Quote:
Originally Posted by
MumblesBadly
You completely ignore how the American Medical Association successfully keeps the supply of new doctors artificially low with its lobbying of Congress to limit funding for medical schools and immigration by doctors trained in other countries, as well as ignoring anti-trust regulations regarding placement of newly graduated medical students in hospital residencies.
And that doesn’t even address how local medical boards in many metro areas effectively serve as gatekeepers for new doctors being able to enter the local market given how referrals are used to punish or reward those new doctors based on how they conduct their own billing and referral practices.
Overall, that oligarchic control over physician services contributes substantially to doctors in the US earning on average far more than doctors in other major developed countries.
But, yeah. Go ahead and blame the downstream participants in this thoroughly rigged healthcare system.
Actually, all of these points are legitimate, and reform is definitely needed regarding the shortage of doctors in the US. As I've said many times, many areas of our existing healthcare system needs reform, and this is one of them.
However, this is NOT the reason doctors in the US earn more than their other first-world counterparts. Also, as nightmarefish pointed out, many doctors start out heavily in debt, and can't get their careers started until they're around 30 years old. They also spend a tremendous amount of time and effort in residency for very little pay -- something also overlooked and which is both unfair to young doctors AND dangerous for patients.
The reason the US doctors earn more is because of the antiquated, opaque, and piecemeal billing system which allows the same test/exam/procedure to be billed several different ways, and for the patient to have no visibility into what services he's buying (or their cost) until it's too late.
Lobbying allows artificially high Medicare rates to be set for certain tests and procedures, which then affects private insurance rates, which doctors then pick up on and look to steer you toward those tests and procedures. Then the loophole is eventually closed, and another one pops up, and it's an endless game of whack-a-mole.
I'm not blaming the people "downstream". I'm blaming lobbyists, politiicans, and healthcare providers.
Want a good example of this? The nuclear stress test is a somewhat harmful and often-ordered test ordered by cardiologists, simply because it's far more lucrative than its non-radioactive counterpart. This vast difference in compensation was a result of corrupt lobbying. In turn,
many unethical cardiologists will tell patients they need a nuclear stress test, even when they don't really need it at all.
My mom was even an attempted victim of this scam. Her cardiologist asked her to take one of these, and she was suspicious. She then spoke up and said, "My son is a top cardiologist at Stanford. If you don't mind, I'm going to ask him for his opinion, as well." The doctor seemed nervous, and then later on in the day, he personally called her and said that he had been thinking about it, and decided she only needed the non-nuclear version. He then offered to schedule the test "any time, even today, just tell me when", and went into full asskiss mode. Basically the guy was in a panic because he knew my brother would tell her that she was being scammed, and he didn't want his reputation ruined. Indeed, when she told my brother about it, he said that a nuclear stress test was ridiculous given her circumstances.
That's Medicare lobbying at work.
Lobbyists get the nuclear stress test reimbursement rate set artificially high, the insurance companies are then pressured to follow suit, and then doctors go out of their way to make sure their patients get that test, even if unnecessary.
This isn't capitalism. It's corruption. And it will get worse under Medicare For All.