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.

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  1. Bob
    Bob says:

    Where will the Canadians go when Obama screws up our health care system?

    The whole insurance scheme came up after WWII when the government put wage controls in place. Employers couldn’t pay more money to get the best talent, so they offered benefits. This gave rise to the whole system.

    We shouldn’t insure routine healthcare, and costs would drop dramatically. You could pay cash and be ahead of the game.

      • Danielle
        Danielle says:

        As a Canadian, I can tell you that it is a misconception that Canadians routinely run south for procedures. I can’t think of a single person in Canada who is unhappy with our health care system’s “socialist” aspects, although I am sure these people exist. In fact, most people I know, myself included, would like to see it go the OTHER way – to covering prescriptions and dental care as well.

        In Canada, we are much amused by Americans and their utter terror at the idea of the government controlling health care. They do it with your police service, firefighting, etc and no one complains because that is how it has always been done. Americans need to man up, take the leap and consider the long-term time horizon.

        I should also mention that as a Canadian med school hopeful, I am more aware than the average person about the shortcomings of our system. But even with this knowledge, I still feel incredibly thankful to live in Canada and not the States.

        And on a related note, Canadian doctors are paid significantly less than their American counterparts, but our med school tuition is also substantially less.

  2. Clare
    Clare says:

    Hmmm.
    I’ve never understood the US healthcare system. We have universal free health care in the UK, paid for out of our taxes. It’s not perfect by any means, and standard of care can vary from town to town. But you don’t need to worry about not getting treated in an emergency if you don’t have insurance, and you can always go to your doctor for routine care.

    Doctors get paid by the state, though can bump up their earnings by also doing private work on the side. If anything, there’s a lack of qualified doctors rather than a surplus, though I don’t have statistics to hand.

    Would this system be considered too “socialist” for the US? Probably…

      • Stephanie
        Stephanie says:

        Bob —

        I have to disagree with that statement. I have seen uninsured patients who needed critical emergency care turned away from hospitals because they could not pay. In one case that still haunts me to this day, a young man who was accidentally shot (by a cousin while they were playing with a gun) ended up dying because the emergency room couldn’t transfer him to the nearest facility that could treat him and they couldn’t find an available “charity bed” anywhere in the state. When they finally located one outside of the state it was too late and he died enroute. If he had been insured he would have been cared for much more quickly and may have survived his injuries.

        So while there may be hospitals and doctors who do care for uninsured patients, they are not easily accessible to ALL uninsured people.

      • Ben Varone
        Ben Varone says:

        Bob, JP:

        Stephanie’s story sounds like hyperbole to me as well, but hospitals can turn away patients. ED’s are classified in levels, from 1-4, and can elect to turn away patients who they believe are beyond their skill to treat. Their only responsibility is to stabilize the patient and prepare them for transfer.

        However, the transfer creates the ED loophole. The hospital can argue that the transfer absolves them of any responsibility under the EMTALA. Hospitals are sometimes placed on “override” where they have to accept anyone regardless of Trauma Level, but you’d hardly want to roll the dice on it. The EMTALA also only applies to hospitals that accept CMS patients, so if they’re a private hospital that doesn’t accept medicare/medicaid, they can do whatever they please, including turning away gunshot victims.

        It’s also worth saying that the system Bob is describing would be a pretty crappy one. Health care is not a market in the traditional sense; it is more akin to National Defense. When you are attacked by a foreign power, you are hardly in the position to negotiate the terms of your defense in a rational and economic way. The same applies to health care; when you’re bleeding from a gunshot wound, you don’t have the luxury of making the most economic decisions. This, in brief, is why most health care should be under the control of government, and not private enterprise.

      • Stephanie
        Stephanie says:

        Bob and JP —

        There is no article documenting this incident. I witnessed it for myself when I worked as the admissions clerk (while in college) at a small regional hospital. Our emergency room was not equipped for this kind of trauma and the nearest facilities would not accept the patient without insurance. He had to be transferred to a trauma center that would accept patients without insurance. As I stated earlier, the one in-state did not have room for the patient and the out-of-state one was two hours away and required lifeflight. He was transported via helicopter but died on the way there because it had taken HOURS for them to locate a trauma center that would accept him.

        This small regional hospital does treat patients without insurance, but in this case the patient needed care that they could not provide with their limited resources/facilities. The ER staff did everything they could to keep him alive as long as possible — but there was only so much they could do and there was nothing they could do about the problems with locating a trauma center that would take the patient in time to save his life.

      • Ariella
        Ariella says:

        Bob, that’s true only in the case of a life-threatening emergency. The federal law is known as EMTALA and arose because hospitals were turning away women in labor because they were uninsured and the hospitals knew they would not be paid for their services. As a result, the laboring women and their children often died. So the government said, “No more!” And now hospitals can’t turn you away if you’re about to expire or give birth on the floor. But they can damn sure turn you away if you’ve only got strep throat or a cold.

      • Kenneth Wolman
        Kenneth Wolman says:

        This is true: no one is turned away from a hospital physician, e-room, etc. If you do not have money or insurance you may be subject to something called “Charity Care.” But what is charity care? A confederation of state-operated systems that are running out of money because fewer and fewer people have insurance because many people no longer have jobs and have exhausted their Cobra or ability to pay for it.

        I do not know the formula by which Charity Care is calculated, but if you made around $40K the year before–and that is admittedly not a living wage in an area like New Jersey–then you will be assessed 80% of your costs. I received a bill from a local hospital in 2007 for $20,600 for being incarcerated in a psychiatric ward partially because I’d gone nuts-broke!. Real expensive hotel, isn’t it?

        The hospital told me they could not turn me away because I told them I as busted. But they also lied to me about the conditions of Charity Care. Otherwise I’d have gone home with a fistful of pills and an psychiatrist’s appointment. So who lost here? The hospital backed off when I went to a newspaper and gave them the story plus names. But my credit back off to somewhere in Outer Mongolia because institutions do not like to be publicly embarrassed.

        No, you will not be turned away. But you will be treated to condescension and fabrications. I long for socialized medicine. I believe that universal health care for all citizens is a no-questions-asked right. I do not care whose wealth is confiscated to pay for it. That is change I can believe in.

