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Originally Posted by Replaced_Texan
Nah. Just very much wanted in smaller communities. My cousin-in-law has a very, very sweet deal in Longview, Texas. My cousin, his wife, doing straight up internal medicine in a hospice setting, makes a fraction of what he does. They graduated one and three in their medical school class and excelled at their respecitve residencies in one of the top teaching hospitals in the country. Theoretically, they should be on par with one another, financially.
I think that some physicians are grossly over-paid and some are grossly under-paid. Depends on the specialty and how reimbursement works in their areas or specialties. Dermatologists rake in the cash when pediatricians can barely make enough to cover overhead. My anestheisologist made more than my surgeon when I had my gallbladder taken out a few years ago.
We do a horrible job of aligning reimbursement with effectiveness. Look at stents, for example. No evidence whatsoever that they do any better than drugs. But cardiologists get a heck of a lot more money if they hang out in the cath lab shoving metal up arteries than if they hang out in a clinic writing prescriptions and talking to their patients.
Medical school education is really, really expensive. But, so are a lot of other schools. You don't hear people crying over the people who spent $40k on cooking school and then end up in $18k a year jobs afterwards. There are thousands of newly minted lawyers out there in mortgage sized debt who can't find jobs at all, much less jobs that can put a dent in the loans.
I'd love to cut down on the cost of education borne by the student. But my legislature--and the legislatures of a lot of other states--aren't particularly interested in that sort of thing.
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It's fitting two grossly overpriced services - education and healthcare - should be discussed in tandem. Aside from the way one's cost impacts the other's, they share a common driver found in every inefficient, cost and debt-ballooning product/service delivery industry: Third Party Payment Structures.
Third party payment structures don't work. And they never will in any consumer setting.* The only way to curb costs, over-use and poor use is to make the purchaser feel the pinch at the point of payment. As long as people can think, "Maybe insurance will cover this test," or "I'll find some way to pay off this $100k History degree later," people will purchase that which they cannot afford. It is proven millions of times a day, every day, and yet our solution is to tweak the third party payment structures at the margins while never addressing the root problem. It's classic "Doing the same thing, expecting a different result."
And I know the response I'll hear... "We can't go and remove govt guarantees on student loans, or drastically overhaul health insurance to force people to pay more directly. It's unrealistic... People are conditioned to what we have - what they expect. We can't radically change it." This is what some author a few years ago called the tyranny of bad ideas. That something bad is ubiquitous, that it might be woven into our collective understanding of how society and government operates, doesn't mean that it must persist forever. Or can persist forever. If it violates math and renders us uncompetitive, it's going to be radically changed one way or another. The only question is whether we address it pre-emptively, or wait for crisis.**
*Outside credit cards, factoring models for which only work because the creditor controls the cash flow and can directly hammer the borrower for payment... and makes money on high enough across-the-board interest to offset losses.
**I give Obama credit for at least trying to fix health care. Sadly, his approach included an expansion of third party payment structures, which ultimately makes the problem more acute. Too much policy think, not enough appreciation of how a market, and the brain of the common consumer, operate.
