Exactly.

US salaries for healthcare are the best on the planet, period.

The comparison (and to be fair, this is a very high level) paints an extremely clear picture:

United States $313,000

Germany $163,000

United Kingdom $138,000

France $108,000

Per: https://www.worldatlas.com/articles/countries-with-highest-p...

So yes, I absolutely want to see how many physicians stick around if you tell them "your salary will now be half and we're maxing our your workload". Alternatively, I want to see how long the State's finances last if they say "we'll pay the national market rate for your services and we're now maxing our your workload".

And even then I don't want 10 years, I want a generation or two. Even pre-COVID we had multiple surveys indicating that 60-70% of doctors would not recommend becoming a doctor. I want to see how that number changes as States run their experiments.

I see this argument made often on HN. I would imagine if we compared software engineering salaries in these same countries you would see that similarly software engineers in the US are also "overpaid".

Software

United States of America $95,879

United Kingdom $68,664 = 72% USA

Germany $61,390 = 64% USA

France $47,617 = 50% USA

Medicine

United States of America $313,000

United Kingdom $138,000 = 44% USA

Germany $163,000 = 52% USA

France $108,000 = 35% USA

(I believe the software salaries I've sourced are somewhat conservative)

[0] https://www.codingame.com/work/blog/find-developers/average-...

This will be a tough problem to solve. We could start by eliminating the AMA.

> "your salary will now be half and we're maxing our your workload"

should be fine if they pay their student loans no? isnt that the main reason the salaries are so high? cost of living + debt

> isnt that the main reason the salaries are so high?

It's because the NIH limits the amounts of medical residencies in the country, and to become a doctor with a license to practice, you must have completed residency somewhere. The amount of doctors in the US are kept at low numbers because of this.

I thought it was the AMA, but yeah I know about this and agree. This is the real problem

AMA lobbies but doesn't decide how residencies are funded.

I didn’t know that. Why does the NIH limit the number of residencies?

Medicare funds medical residency (not the NIH and not the AMA). The 1997 balanced budget act passed by congress limited the expansion of new medical residency training.

[0] https://www.npr.org/2018/03/09/592333771/severe-shortage-of-...

Thanks for the correction and source.

Professional organizations have stronger incentives to increase their compensation through restricting supply instead of decreasing their compensation to help their customers.

The AMA is actually doing a great job at this recently compared to the ABA, where there have been too many lawyers graduating recently for insane salaries except at the top.

Imagine you were working in an industry where you got to decide the number of people you can let in behind you.

The option almost everyone picks is “no one”. Keep supply of your services low and increasing demand means more money for you.

Paying off 200K in debt with a 300K minimum salary is pretty trivial unless you immediately qualify for a 4 million dollar mortgage, buy a BMW, then get divorced six times after med school.

cost of living isnt the reason for high salaries in Medicines. Unlike tech, salaries in medicine increase as you go to rural and/or underserved areas. It is driven by supply/demand and quality of life in urban vs rural areas.

Sort of, the supply of physicians is artificially limited by the AMA - which dictates how many physicians there are. That keeps the cost of physicians nice and high.

100% agree but note that the AMA's limits are at a national level. So the [very high] base salaries are indeed driven by scarcity (as dictated by medical boards.) However the local scarcity is not driven by the AMA (note the salaries just get even higher! in remote locales as the local scarcity compounds atop national scarcity.)

> want to see how many physicians stick around

Why would they bother to leave? Physician salaries might still very well be highest in the world.

> Personally, I’d like to see some states ban healthcare outright. Others have full coverage and everything in between. Then wait 10 years and we can see the results. I strongly suspect there would be states willing to do this.

This is the most HN comment I've ever seen

I'm not even sure what they mean by ban "healthcare" (insurance, doctors, hospitals?), and I can't decide if that makes me agree with you more or less.

I meant health insurance, but gonna just leave it lol

I figured, but with the "Most HN comment" meme and Poe's law providing context, it can be hard to be sure someone isn't suggesting something a bit more... extreme. :)

Lol first time my thoughts on banning health insurance is the less extreme option haha...

For reference, the idea is to optimize for public good. Banning insurance would drop fees dramatically because people would get less unnecessary work done. At the same time, hospitals and others would be willing to offer loans provided you could pay it off. This would drive down costs to the point even the poor can get some decent medical treatment. Any gaps can be made by non-profits, religious organizations and the like (similar to planned parenthood). Not perfect, but makes healthcare abundant and cheap.

> At the same time, hospitals and others would be willing to offer loans provided you could pay it off.

I'm not sure we want to encourage people to go through loan terms while possibly fearing for their life, especially when the people advising them on their health options are associated with those offering the loan.

"We need to operate as soon as possible, you're at risk until we resolve this. Oh, here's the loan information if you choose to get a loan through the hospital. The terms aren't as favorable as some others might offer, so feel free to take your time and shop around. Oh, but don't forget that your time is limited. Let me know when you've secured funding and we'll schedule the operation."

> This would drive down costs to the point even the poor can get some decent medical treatment

Or we could just offer free healthcare without relying on unfettered capitalism to "work".

>unnecessary work

With capitalism as the driving force, anything unprofitable becomes unnecessary. Probably goes without saying, but focusing on profitability likely won't drive the best healthcare outcomes.

> Why would you want it nation wide?

They didn't say they did, they said we're closer to having a legitimate discussion.

But to answer your question, if it's better, we might want it nationwide for similar reasons we have a national minimum wage and national child labor laws. For some things making sure there's a lower bound that everyone can rely on is a large part of the benefit, so inconsistent rules across the nation don't allow for a large portion of the benefit to be realized.

Whether this is one of those cases is something we'll hopefully get some more data on.

presumably, you don't actually mean "ban healthcare" so much as some version of "prohibit government spending on healthcare" or somesuch?

I'm pretty sure there's actually no constituency for outlawing the practice of medicine.

Or maybe you're actually the misanthrope that I sometimes pretend to be?

This argument makes no sense. If you're really interested in "selecting the best option", there can always be a federal option complementing state "experiments".

Ban healthcare? Like make it illegal to receive care or are you saying have no concept of health insurance and everything is out of pocket?

Yep. I vehemently oppose federal Healthcare initiatives but im very receptive to state options.

You need only peer across the globe. Take your pick between Germany, Singapore, Norway, etc.