      • Kim
        Kim says:

        My brother was a self-employed plumber in Los Angeles. He had no health insurance. When he finally sought care for what he thought was a torn rotator cuff, he was turned away by several doctors and hospitals. Finally, someone did X-rays and it turned out he had bone cancer. He had a very, very difficult time getting treatment, until, after much battling on my mom’s part, he got Medi-cal. By that point he had stage 4 cancer and died a very painful death. He was 44.

        I know another unemployed person who wasn’t exactly turned away by Highland Hospital in Oakland, but he sat in the waiting room for 8 hours with no indication that he’d be seen… so he gave up. (Actually, that happened to my brother, too… I gather it’s quite common.)

        So, it’s a nice myth that no one is turned away, but it’s just that: a myth.

    • Jim C.
      Jim C. says:

      I have never used the British Nationakl Health system, but I have read plenty of news accounts of it. The system seems to have a couple of problems:
      (1) Sanitation in British hospitals is abysmal. Hospital-borne infectious diseases knock off quite a few patients a year and sicken many others.
      (2) There seems to be a shortage of British doctors willing to work in the system, so they hire Asians instead (Pakistanis, Arabs, etc.). Those doctors bring their own problems with them, such as the substandard medical education systems in their native countries. Oh yes, and also a tendency to plant bombs in their Mercedes sedans.
      You can keep National Health.

      • Bob
        Bob says:

        Why do we need to insure health care? Food costs more, has a larger impact on health, and is more of a necessity, yet we don’t insure it.

      • Deb
        Deb says:

        @Jim C.: I think that was an insensitive comment which generalised the perception of Asian doctors (you could at least add “some” to the beginning of your statements, or else you may have to back it up with empirical research). Besides, if the medical education system in Asian countries is so uniformly substandard, how is medical tourism flourishing – those who can’t get treated by NHS actually spend their own money to get treated in hospitals in Asia!

      • CJ
        CJ says:

        I used to date a hospital system executive and she told me that their biggest killer in the US wasn’t mistakes by doctors, but was diseases contracted during patient stays.
        I have also heard these same things said about Canadian hospitals and care. But when I asked about the conditions they were comparing, it turns out is was basic care in Canada to the yuppie suites they have here. Yeah, I like the yuppie suites, but if it doesn’t make a difference in health care and giving them up is what would occur to allow healthcare for everyone, then I say goodbye to them.
        As for your other comments, it’s obvious that you are an ignorant bigot.

    • Deb
      Deb says:

      @Clare: Brings us back to what PT indicated. Is there “a lack of qualified doctors” in UK because being a doctor is not as paying as, say, in the US? People intuitively flock to professions or occupations with a perceived potential to make the highest money. Ask the millions who cram, join tuition classes and do just about everything to pass the Govt. administrative service exam. in India! (and the official salaries here used to be real low till recently)

    • Rosie
      Rosie says:

      Clare,
      People in the US are turned away from doctor’s offices every day for lack of insurance. That is why so many uninsured end up in E.R.s with conditions that could be treated much more economically through a regular doctor. And even E.R.s don’t always take the uninsured – just a few years ago in Chicago there was a news story about a gunshot victim left to die outside a hospital because he had no id or proof of insurance.

  3. JP
    JP says:

    I think you are high.

    How do you go about implementing this whole pay doctors a lot less thing? Some new legislation? Who decides how much they can make?

    Do you plan on lifting the malpractice insurance burden?

    Do you think that doctors are partially compensated for a high risk business? I mean if a teacher screws up, that is not good but the kid continues to breathe.

    Do you think they should be compensated for barriers to entry? Starting in the medical field is painful from what I hear.

    Are you sure you can still go to a doctor and pay cash? I’m guessing there will be a mandate of some sort as a condition of the license to practice medicine.

    • CJ
      CJ says:

      I was just thinking about this along another line. What happens when these schools output students that can’t read or write? Do we give the kid back his 12 years?. I mean it’s a profession and in some cases I would find that the administrators were criminally negligent. There is a lot of money which goes through these schools, and then we find out that the children were given a substandard education.
      In my local area they found a number of teachers who couldn’t pass a basic test on fundamentals of English and Mathematics, after 7 tries.

  4. Mhughes
    Mhughes says:

    I currently work in the healthcare industry and the reality is its all a hoax anyway. If a doctor charges $500 for a procedure, he might only receive $100 or so from Medicare or private insurers and be required to write off the rest. However, he will charge $500 to the uninsured person and not hesitate to pursue that person in collections if they cannot pay. We should protect the uninsured by preventing hospitals and physicians from charging more than they collect from insurance companies. It doesn’t solve the problem, but it is a reasonable solution we could start practicing immediately. If Medicare says that a procedure is worth paying $100 for, then that should be the price charged to the person without insurance.
    Thanks Penelope for saying that there are more important things in the world than things, and we, as Americans, are way behind the learning curve.

    • Jim C.
      Jim C. says:

      Look at it the other way. The Federal government and the big insurance companies force the doctors and hospitals to give them very steep discounts. The doctors and hospitals make their losses up by overcharging the uninsured patients.
      The solution would be to ban the volume discounts. Everyone pays the same.

    • Ben Varone
      Ben Varone says:

      Mhughes, the reason that they charge the uninsured person the actual 500 dollars is that they have to. CMS (Medicare/medicaid) forbids providers to have a two-tiered system for service payment. Therefore, anyone who accepts CMS patients has to charge everyone the same amount, even if they aren’t reimbursed the same. There are ways to get around this, by charging them for an office visit but not for testing/procedures performed in addition to that visit, but that still exposes them to risk if their books are audited.

    • Sara
      Sara says:

      My father is a family practice physician. Are you aware that insurances frequently reimburse doctors LESS THAN THEIR COST to run certain tests, procedures, etc? If the doctor wants to take that insurance (and be able to treat those patients), he/she has to take whatever the insurance decides to pay and hope to make up the difference elsewhere (more profitable procedures and yes, patients paying cash). Medicare/Medicaid is the worst for this which is why so few doctors accept it. The doctors that do (especially general practioners) certainly aren’t doing it for the money – they are doing it as a civic service.

