In my view, the fact that we don't know, is a major part of the problem. Our system is such an entangled web of business entities, that we probably have no idea where the money is coming from and going to. Everybody says that somebody else is gouging us, which means that they're all probably gouging us.

And they are all invested in each others bags. For instance I've read that doctors are major investors in health providers, are often the owners of the expensive equipment, and also heavily invested in the malpractice insurance industry.

Half of billing is multiple businesses billing one another.

It seems quite possible that what makes government health care more efficient is simply knowing where the money is going, if it's all coming out of one checkbook.

Predominantly (there's also general overall bureaucratic bloat with absurd numbers of administrators at all levels) .

It's certainly not the majority of healthcare workers.

Physicians are often scapegoated as responsible for healthcare costs when in reality physicians in Canada, New Zealand and Australia earn similar salaries without the massive cost blowout.

There can be instances where physicians are paid the same or more outside the US (I've heard family practice can pay better in Canada), but overall US physicians earn much more.

https://www.physiciansweekly.com/how-do-us-physician-salarie...

I guess it depends on your comparison - that article didn't include Australia, NZ or Canada.

Also if you factor in earnings and expenses over a lifetime (including cost of studying and the fact that many of the countries mentioned have free healthcare and education and far lower insurance requirements) it evens out substantially.

More importantly, even the highest physician salaries are orders of magnitude less than insurance company CEO salaries.

Disclosure: I'm a physician, currently practicing in the US, previously in New Zealand and the UK.

I’ve got several friends who specifically moved to the US from Canada because the pay was so much better. No doubt it varies by circumstance, but docs ive known in the US pay off their $500k in student debt pretty quickly if they specialize.

And sure insurance CEOs are paid more, but there are also a several magnitude more doctors than insurance CEOs. You could pay all the CEOs $1 and the cost of healthcare isn’t going to budget much.

doctors in Australia, NZ and the uk generally have only 30-50k in loans. And earn a living wage during their residency (in Australia can reach 6 figures within 1-2 years as opposed to flat 45k for 6 years in the US)

This simply isn't true.

https://www.beckershospitalreview.com/payer-issues/what-5-he...

And its not just the CEOs - its all the parasites in the c-suite.

And these people contribute less than nothing to the health of patients, quite the opposite.

The CEO pay there is ~$0.30 per person in the US. Healthcare spending is about $12,000 per person.

Seems likely enough that adding another 100 CEOs wouldn't make the total much more.

And, in the US, you could pay all doctors $1 and you'd still be left with more expensive healthcare than most western countries...

Please show your math.

> First, according to multiple sources, doctors’ salaries account for only about 8% of U.S. healthcare costs. Even a 40% cut in these salaries, which the Kaiser Family Foundation concluded would result from reimbursing providers at current Medicare rates, would reduce healthcare spending by only about 3%.

https://www.latimes.com/opinion/story/2021-09-14/dont-blame-...

I'm not trying to convince anyone. That was just a passing observation on my part because, as an MD, I have a very good idea of why healthcare is expensive. But I lost any hope of making anyone who's not working the clinics understand this

Indeed, I think the deal should be: You go to medical school for free, then you work for the government for a nice professional salary. Malpractice insurance can be a government function.

An interesting side effect might be to change the demographics of who can become a doctor, maybe attracting more people from middle class or blue collar backgrounds.

Not sure the opportunity to work for the federal government is a great way to incentivize the best and the brightest.

Doctors already come from a variety of different backgrounds.

As opposed to working for the insurance industry? My knee jerk response is that incentivizing the best and brightest has gotten us to where we're at now. I've read that doctors are deluged in paperwork and bureaucracy, and incentivized to choose treatment options based on insurance coverage. I've had more than one doctor say to me: "The insurance says I can do X but not Y," and "your treatment ends when your coverage runs out." Of the several doctors among my friends, those who are not also professors or entrepreneurs have opted for part-time status, or have retired early.

Incentivizing the best and brightest in the software industry has gotten us to where we have to give new computer science graduates a coding exam, to find out if they can program.

It's worth noting the debt burden that different medical education systems place on physicians. Debt load and lost income are huge in the US medical education systems.

Many people that browse this forum will likely have lifetime income similar to that of a physician.

Average debt is like $500,000 and average wage (across all specialities) is $250,000. The debt burden isn’t that high.

And sure, comparing it to Silicon Valley looks bad, but so does every other job. “Amazing how bad other jobs look when you compare them to the top 1%”

> The debt burden isn’t that high.

It's much higher than other countries. There's also a 7 to 10 year period of medical school and residency where you're making no wage or a poor wage. People tend to get fixated on the attending-level annual salary while ignoring that piece. That's 7 to 10 years where you're not really building any savings, retirement, or wealth.

My wife (a doctor) and I (a non-SV software engineering who's career has taken a backseat to hers) ran the math. On an hourly basis, she will likely never come out ahead of me. She just has too many unpaid and low-paid hours in med school and residency to overcome. In aggregate, she will likely out-earn me - but that break-even point will be in our 50's with her having worked many more hours than me. That's 30 years into our careers.

I'm curious, you seam to have a particular animosity towards physicians. (Or at least animosity towards the idea that physicians should be well reimbursed.)

Is there a particular reason for this?

In a world where people are making billions for photo-sharing apps and financial rent seeking, is it really that egregious for people that treat disease to do well financially?

I don't want to paint with too broad a brush, but in Poland, physicians are genuinely a separate, well-organized labor class. As such, and I have not followed it as closely for a while, during last 'reform' what I heard was lip-service about patient care followed by implementation so bad that people actually opt for a private insurance ( if they can afford it ). If they are scapegoated, it is because they are part of the equation. Luckily for them ( and pharma for that matter ), they are the only part that is actually necessary.