Why would not paying doctors be the natural consequence? It’s a fairly significant jump to go from don’t let cost be a primary decision driver to let’s force doctors to work without pay.

Because in reality, there are always tradeoffs and constraints. In the US, a disproportionate amount of healthcare costs come at the very, very end of life.

It's possible to meet the sole criteria of science, quality, and patient wishes with exploding costs. I think the OP's point was that money has to come from somewhere.

"a disproportionate amount of healthcare costs come at the very, very end of life."

One might ask why that is; while some is surely due to natural decline in later years, one could likely also posit that the cost-fears leading up through that period (decades), and the general inability to get people to do preventative care throughout adulthood contribute to that significantly.

> One might ask why that is

Indeed.

It is one consequence of a highly atomized culture. I suspect it happens because individuals are expected to take responsibility for their care (basically, this is the human side of cost-shifting and corporate planning around the care gradient available to someone at a given wealth level).

To someone at the end of their life, money is usually less interesting to them than a few more days of breathing. So the market provides.

The explanation I've heard is that it's rooted in the cultural sanctity of life and how that translates to trying to preserve life at any costs (even when quality of life is no longer present).

To be clear, I'm talking about the absolute twilight of one's life that's reached regardless of levels of preventative care. I think there's potentially an opposite point that could be made: taking care of one's self can prolong this period and make it cost more. Someone who drops dead of a heart attack one afternoon won't have the same end-of-life costs as someone who gradually becomes enfeebled with age.

Doctor pay is high because supply is constrained.

We’re “fixing” this by flooding the market with less trained nurse practitioners and PE. Doctors are being gobbled up by regional medical cartels and put where they can maximize billing.

>>We’re “fixing” this by flooding the market with less trained nurse practitioners and PE.

In reality though, the overwhelming majority of cases that walk into a doctors office on any given day do not require an actual MD - NP and PA's are more than capable of handling many, many things that a typical patient needs.

Everybody tends to think they need a 'real doctor', they usually don't. Its good they are there when they are really needed, but do you really need an MD to diagnose a sore throat, adjust your BP meds or many other routine things that are people are seen for everyday?

True, but which ones?

> The skills need to run a hospital are quite different than those required to be a doctor.

And still, in many countries, including highly industrialized ones, hospitals are run by doctors. So either US administrators are making their hospitals run a lot better (which does not seem to be the case), or the core incentives each group optimizes for are different.

It should still be doctors. Just makes administration a career path that a doctor can choose to move into. There would be plenty of takers from the ranks of those burnt out on patient care. They could even find new meaning in being able to help people without going through the bedside wringer. If professional administrators have a place in the system it’s in positions under experienced physicians where they can help with implementation of policy, not shape it.

> The skills need to run a hospital are quite different than those required to be a doctor.

Why do you think law firms and accountancies are partnerships? Because the best proffesional for managing lawyers/accountants/develipers is such a proffeshional with loads of experience. Thats why we have progression, you gain management skill as you bevome more senior but you still know how the industry works and the people you manage

That’s the definition of the “Peter Principle”. Just because you are good at your profession doesn’t mean that you are good at management.

Is it impissible to select those who are good at management from the pool of thousands of people who are good at that proffeshion?

No, you first find people who want to go into management, then you give them management responsibilities without promoting them until they prove they can handle it.