  5. LJ
    LJ says:

    The best way to reduce doctors’ wages would be to eliminate the caps on med school admissions, and to limit the power of state licensing boards. Medical professionals’ wages are kept artificially high because of the limited number of spaces in med school, and therefore the limited number of licensed medical doctors. Allowing more people to enter med school, or changing the laws so that “unlicensed” or “not-quite” doctors could perform more general practice procedures would help close the gap between demand and supply that’s keeping the wages so unaffordably high.

    Although to be fair, our increasing reliance on expensive new medical technology is a bigger cost driver than doctors’ wages.

    • Jay Godse
      Jay Godse says:

      Technology is not often the culprit. For example, arthroscopic surgery has turned a knee-cap operation from a 1-week hospital stay to day-surgery. That reduced the cost of the procedure. Angioplasties are relatively high-tech, but using them avoids having to do horribly expensive open-heart surgery.

      High health-care costs are dominated by labour costs, billing & administration costs (i.e. more labour), and monopoly rents (often in the form of high labour costs).

  6. Jay Godse
    Jay Godse says:

    Very interesting post Penelope.

    If you want to lower health-care costs, you have to break the virtual monopoly that allopathic medicine has for the providing publicly funded health-care. Until that happens, allopathic doctors are the only game in town.

    I heard that in Switzerland, health-care providers of all types (allopathic, homeopathic, naturopathic, chiropractic, herbalists) have equal access to public funding for health-care. The consumer decides which of these types of doctor will treat his bobo (technical term). This gives consumers choice and allows the most effective treatments (often not allopathic) to succeed in the market.

    This won’t come from your governments because allopathic doctors, pharmaceutical companies, and health management companies all profit greatly from the current setup, all have the top levels of governments stacked with their proxies (e.g. FDA, Rumsfeld, etc), and all would have their profits decimated if health-care provision were opened up to competition from other types of doctors. (Competition for government cronies? How un-American…)

    Only when the 50 million uninsured grow to 100 million uninsured will those consumers start looking at cheaper or more effective health-care alternatives. Until then, good luck…

  7. jrandom42
    jrandom42 says:

    I’m still waiting on Penelope to tell us what strategies and methods that those of us who have Asperger Syndrome can use to thrive and succeed in the current workforce. It’s been a year and a half, but I’m still hopeful she will post something.

  8. abdpbt
    abdpbt says:

    Generally speaking:

    1) Teaching is not rewarding, as anyone who has done it will tell you, with the very occasional exception of certain individuals who are very very rare; and

    2) Colleges, Universities, Graduate Schools are not expensive because of the salaries of professors. Most professors do not earn very much money–yes, medical, law, and business professors make a lot more than others, but it is still not these people that make it expensive. It’s the insane bureaucracy, funding projects to expand the university, etc.

    Also, did you just watch Notorious? Is that why you have the teacher/trashman reference?

  9. Mark W.
    Mark W. says:

    What I’d like to see from our health care system here in the U.S. is a lot more transparency regarding specific costs broken down by specialty, procedures, geographic regions, etc. Have you ever walked into a doctor’s office and seen a price list posted? If you ask about costs and alternatives before the procedure, you’ll likely get strange looks to say the least from office staff. Is it too much to have an honest discussion about costs? I knew from day one that I made the correct choice in the selection of my current dentist because besides the fact I knew he was a good dentist he was very comfortable with discussing his rates and his own expenses with specific numbers. It’s only a start but I believe a good start to awareness. The hope is to eventually get the patient more involved in the financial and decision making process and having market forces taking over for a more competitive environment.

    • Angie
      Angie says:

      I do ask about costs since I have a high-deductible HSA, and the people in the doctor’s office HATE that I ask. I also insist that the doctor not order any tests that are not NECESSARY.

      • Mark W.
        Mark W. says:

        Angie – I’m glad to see I’m not alone here. :) You bring up a great point regarding tests that are not necessary. I think that’s where the patient needs to get involved in understanding their testing and treatment by asking the doctor enough questions so both parties are on the same page and in agreement. The patient needs to take more personal responsibility in their care. I am somewhat sympathetic to the doctor’s plight as he/she not only has to treat the patient but also has to watch their backside from possible malpractice claims. I have a feeling many tests are ordered by the doctor as a way to protect themselves from possible malpractice claims.

  10. Carol Saha
    Carol Saha says:

    Bob, there was an hour long special on PBS that profiled three uninsured Americans and what they went thru trying to get medical care. It was horrible and scary. One of the patients was going to go to Mexico for his procedure because it was significantly less than in America and it was the only way he could afford it. His doctors here decided to do it pro bono. Probably because it was being televised. What about the other millions that aren’t on national tv?
    Mhughes, I totally agree. It makes me feel ripped off to realize I’m paying 4 or 5 times as much for the same thing the insurance companies get paid for.

  11. Elizabeth
    Elizabeth says:

    Actually, teachers are paid badly in part for historical and gender reasons–it was and still is seen mostly as a female profession–and since women were *all* married with husbands earning the “real” money back in the day, women’s jobs like librarians and teachers were paid lowly wages, and nothing much has changed for those professions, even though more men are in those jobs, and women in these professions often are single or need to help support a family. I disagree that we should pay jobs that are meaningful crappy pay just for the “deep fulfillment” we could supposedly get from the job. It makes no sense at all…. we pay entertainers millions but teachers are supposed to just suck it up because their jobs are (supposedly) so fulfilling?

    • Joselle
      Joselle says:

      You bring up a good point, Elizabeth. In my experience, both in terms of my family and as a patient, the best health care I’ve received has been from nurses, yet they make considerably less than doctors and that is because of the “pink” ghetto.

      Unless my life were in danger, I’d never let an OB/GYN anywhere near me. They are great for when you’re in crisis. Not so great with managing healthy pregnancy, delivery and wellness care. Nurses focus on the whole person and on health, not just on what the x-ray tells them is (or isn’t) wrong with you. They also do most of the work and are the last defense if your doctor screws up. And god bless you if you end up with a shitty nurse (there certainly are plenty) while you’re in the hospital. You can survive if your doctor is mediocre. You’ll die on the vine if your nurse (and surgeon) is.

