What makes it hard to discuss is everyone at every level is gouging for various reasons.
Like, for example, doctors are going to be paid more than foreign counter parts, but they also end up needing very expensive schooling. (Similar thing happens to dentists).
Go into the hospital, and you end up paying 10x the amount for any medication (Tylenol being a good example) because either the hospital has an agreement with a medical supplier for exclusive supplies or they are trying to make up for ER treatments.
Then there's simply the added layer of bloat on top of everything. Health insurance ends up hiring a large staff of people to try and reject all claims while hospitals hire patient advocates to appeal the denials for the patients. All that ends up being paid for somehow (usually a large chunk is from the patient's insurance principle).
And, much like funerals, slap on "medical" on any piece of equipment and you get to raise the price by 10x. A $10 stethoscope ends up costing $100 from a medical supplier. Or one I've personally seen, a "medical" pocket protector made from $1 in fabric costing $50.
The reason non-us healthcare ends up being cheaper is because the governments are running most everything rather than having 3 or 4 private businesses duking it out over cost. It eliminates a huge amount of redundancy in the system when a government builds the hospitals, pays the doctors directly, and is the only one negotiating with medical equipment providers.
I don't disagree and wouldn't valorize anybody in the field† (though: of all the entities, I come closest to respecting Pharma's role and, if those companies were well-behaved, could make a pretty coherent argument for why they should be making much more money given what they produce).
But it remains important to get a picture of where the money is going, and the real picture disrupts a bunch of narratives.
Even in your comment: you're handwaving past physician comp and overdelivery!
> Even in your comment: you're handwaving past physician comp and overdelivery!
I'm really not. I'm simply pointing out exactly why they have such an oversized salary. It costs a ton of money to become a physician. In order to survive, they initially need a pretty sizable salary.
After the loans are paid off, that salary can't go down, there would be a revolt if it did.
Over delivery is really just a general attitude of wanting to test everything to make sure nothing is missed. I have a hard time faulting them over that.
IMO, the way to address this problem is addressing the cost of education for physicians. There's no reason getting an MD should cost $500,000, and yet it does.
And, of course, the best way to do this is to make medical school publicly funded and tuition free. A lot of small hospitals close down because they can't afford regular doctors. It's also next to impossible for a doctor to setup a private clinic.
That won't fully solve the current salary bloat, the only way to really address that is expanding the number of doctors being trained.
Sure it could. Physician compensation, RVU billing, upcoding, and overdelivery aren't facts of nature. In fact, a lot of these problems are caused by Medicare regulation; we deliberately restrict the supply of physicians by underfunding residency slots, which is something the AMA lobbied to do.
But when institutions try to take these problems on, like when Blue Cross (IIRC) went after anaesthesiology upcoding abuses, industry lobbyists spin people up to think that insurers are demanding surgeons wake people up in the middle of operations. It's a real problem. People understand so little about how our system works that they will vociferously take the side of practitioners who are screwing them over.
(Everybody is screwing everybody over; I'm not taking a side, except to point out that Table 19 of the NHE makes a pretty stark statement about where the money is going.)
Like, for example, doctors are going to be paid more than foreign counter parts, but they also end up needing very expensive schooling. (Similar thing happens to dentists).
Go into the hospital, and you end up paying 10x the amount for any medication (Tylenol being a good example) because either the hospital has an agreement with a medical supplier for exclusive supplies or they are trying to make up for ER treatments.
Then there's simply the added layer of bloat on top of everything. Health insurance ends up hiring a large staff of people to try and reject all claims while hospitals hire patient advocates to appeal the denials for the patients. All that ends up being paid for somehow (usually a large chunk is from the patient's insurance principle).
And, much like funerals, slap on "medical" on any piece of equipment and you get to raise the price by 10x. A $10 stethoscope ends up costing $100 from a medical supplier. Or one I've personally seen, a "medical" pocket protector made from $1 in fabric costing $50.
The reason non-us healthcare ends up being cheaper is because the governments are running most everything rather than having 3 or 4 private businesses duking it out over cost. It eliminates a huge amount of redundancy in the system when a government builds the hospitals, pays the doctors directly, and is the only one negotiating with medical equipment providers.