fill medical schools twice over with all the candidates who didn't get in. Don't tell me they're not smart enough. They passed organic chemistry. That's fine for me.
So we should pay doctors a lot less. Those doctors who are motivated by helping people and doing good things for the world will stay. And those who want a lot more money can go to finance.
Oh. Wait. They can't do that. Because the days of finance guys making tons of money for doing something that is really long hours and not helping anyone are over. So we should certainly also be done with guaranteeing people loads of money WHILE they do good things.
So doctors who were in it for the money will need to go to professions like VP of Intellectual Property at a Fortune 500 company where they can sue small entrepreneurs and ruin their lives in the name of corporate profits. A job like that is pretty certain to be a good living and the price you pay is that you don't get to save the world.
It is all adult life. It is a trade-off. You get to do good things or you get paid a lot. It's why moms don't get paid. It's why garbage men earn more than teachers. Why should doctors be any different?
The doctors who complain about this will talk about insurance (premiums will be lower if no one can pay: Duh). And they'll complain about school loans (outrageously high, yes).
The cost of medical school is the obvious objection to paying doctors less. Actually, the cost is a joke. Research scientists are happier, on balance, than almost any other type of career. Teaching at med school is a great job. You solve interesting problems, and teach people to save lives, and you have great hours.
Those med school professors are totally overpaid. So make med school cheaper by paying the professors less. Then we can pay doctors less. You'll lose the surplus of applicants each year, but who needs that big a surplus? This is a good step to starting a universal health care system.
Sure, health care probably won't be as good as what we have now. For the insured, that is. But fifty million people will be able to go to a doctor who couldn't under the current system.
And yes, I know, there will be a two-tier healthcare system where many of the top-notch specialists will only work for cash. But, newsflash: This already is happening in NYC. As the mom of two special needs kids, I saw all the best doctors in NYC, for a wide range of issues, and most did not take insurance. So we already have that system. Cutting pay to doctors across the board won't create it. The only thing it will create is a way for poor people to get health care.