      Doctors make a ton of money but not that much in comparison to the business world and that is because of malpractice insurance costs and the debacle that is for-profit insurance companies. If I were to go into health care, I’d be a nurse. You get so much more personal contact with patients, your clinical knowledge is buttressed by all the practice you do as a nurse, and the risks are not as high–generally–as it is for doctors in terms of lawsuits. If someone really wants to make an impact on patients’ lives consider nursing. Advanced practice nurses can easily make six figures. My mom has her master’s in nursing and that’s the salary range she’s in. Plus, she’s an awesome nurse. If I ever get seriously ill, I hope she’s still around to make sure my doctor knows what the hell he or she’s doing.

      • Ina
        Ina says:

        Nurses don’t make that much less. With a huge nursing shortage in the US and nursing schools full up, nurses can command very good salaries, esp. in specialties like ob/gyn, neo-natal and operating room.

    • Deb
      Deb says:

      Right, Elizabeth. No one should be expected to be fobbed off with less money in exchange for perceived professional fulfilment. It can be a personal decision, and lot many people irrespective of gender must be making that decision, to opt out of the corporate rat race. Here in India, there are stray stories of (relatively) highly paid software programmers going off to work as teachers in schools in remote areas (probably because they’ve made their moolah already!? – a cynical view). Or of people taking ‘early retirement’ to go bee farming.

      But this decision cannot be thrust upon you, and you being expected to abide by such supposedly high moral standards of society.

  12. G
    G says:

    Since when is $42k/year for 9 months of work barely a living wage? Last time I checked, that is above the median income in the United States, especially if there is someone else in the family working.

    The reason why teachers don’t get paid much is simple supply and demand. Any adult with a college degree is a potential teacher. The mindless hoops you have to jump through to get “certified” is the only thing which creates an artificial restriction in the labor pool.

    Likewise, the number of doctors is kept artificially low by the AMA. You are correct that the students not admitted to med school would make fine doctors, but increasing the supply would decrease the salary of medical professionals. The AMA is the organization which certifies medical schools.

    Every professional organization from the AMA, NEA, ABA, or any union knows that you have to restrict the labor supply to keep salaries up. That is why you have interior designers in some states lobbing state legislatures to make practicing interior design without a license criminal. By controlling the licensure process and making competition illegal, you make more money for everyone who is a member of the club.

    All of the above groups will cover their actions under the guise of “safety” or “quality”. The reality there are tons of people who would gladly do the work but are kept out of the club by the people who are already in.

  13. Jonathan Vaudreuil
    Jonathan Vaudreuil says:

    First off, I love the post.

    I love the post because it attacks a particular problem with our medical system, complete with analysis, comparisons, and a viable solution. You may or may not agree with the solution. If there were more med schools and more seats open to potential students then we’d have more doctors. What does having more doctors mean?

    Yes, it means lower costs. It also means more time spent with the doctor! I went on Monday and I felt like the doctor was rushing me out the door while smiling at me. Nothing rude, just no interest in anything beyond what I asked her about. It’s not the first time I’ve experienced this, and I’ve heard others say the same thing.

    How are either of those things a bad idea for society?

    It’s not the only problem with health care. It’s not going to fix everything all at once. It IS an idea, one which should work based on the law of supply and demand, and right now we have the demand without the supply. It’s a piece of the puzzle. I’m not sure where Congress is going to go with their current health care push. What I do know is Congress is concerned with Democrats vs Republicans as much, if not more than, doing what’s best for Americans. If any of them have half a clue as to what is best for people who have jobs and kids and mortgages and no trust fund.

  14. Alexander Blau
    Alexander Blau says:

    To the original poster-

    You compare doctoring to teaching, saying that they both have significant non-monetary rewards. Agreed. However, in describing the implied parallels between these two professions you mention that teachers ‘do not need a ton of schooling’ to qualify for their profession. Having just graduated medical school two weeks ago, a journey that began for me in 2001, I can assure you that this is not a commonality between these fields. I’ve given up most of my adult life to date in pursuit of the rewards of doctoring, and I’m still not done with my education. I’ve got four more years of residency training to complete before I will be anywhere near overpaid. Now, I have the utmost respect for teachers (I’ve had many in my life, and am even dating one now), but if teachers had to spend 8+ years (and grueling years, without summers off, I might add) in training just to earn the financial thanks that $37,000 a year represents, our kids would be spending their days alone.

    I’d like to think my motives are fairly pure in choosing my current profession, but I don’t think I could bear the sacrifice of working 32-hour overnight shifts every three days for the better part of my youth if I had to struggle financially on top of it. There’s a happy medium out there, I’m sure.

  15. t
    t says:

    This post is filled with interesting ideas that make a lot of sense… but unfortunately reflect almost no understanding of the economics and workings of our actual health care system.

    Most research scientists, even in “medically oriented” research, are not MD’s. They are happy working long hours after having done PhD’s for which they received a stipend rather than paying money. Also, these people are minimally involved in medical education.

    Medical school is not expensive because of the salaries of the professors.

    Although you list not needing a ton of schooling to go into education as one of the reasons school teachers aren’t paid very much, you ignore the fact that for the higher paid MD specialties, you don’t get that high salary until after, at a minimum, 4 years of college + 4 years of medical school + 7-9 years of residency = 15-17 YEARS of unpaid or low-paid labor, most of which with incredibly long hours and a dominating influence on your life. For the relatively poorly paid MD specialties, it’s only a 3-5 year residency instead – so “only” 11-13 years of education there.

    I could go on… but I don’t have time, since I still work very long hours for extremely little pay….

    Signed,

    MD/PhD at a major, nationally known medical center.

  16. t
    t says:

    (Not to be snide, but, really, given your readership size and your attempt to speak with some sort of authority on these issues – ie, this isn’t a joke blog – you should really do a little more research before you throw out totally uninformed opinions like this. “I have a lot of doctors in my family” doesn’t actually qualify you to have much insight into the financial system of today’s medical system. I think you even posted about how important it is to do research about what you post on not that long ago…!)

