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After the Health Care Sideshow

Why Obamacare—and the efforts to repeal it or fix it—are largely irrelevant to the real problems facing the U.S. health care system.

Appeared in: Volume 13, Number 2 | Published on: August 15, 2017
Mark Hammer is in the private practice of ophthalmology.
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  • WigWag

    Dr. Hammer’s essay is self-serving poppycock. He blames everyone he can think of for the American healthcare disaster except physicians. Surprise, surprise, the author is a physician himself. Who would have guessed it?

    He acknowledges that payments to physicians represents the second largest component of American healthcare costs (after hospital costs) but this is the single component of the healthcare system that he doesn’t think needs fixing.

    He trots out all of the oldies but goodies like the outdated and ridiculous claim about how onerous malpractice insurance costs are. He’s being disingenuous and he knows it. Malpractice insurance costs have plunged. Tell us Dr. Hammer, what are your monthly premiums for malpractice insurance?

    In 2017, the average salary for physicians in our country was $294,000. For physicians employed by someone else, this represents salary. For physicians who are self-employed this represents take home compensation after expenses but before taxes. Specialists made on average 46 percent more than primary care doctors. Contrary to Dr. Hammer’s claim, physicians’ salaries have been going up, not down. In fact, physician take home pay has increased every year since 2011.

    Dr. Hammer is an ophthalmologist; in 2017 the average pay for ophthalmologists was $345,000. His salary and the salary of physicians generally is dramatically higher in the United States than it would be in any other OECD nation.

    Physicians in our country earn somewhere around 30 to 50 percent more than they should. The reason for this is simple; the medical profession, like any corrupt guild, deliberately eliminates competition by restricting the number of people legally permitted to practice its trade. Medical schools matriculate a small percentage of qualified students and an extraordinary number of arcane and unnecessary rules make it very difficult for physicians from foreign countries to practice here. The most talented and experienced ophthalmologist in Europe would be thrown in jail if he tried to dilate the pupils of patient in the United States without doing a residency and passing a special test that hardly any experienced American doctors could pass.

    The truth that Dr. Hammer is not telling is that there is no way to significantly reduce American medical costs while exempting the second largest cost component; physician compensation.

    If we paid our physicians like French, Australian or Israeli physicians, the quality of care would be just as good at a dramatically lower cost.

    What Dr. Hammer and his colleagues don’t want Americans to know is that the mystique surrounding the medical profession is a hoax. Anyone smart enough to be a school teacher, lawyer, accountant or perhaps even an Uber driver is smart enough to go to medical school (which should be at most three years not four) and learn to be a doctor.

    To see the data that I cited, go here.

    http://www.medscape.com/slideshow/compensation-2017-overview-6008547

    • FriendlyGoat

      I upvoted you for this because you are right about the compensation of certain health care workers being too high, not because I agree with you that anyone who can teach school or drive for Uber can go to med school and be a doctor.

      But we should not just knock the doctors about compensation. We are also paying the moon for hospital administration, corporate administration of medical-related companies and for plenty of players in the insurance games. In our decades-long march through high-end tax cutting, some might have predicted that if you taxed all these people less on their incomes that they could and would reduce the prices for their services. Well, guess what? The exact opposite happened. Surprise, surprise.

      • WigWag

        I agree, it’s certainly not just the fault of the doctors. But there’s something fishy about a doctor writing an essay about what is wrong with the healthcare system while blaming everyone in sight except members of his own profession.

        No one is being strangled more by rapidly escalating medical costs than middle class and working class people. One of the reasons that salaries aren’t going up for ordinary people is that the insurance premiums paid by employers for healthcare are escalating so rapidly that there’s little left for pay raises.

        Doctors are far from blameless. There’s something disingenuous about physicians and other upper middle class people who have a liberal point of view about allowing the immigration of people qualified to be roofers and house painters while at the same time doing everything possible to discourage the immigration of people trained and qualified to be doctors.

        It’s not Bernie Sanders millionaires and billionaire screwing working people, it’s also the upper middle class physicians and college professors who are guilty.

        • FriendlyGoat

          Maybe it’s ophthalmology. Am I crazy or is that not also the specialty of Rand Paul and Bashir Assad?

          • WigWag

            Rand Paul is an ophthalmologist; Assad is an optometrist.

          • Boritz

            Why do I believe that if government got sufficiently (by their standard) involved the cost would be $300,000 and continue to rise sharply?

          • FriendlyGoat

            I knew I should have looked up Paul and Assad before shooting from vague recollection.
            Oh, well. As idiots often say (speaking of myself on this one), “ah, about the same” (even when it isn’t).

            Since you’re generally a serious guy, I’ll share with you how I think we need to “get serious” on health care. The Left needs to stop pretending that every life is actually worth prolonging at unlimited (unlimited) private or public expense—-since we all pass away. And the Right needs to stop pretending that competitive free enterprise solves everything in the health care realm. Both sides need a reality adjustment and a pensive acknowledgement that the best management of this issue involves some of both and not too much of either extreme. Both political sides have their “principles” and they both have flaws which need to be mitigated in a sensible middle. It’s hard to talk about limits without the “death panel” screaming, but there are limits to what is sensible. Meanwhile, those limits should not be determined (as the Right’s position assumes) only by one’s personal status on the wealth spectrum or by “going shopping in the market” at the moment one’s neck happens to be broken in a car accident (for instance).

  • Gary Hemminger

    Probably the single best article I have ever read on TAI. Very informative and bi-partisan. Unfortunately this apolitical work exists in a very political world. I am happy I have good quality, company provided healthcare. I feel for those that don’t. But those feelings don’t go so far as me wanting to end my healthcare for government sponsored, poor quality, hard to get healthcare. You can call me self-centered, or you can call me prudent… but I don’t want to pay more for more people to get no cost health insurance, while the people that can barely afford it get killed with higher and higher premiums. That is what single payer ultimately means and I want no part of it.

  • Boritz

    Healthcare costs going critical…
    No flatline in sight for health insurance rates…

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