It’s the Doctors, Stupid

Time: Bitter PillSteven Brill has gotten a lot of attention for his big cover story for Time, Bitter Pill: Why Medical Bills Are Killing Us. In general, I don’t pay that much attention to healthcare policy. The truth is that the issues are clear. The only things that get in the way of good policy are the installed interests and the Republican Party. So I didn’t even hear about the article until Brill showed up on The Daily Show. I was none too impressed.

Brill’s main claim is that hospitals are charging too much for things. Three dollars for a capsule of Tylenol?! I understand that these things are outrages, but they aren’t the main issue. Even the centrality of insurance companies in healthcare delivery isn’t the main issue. The main issue is that doctors make far too much money in the United States. Primary care doctors make 50% more in the US than they do in Germany and Canada; they make almost double what they make in France and Australia. I don’t think anyone is arguing that doctors in the US are better than they are in Germany, Canada, France, and Australia.

And yet, in Brill’s big bad indictment of the healthcare system, the doctors are the heroes. He dismisses the idea of a single payer system because—This is rich!—the doctors wouldn’t make as much money. So we have a system where general practitioners make roughly $200,000 per year, but we can’t have a decent healthcare system because these doctors would suffer if they were only making $150,000 per year. It really is that pathetic.

Note: this has nothing to do with single payer systems. The government keeps doctor salaries artificially high by lowering the supply of doctors through immigration policy and certification standards. I understand that we probably want to keep certification standards high. But why are American doctors shielded from the effects of globalization but manufacturing workers aren’t? I suspect that Brill has never even thought about that question. I’d bet he has friends who are doctors. This is same old thing: one member of the upper (or perhaps upper-middle) class taking care of another.

The United States has two big problems with its healthcare system. Doctors are paid too much and insurance companies increase costs while denying care. It may be unfortunate that a hospital charges $3 for a capsule of Tylenol, but that problem isn’t anywhere near central. You would think in 24,000 words that Brill would have figured that out.

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About Frank Moraes

Frank Moraes is a freelance writer and editor online and in print. He is educated as a scientist with a PhD in Atmospheric Physics. He has worked in climate science, remote sensing, throughout the computer industry, and as a college physics instructor. Find out more at About Frank Moraes.

0 thoughts on “It’s the Doctors, Stupid

  1. Did you get your perspective on US protectionism for doctors from Dean Baker’s history of the US since 1980? It’s a prominent theme in that book. (I read it after you recommended his e-book, which I did download, but I hate reading e-books, so I started by reading something with pages I could get from the library. I’ll get to the e-book one of these days.) Whether you got it from Baker or came by it on your own, it’s a great point — that, to elites, globalization is good when it pushes down salaries for the poor but not if it pushes down salaries for the upscale.

    Everything that’s fucked up with our health-care system (our system, period) intertwines so much. I can’t honestly point at one thing and say "this would fix it." If we had single-payer, as you note, doctors would still be overpaid (and as I’ve noted elsewhere, this attracts many people to the profession who are enticed by the money, not the thought of practicing patient care.) If we relaxed restrictions on immigrant doctors without single-payer, they’d probably have to work for health providers that mandated high salaries. (It would alleviate the problem of fewer doctors being available in rural areas, but I doubt patients in those areas would get to avoid paying what Blue Cross demands.)

    It’s one of the huge challenges (insurmountable obstacles?) for the left. Milton Friedman can propose a magic solution like eliminating government licensing restrictions for doctors and letting the Holy Market do its nefarious work. Because he could really give less of a shit about the outcome. We’re stuck with wondering what the best first step is, A or B, because we’re aware the whole alphabet isn’t politically feasible, and because we do care about outcomes. Makes it difficult for our side to rally around that first step, as we are going to disagree about which of those dance-school footprints we should step on.

    (Incidentally . . . John Milton: author of English literature’s most celebrated depiction of Satan. Milton Friedman: Satan. Coincidence? Or proof of a DIABOLICAL CONSPIRACY? As Internet posters tend to say, "do yr reserch and look up FACts you socialst Kool-Ade dumshit."

  2. "It’s the Doctors, Stupid" ?! Just the doctors? What about the hospital CEOs and upper administration?

    Check this out: "The top executive at Carolinas HealthCare System received $4.76 million in 2012 compensation, a 12 percent increase over 2011…"

    and:
    "The top 10 executives at Carolinas HealthCare each received more than $1 million in total compensation. Most received increases of more than 8 percent.
    The system’s annual release of top executive compensation comes as health officials, lawmakers and business leaders agree the cost of health care is rising at an unsustainable rate."

    Read more here:

    http://www.charlotteobserver.com/2013/02/06/3835851/charlotte-hospital-pay.html

  3. @JMF – That was very funny. I wish I had come up with that! Friedman was an evil fool. When his advice was followed but then it didn’t work, he always had an answer: do more of it! That’s the libertarian refrain: some part of the market isn’t free, that’s why everything is going to shit!

    Did I get that from Baker? Probably, but not that book, because I haven’t read it. Baker has taught me more about economics than anyone–including Krugman. When it comes to policy, I think Baker is by far the best economist around.

    To my mind, there is one thing that is the base of all our problems, but of course, it doesn’t have any easy solutions. Our economy is too unequal. This is a terrible problem in itself. But it distorts the economy. I just wrote on another blog that the main reason we can’t reasonably deal with climate change is income inequality. The oil interests are too powerful. The same thing can be said for the medical profession. I assure you that doctors would not be able to monopolize medication prescribing as they do if they were only making double the average salary.

  4. Thanks for tolerating my crap, as usual. You might consider that "RN" could actually be an RN! As in, someone stuck in the bowels of this system and (justifiably) pissed about how it works. I live right across the street from a hospital (and down the block from two more, so when I go camping, soft animal noises bother me more than sirens do at home.)

    Most nurses I know are much more caring and competent than most doctors. (If you’re in a hospital and need pain management, ask your nurse; don’t bother with the day physician.) They also answer directly to doctors, so it’s perfectly understandable they would blame costs on invisible higher-ups and not their immediate superiors. Or the system in general. Ugh. This country can be a smidgen depressing.

  5. @JMF – I was in the hospital for 5 months only about 5 years ago. Nurses run hospitals. I love them to death and note that I don’t say anything about their salaries. (And it isn’t as though I want doctors paid poorly. I would like a better system that would fund medical school and make is easier and cheaper to become a well paid–Within reason!–doctor.)

    My problem with RN was exactly what I said. I run into this all the time, and not just here. People complain about something you’ve written, but haven’t taken the time to read what you’ve written. If RN had said that I was underestimating administration costs, I would have been fine with the comment. I choose my words fairly carefully. Words matter to me. (Of course, the problem could also be that most people are [i]terrible[/i] readers!)

    Nonetheless, I’m grateful to anyone who bothers to comment. And I have my moods.

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