    • Jack
      Jack says:

      The lack of logic here in this blog post tiring. Will having more doctors in the field reduce the risk that any individual doctor faces, of malpractice? Will a teacher be sued for anything close to what doctors get sued for?

      Being an entrepreneur is an extremely fulfilling ‘job’. Ergo, should Penelope be paid less than the zillions that her VC funders pay her? After all, this is the logic used in this post!

  17. confused
    confused says:

    In some states and in some districts it is the norm to pay teachers–at least–a living wage. Also, plenty of people go to school for five or six years to become teachers. What about physical therapists and chiropractors–how do they fit into your equation?

    I agree with the previous commenter that there is a “pink ghetto.” The government is charging us money to bail out automakers and banks and yet sees fit to let schools carry on with so little. Teaching is rewarding but it’s unnecessarily frustrating with schools don’t have enough books or computers and classrooms are stuffed from wall to wall.

    It’s just the culture in our society. Teachers get no respect and Doctors get too much respect. Entertainers get more than their share of respect too and are given a platform if they have an opinion about healthcare policy or nutrition.

  18. Bethany
    Bethany says:

    I have always been under the impression that it is the cost of malpractice insurance and schooling that drive up the salaries of doctors–also that most, after all their expenses, are not actually overpaid. I worked in Risk Management for awhile and was amazed at the lawsuits brought against doctors that were obviously people out for a buck. My favorite–the 30 year old guy suing the doctor who performed his circumcision as a baby for emotional issues and poor sexual performance. Sadly, the guy won instead of being laughed out of court. No wonder it’s hard to find a good specialist–so many states let them be driven out by insane court cases.

  19. t
    t says:

    While my data is crunching away, I glanced at some of your links. The link for how happy these overpaid MD researchers are is actually (1) explicitly a survey of PhD’s, (2) lists their mean salaries at $61k (women) and 71k (men), and (3) is from 2006, just before financing for this area crashed and burned and we all started cutting way back and looking for backup plans. This is clearly not consistent with the overpaid MD in 2009 that you’re trying to paint a picture of.

    (yes, I’m embarrassed to have commented multiple times here – but this really rather touched a nerve, I’m afraid!)

    • JR
      JR says:

      Speaking of links, who says that garbage men make more than teachers? answers.yahoo.com. Well, it must be true then.

  20. Holly
    Holly says:

    I really enjoy your way of thinking and your no-nonsense, not-afraid-to-push-buttons way of expressing your points. I’ve never heard anyone argue what you did about high pay vs fulfillment, and I think it’s a very interesting argument.

    I do have to say that it’s incredibly unfair that those of us (like me) who have fulfilling jobs in helping professions can barely make enough to live on (we’re not asking to make $100,000/year). People (like your commenter above) like to say those jobs make the average pay, especially with 2 earners, but HELLO, who said everyone had to be married and have 2 incomes in your household? I hate that somehow I’m not expected to make a living bc I’m single and I’d be “better off” if I was married.

  21. Dave
    Dave says:

    Do you have anything other than feelings to back your contention that more doctors would lower costs? Take a look at lawyers – we’ve got more of them in the US than anywhere else in the world. Has this led to better laws? I don’t think so. Instead, we’re awash in a flood of trivial lawsuits (hopefully I won’t get sued for slandering lawyers or some such) as all those lawyers look for some way to make money. If we were awash in doctors, I would expect to see them urging us to check in to the hospital and have complex surgery for even trivial ailments, just so that they could work on paying off their student loans. You might want to do a little research into the average debt load a newly graduated doctor is carrying when they exit medical school. Plus, as was pointed out by another commenter, the big salary doesn’t come until they finish their apprenticeship (intern), yet another several years down the road.

  22. Mary
    Mary says:

    What about the children? Have they been completely forgotten? Why don’t they have free healthcare?…. It is inevitable that the US will have to work towards a universal healthcare model at least for children, unemployed, disabled, retirees etc… 50 million uninsured is not acceptable or moral by any means. Without it, we will always be taking 2 steps forward, 10 steps back. No way to progress at all.

  23. BV
    BV says:

    Doctors in Canada work in a socialized system *and* are well paid. Lowering pay for doctors is not what is needed for socialized medicine – heck, you Americans already pay more per person for your health care than we do in Canada! And there’s not much wage disparity for the doctors.

    Inability to pay insurance premiums does not result in insurance companies lowering the rates – it results in services disappearing. Research the places in the US where you can’t get your baby delivered by an obstetrics specialist because OB/GYN’s cannot afford the insurance for that highly litigious field. They can only afford to do the GYN part. So that’s all they do. The problem here has nothing to do with doctor’s salaries and everything to do with the bizarrely infantile habit of some Americans to demand a cash payout in the millions for any problem they encounter.

    And why on earth shouldn’t jobs that do good work be well paid? Teachers work for cheap – we shouldn’t just accept that but rather lobby to improve their situation! Doctors have enormous responsibility and go to school for a long time, and they do amazing good work – this is not worthy of high pay? Saying people who do good work shouldn’t expect a good wage is perverse. There is something deeply wrong with our priorities if we cannot see the value in valuing good works.

  24. WM
    WM says:

    How on earth can you compare the salary of doctors and teachers without talking about working hours? Of course some specialist doctors have great hours, but many doctors have to spend years after medical school working 80 hours on a good week, being on call, etc.

    Teachers get summers off, spring break, winter break, tons of national holidays, etc. Plus a typical school runs classes from 9:00ish to 3:00ish. Outside of those hours the teacher’s work time is flexible and within his/her control.

    People care more about free time and having control over their schedule than money. It’s nuts to not consider this when making a comparison.

    That said, I think you’re great! Love the blog, so entertaining and thought provoking.

    • confused
      confused says:

      Teachers do bring work home. Either they stay until 5 at school or grade at home. They also have to plan curriculum months in advance and write detailed lesson plans that meet state frameworks.

      And in this overconnected age, they do get emails and phone calls at odd hours.

      I don’t think the payscale in this country for positions is predicated on the number of hours someone works. Many (non-entry-level) journalists work long hours for low pay. Retail workers often have long shifts–especially at places that are open until 10 p.m. or so.

