Career decisions shed light on health care crisis solutions
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.
All jobs requires dedication and hard work, but there are some jobs which can’t be replaced with money or can’t be equate with money. Like being a teacher, you work with this career because you think it’s a fulfilling job. Some set aside the monetary value of it, but of course it is important as well in order to live. We just hope that government’s decisions on revamping health care system is better than before, because this will help the citizens to have a privilege to maintain their healthy body.
I love my family Doctor. I actually feel bad for the guy as it seems like he is always working, and the job must be stressful dealing with people who are looking for help all day long. Especially the patients that are in pain and he just has to tell them he can only do so much.
He has shown up to see me in the hospital at 7am one time when I had a kidney stone, he works every other weekend. He must have had a ton of student loans he had to pay off, there is all the insurance and support staff that he pays, plus the paperwork nightmares.
I think some specialties can pull in some hefty dollars, but Ido not think the family physicians pull in their worth. All the healthcare money goes toward test that are required to prove everything possible was done in case a lawsuit erupts.
Will
There’s a relatively small healthcare outfit in upstate NY (Cooperstown) named Bassett Healthcare (25 health clinics, 13 school-based clinics, 4 hospitals, and a nursing home) where costs are lower than 90 percent of the hospitals in NY while quality of care ranks among the top 10 percent in the nation. Bassett Healthcare controls their costs by paying their doctors by salary rather than a fee for service business model. They also employ what they call an integrated health care delivery where primary care physicians and specialists work together as a team for the patient. They are not for profit and their missions are to employ doctors, teach nursing students, and conduct research. There’s a good New York Times article on them at http://www.nytimes.com/2009/07/25/health/policy/25doctors.html .
Thanks alot for the article, i like your articles alot, espeically this one, keep it up..: )
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.
Well said, Jay!!! Very true. The underlying problem of our health care system is lack of competition on many different levels.
Even with just allopathic medicine, it is highly uncompetitive. Most of us have limited options in government or employer sponsored plans and the health care market does not cater to individuals.
Why can’t health insurance cater to individuals just like car insurance does????
Thanks for the link, Mark!
we can always avail of food stamps if we can’t afford great food:,’
Mark W, in reference to the Hospital in Cooperstown, NY. They pay their doctors a salary and those so called doctors pass all of the work onto the Physician’s Assistants and patients never even talk to the actual doctors. My Mother went there several times over a year ago because she couldn’t keep food down and her abdomen was swollen to the size of a 8-month pregnant woman. They could not find anything wrong with her and just kept telling her to “drink clear fluids”. Mom knew something was seriously wrong so drove from NY to Dallas (where all of their children live) and immediately went to the emergency room. She was diagnosed with Stage 3C Ovarian Cancer within 2 hours! Recently her Oncologist suggested she have a mammogram as her breasts didn’t look and feel right. So they ordered the films from the Mammogram they did in Cooperstown a year ago and low and behold, there was an obvious large cancer mass that no one seemed to be able to see. Now a year later, the mass is even larger. So, I’m sorry, but the “salary” idea does not work, especially in Cooperstown, NY. That is a horrible place that, as far as I’m concerned, will cost my mother her life! I have no idea how it keeps getting such rave reviews! I’m sure, like everything else in the medical industry, money will pretty much buy anything.