      There is not enough causality and data in your post. And, truly, how can you compare teachers to doctors? Why not compare two year olds to twenty two year old? You should ask yourself before writing: What good will this comparison do?

      I think people are motivated by money, fulfillment, caring for others, benefits, schedules, perks, desperation–people work for so many different reasons. If ask me if I work for money, today I would say yes. Yesterday I would say fulfillment. In this recession, everyone has to hang tight because there are so few job opportunities to jump to.

    • imelda
      imelda says:

      Oh my god, get real. Teachers work ridiculous hours: time spent grading, making lesson plans, leading extracurriculars, PT conferences and meetings, calling parents, class trips, union meetings, training, etc etc. Also, what school in this country begins at 9 am? That said, you are absolutely right about the extensive vacation time they receive, and that certainly should be counted as compensation.

      @Penelope: I think it’s hysterical that you’ve noticed the inexplicable wage canyon between teachers and doctors (or even doctors and nurses), yet insist that no gender wage gap exists. Doctors get paid craploads because they’re traditionally male, teachers get paid crap because they’re traditionally female. End of story.

      • WM
        WM says:

        Show me a teacher that works more than 50 hours per week on average and I’ll show you someone with poor time managment. Your regular hours are no worse than your average professionals and you get a more flexible schedule and more time free from work.

        And union meetings are not work – fyi.

        That said, I’m not saying that teacher’s aren’t underpaid. But I am saying that doctors have it way worse and that the comparison isn’t valid.

  25. Steven
    Steven says:

    I had this conversation with a premed from Sweden last summer; I asked about the salaries of doctors, and he unflinchingly remarked “Being a doctor in my country is less about money, and more about helping people.” Not sure how this could actually be implemented in our system, but an excellent post.

  26. Steve
    Steve says:

    WOW! You can tell that PT is writing this entry with the POV of someone who is completely ignorant of basic economic principles. Simple Question: Why will anyone pursue a career in medicine when it become an economic impossibility to do so? (Pay so low compared to costs of education, insurance, and lawsuits.) Better question: Who will provide Americans with medical care when all doctors either retire early or young potential doctors decide never to practice. I know PT’s answer is that they will merely “feel good” about helping people. Will the electric company and med school loan holders accept “feeling good” vs. dollars to pay for real items in the real world? PT, seriously! What world are you living in? Will you accept goodwill vs. money to pay the bills for your business? Yeah. Didn’t think so.

  27. JR
    JR says:

    Health care is not expensive because the doctors make too much money. It’s expensive because of people wanting to see a doctor (for free) every time their kid gets the sniffles. And elderly ladies making an appointment just to have something to do that day (my wife, a nurse, sees this often.) And people demanding the new high priced drug that they just saw the commercial for on TV. And uninsured people clogging up the ER, from which they know they cannot be turned away, or be forced to pay for. And of course, the malpractice suits.

    Fine, cut the family practice GP’s pay in half. It won’t make a dent.

  28. D
    D says:

    Penelope, I’m shocked at how embarrassingly poor your research was for this article. Show how much doctors pay for malpractice vs. salaries, then let’s talk about whether they are overpaid or not. For example, look up how much malpractice insurance costs for Ob/Gyns in Pennsylvania. Then look at the dropping numbers of Ob/Gyns in Pennsylvania.

    Look at how few lawsuits (1-2, they don’t even have to win) it takes to put a doctor out of business – which they spent their whole lives building towards. Where are all those well-meaning doctors who are willing to work for nothing, and at the risk of getting sued out of the business?

    What happens when you expand the pool of medical students to include those who haven’t performed as strongly? Your care gets worse, patients sue more, the doctors can’t practice anymore. What a fruitless, harmful and expensive exercise. Yes, healthcare would be cheaper if there were a much wider pool of doctors – but the healthcare would also be worse. And litigious Americans are not willing to compromise for it.

    Is it worth it to pay doctors how much they make? Yes, and much more. Your life depends on them. And they make themselves available 24/7. How could you possibly justify paying a teacher’s salary to someone who wakes up in the middle of the night to save your life? Who spends multiple nights a month (and often a week) working all night long?

    The real culprits in healthcare who are burdening the system:
    – Pharmaceutical companies
    – Malpractice lawyers
    – Litigious patients

    Research these areas, and then revoke your ridiculous post.

  29. IMK
    IMK says:

    I think this is the stupidest post you've written so far. It is so lacking in depth and understanding of issues it's embarrassing. As a start, I suggest you look at countries that don't pay their doctors well – €“ many of abovementioned doctors move to countries that pay them better (examples – €“ Polish doctors going to Britain and Philippine doctors becoming nurses in the U.S.). And the level of education in this country speaks volumes about level of teachers here – €“ enough said. I am quite happy to have my taxes raised to pay our teachers better – €“ the good ones deserve it, and the bad ones can teach your kids (they can count till 10, so they must be good enough, right)?

    • IMK
      IMK says:

      And while we're at it – €“ why don't we lower pilots' salaries? These guys love flying anyway, they get lots of personal satisfaction out of it, they'll work anyway. Oh wait.. that didn't work that well for Colgan Air, now, did it?

  30. Becky
    Becky says:

    Is this post a joke? Why are people trying to respond to this intelligently in the comments?

  31. Alex @ Happiness in this World
    Alex @ Happiness in this World says:

    As a primary care physician who’s run a primary care clinic in a major academic hospital, I can say with first hand knowledge that’s wrong with our health care system is so complex it boggles the mind–as does the number of people who work outside the medical field who think they know how to fix it. Certainly a patient’s experience can identify the problems, but solutions…? Ten years ago when I last looked at the data doctors’ salaries contributed 3% to overall expenditures on health care costs in the U.S. Considering that the rise in costs since then has been mostly in new technologies and increased utilization of expensive tests, this percentage is almost certainly lower than that now–so cutting doctors salaries would barely dent our society’s health care costs. What it would do is drive doctors out of their fields (which is already happening).

    The main reason customer service is so poor in doctors’ offices is because demand for medical services far outstrips supply (increased population, increase utilization per person until this economic crisis hit). And you want to cut doctors’ salaries? Expect longer waits to see your doctor and if you think your doctor doesn’t return your phone calls now…? Whatever the reasons for the cost of a medical school education (and it’s NOT teacher’s salaries as has already been pointed out) medical students are graduating with loans so enormous they’ve been choosing more lucrative specialties just to be able to pay them back for about the last five years, leading to a worsening shortage of primary care doctors. About 45% of primary care docs in this country want to quit, by the way, and not because they aren’t paid enough–because their ability to do the good job they signed up to do is being eroded every day. Doctor’s salaries are only partly set by market forces. Third party payors, the biggest of which currently is the government, set reimbursement rates, which in turn sets incentives for which specialties get the smartest people going into them. Pay is often not set by what people think it should be, ie, risk to life, time to train. If it were, firemen and police officers would be paid far more than they are and entertainers far less.

  32. Holly Hoffman
    Holly Hoffman says:

    It doesn’t happen often P, but I totally 100% disagree with you here. Doctors may face pleasant feelings to the Nth degree when they save lives, but when people inevitably die, right there in front of them, they experience far more pain, discomfort & lasting unpleasant feelings than any 10 garbagemen combined.

    My sister is a nurse and when I see her after a hard day (i.e. she’s seen more people die in 1 week than most people will see in their entire lives), I know why doctors & nurses get paid what they do.

    Our healthcare system being broken is a symptom of a larger problem: a society that continues to live beyond their means, buys on credit and refuses to save for emergencies; the resulting strain on social services, government aid, and hospitals; which is passed on to consumers who are responsible in the form of higher premiums & deductibles.

    Teachers should get paid more. Period. Doctors should make good money. Credit card companies, insurance CEOs, and auto & bank industries should make less. Duh.

    But yes, please, let’s take money away from the people who hold our lives in their hands and not the ones making life-altering decisions like whether to include a hot chick in a car commercial.

    • Deb
      Deb says:

      Very perceptive & analytical comment, Holly. The factors you outline, alongwith the high propensity for litigiousness (encouraged by tort lawyers), point to the crux of the issue.

  33. Anonymous
    Anonymous says:

    Penelope,

    Love this post.

    The big problem with the U.S. health care system is that it focuses on curing life-threatening illnesses (cancer, etc) while almost uniformly ignoring non-life threatening conditions that greatly decrease the quality of life and happiness of a lot of people.

    The doctors’ basic assumption is that if you can live with it, you should learn to live with it.

    That is really screwed up. The point of medicine is to increase the quality of life for people. So maybe we should have more doctors who do not necessarily go through such intense and expensive medical training and end up “practicing medicine” by regularly ordering expensive blood work and shrugging at the results, but go through less training and actually practice more compassionate medicine.

    And yes, all the best doctors take cash for their services. And that makes sense. I would pay $700 to go see the expert in his field. But I do not want to pay $700 to go see someone who will order blood work and tell me to learn to live with my condition. Screw that. That is useless to me.

    • t
      t says:

      It sounds like you’ve had a bad experience – and need a new doctor. I promise that’s not what they’re teaching in medical school these days….

  34. Irina I
    Irina I says:

    Unfortunately, doctors get paid so much because there are just not enough of them. And so the really bad ones get paid a lot too.

  35. Tina H.
    Tina H. says:

    Can’t even begin to comment on this article as a whole but I found the “Research scientists are happier, on balance, than almost any other type of career.” comment, based on an article that is itself based on a self-selecting survey, positively hysterical. I thought it was hysterical when I read it in Science and hysterical again being quoted here… I’m a research scientist. So are most of my friends. I wouldn’t touch an academic post-doc with a ten foot pole, and I’ll let every newly-minted bachelor’s graduate know exactly what a life-eating experience gradschool was for me. There was another article in Science or Nature or the like that discusses how depression and mental disorders in general are now considered a normal part of the PhD experience. Sheer bitterness keeps me away from Science surveys and the like. The medieval system that continues to run graduate schools and funnels funding from the NIH is so obviously messed up, there’s no point even screaming about it anymore, much less filling in little survey bubbles. Now you know, too.

  36. dean dad
    dean dad says:

    Dunno about the health care part, but the education part is just wrong.

    In the rest of higher ed, we’ve been squeezing instructional costs for decades now by steadily increasing the percentage of adjuncts. Yet tuition (and the real costs colleges face) continues to rise faster than inflation.

    The issue is productivity. As long as we can’t figure out how to improve that, costs will continue to climb. Squeezing the help is a palliative at best.

  37. William Bruce
    William Bruce says:

    As much as I hate to ask a pat, libertarian meta-question, it seems germane to this particular post:

    Who is the “we” that is going to make these changes?

    …but perhaps that is just a more abstract way of voicing the various “economic” complaints of other posters.

    Nevertheless, I await any rebuttal (or answer) with avidity.

  38. Ms. Mama
    Ms. Mama says:

    I love how you get the masses so riled up. Is that something that only Gen X women can do. I see it everyday in my friends. Love it.

    If you’ve got medicaid then you can do pretty well, but if you’re just above that line, then forget about getting treatment.

    I keep saying that about everybody. So why can’t GM just pay people less. Charge less for the cars. ETC…. I guess it is some sort of a crazy loop.

    BUT, if no one is buying an MRI, what is the radiologist going to read? If no one is working who will pay the insurance premiums? If the insurance money isn’t coming in then who will pay all those nice people on the customer service lines at Anthem?

    Once again, I see that the book, If You Give a Pig a Pancake has some basis in my life as a grown-up.

    Love the idea. It seems perfectly sane to me. And I’d like to add, why does everyones socks have to be perfectly clean? Do we really need new stuff all the time?

  39. Casual Surfer
    Casual Surfer says:

    But according to your logic, female doctors should be paid more for the same amount of work. And somehow the CEOs of start-ups are worth $200k+ (your reported salary)?

    I don’t think so. The doctor who diagnoses you with strep throat & prescribes an antibiotic that won’t trigger any of your known allergies is worth a LOT more than any CEO of anything. I think CEOs should start making crap money. There are tons of egomaniacs who want that cushy office & like to crack the whip. Hell, you don’t even need to have an advanced degree to get that job. I think we ought to start paying CEOs less than $50k/yr so we can afford to have more small businesses in the US. Maybe we could have a cap – you can’t make more than $5k per employee in your company. How does that feel?

    You want to reduce healthcare costs, it’s simple. Reduce the paperwork. Did you ever notice that it takes as long to check in & check out of a doctor visit as the actual visit lasted? Another way to reduce costs is to let physician’s assistants handle most of the sick visits (and strep throat tests), so the doctors can handle the more indepth visits.

    I’m not a doctor, I’m an engineer. But I don’t begrudge my physicians one dime. Hell, I wish they earned more (particularly a few surgeons I remember). Bottom line – you should never have a doctor do a nurse’s job (they’ll screw it up) and no one needs to spend 50% of their week documenting what they did during the other 50% of their week.

  40. isha
    isha says:

    here’s the flaw in your argument, doctors dont get paid a lot, they get compensated for having brain functional enough to save a man’s life, at the end of a 72 hour shift in ed. They are compensated for a shit life.

  41. principalspage
    principalspage says:

    Teaching salaries aren’t based on the amount of good work that we do… they are based on supply and demand.

    And in many parts of the country there are far more candidates than positions available.

    There are places that experience teacher shortages, but I am not sure paying twice the salary would even help in these areas.

    There can be a rumor of a 3rd grade opening in my area and I will have 75 resumes in a week.

    As educators we like to say that we are underpaid, but most of us don’t leave the profession. And if we did, there are hundreds of people waiting to replace us.

    On another note, my assumption is you are just messing with me when you Twittered about wanting the farmer back.

    You are a cruel, cruel woman.

  42. Anne
    Anne says:

    “Since when is $42k/year for 9 months of work barely a living wage?”

    Agreed. Except that the average teacher does not earn that much. The salary quoted is what teachers in wealthy districts are paid. In my state, the difference in pay varies even between neighboring counties. The poor counties cannot afford to pay as much. Pay for teachers varies widely by city, county, district and state.

    As far as doctors go, I am in favor of doctors getting paid every penny they are worth. You can talk about non-monetary rewards all day long, but money is often the reward that motivates people the most. I don’t want an appointment with a doctor that gets cut-rate pay, because that is a doctor who is not as motivated as the doctor who is compensated fairly.

    Also, the responsibility that a doctor has is far greater than that of a teacher. If a teacher makes a mistake teaching, a grade may have to be changed or a student may need a tutor. If a doctor makes a mistake, someone could die. More responsibility absolutely should mean more pay. Doctors have an extensive and grueling education process. If it was that easy everyone would do it. It’s a highly specialized occupation. The hours and intensity of labor involved deserve to be fairly compensated.

  43. elissa
    elissa says:

    I am a fairly new reader of your blog and I usually enjoy your posts, however, I take issue with this one and some of the comments. I realize that this post is primarily about the state of healthcare, but I am reacting primarily to your thoughts on teachers.

    As a former teacher, I feel some big assumptions are being made, both in the post and in the comments. In many states, teachers now need a master’s degree to teach – and in time this will most likely become the case with all states. So while teachers don’t need as much education as doctors (which seems fitting due to the nature of the job), there is quite a bit of training involved.

    Teaching is a tough job – physically and emotionally – and is also fast becoming dangerous with violence in schools on the rise. While I acutally don’t feel a teacher’s salary is currently too off-base – depending on where one is teaching – I do feel that a teacher’s job is one of the most important. Unfortunately, whether it’s due to the pay or the nature of the job, we don’t have enough “quality” (not qualified – in many areas there are plenty of those) teachers who truly care about a child’s education – and it’s the child and eventually our society that suffers.

  44. Margaret
    Margaret says:

    This post is sooooo lacking in credibility for a number of reasons. The biggest is that you are linking to pay scale: 1) which is self reporting and 2) pays you to write about them.

  45. Catharine
    Catharine says:

    I like the post about offering alternatives to allopathic medicine. Once while traveling in Europe I met an American who worked in a Swiss lab. He managed to burn his arm quite severely. Instead of grafting, the medical team bathed his arm in one kind of tea and ordered him to drink huge quantities of another kind of tea. He said the wound healed without a scar. His American doctor friends were dismayed at first, but this treatment was cheaper and pleasanter.

    There’s some irony in complaining aboout the high cost of health care while every supermarket stocks sugar cereal, potato chips, high-sodium canned products and more. There’s an irony in paying hundreds of thousands for blood pressure medication and anti-depressants for a population that won’t exercise or perform simple stress release actions, such as meditation.

  46. Steve
    Steve says:

    There is something inherently wrong with a system that allows doctors to live in lavish waterfront compounds and the lap of luxury while 44 million citizens have no insurance.

    This system treats symptoms and not causes. If all citizens had access to primary care we could catch diabetes, heart disease and cancers much sooner and treat them before the solutions required are $250,000 heart operations. We could have screened them for cholesterol and given them statin drugs twenty years earlier and prevented the operation.

    Prevention is the path to reforming health care both in terms of national health as well as reducing costs over the long run.

    • Jay Godse
      Jay Godse says:

      Diabetes and heart disease are, by and large, diseases caused by eating too much and/or drinking too much pop, and by not exercising enough. From what I have read, poor uninsured people are at least as guilty of this. Cut the calories, cut the pop, bring fresh fruit, vegetables and fibre into the diet, and go for a 30 minute walk every day. A lot of these problems will diminish or disappear in society as a whole.

      You don’t need a doctor for that…

      A large factor in the cost of American health care is that Americans are, on average, way too fat. That includes poor uninsured folks. That correlates very strongly with expensive health care problems. I have a friend who moved from Ottawa Canada to Houston Texas. She said that compared to Houston, most folks’ bodies in Ottawa look like those of super models.

      Alternates for cancer exist. For example the Simoncini method and Low Dose Naltrexone have shown success, but Naltrexone is off patent, and you can’t patent baking soda. However, the allopathic medical establishment and the pharmaceutical industry won’t allow this because they can’t make money.

      If you want to lower health care costs, break the monopolies.

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