I’m not too worried about doctors getting pay cuts. Again, lots of people willingly choose lots of kinds of jobs in life, and doctors aren’t particularly special snowflakes in this regard. I have many friends and family members who are doctors, and nearly all support some version of nationalized healthcare, and would immediately trade the loans and uncertainty they faced, plus participation in a medical landscape that seems really unbalanced to someone who took the Hippocratic Oath, for a more manageable tuition followed by secure, even “government” employment without having to worry about individual administrative stuff.
I do think it’s analogous to being a teacher - I was reflecting on @fractalmstr 's comments, actually, in this regard. So, no particular individual has the “right” to my teaching services without my consent, but collectively our country believes that kids do have the right to an education. So the government (federal/state/local) creates a system where they can in theory attract/retain the necessary faculty, and have done so, including me. (I say “in theory” because some areas do have teacher shortages or questionable teacher quality. It’s obviously a work in progress.)
Primary care doctors, and nurses, and NPs, would have around the same salaries (based on what I can see of EU salaries). Specialists might have to compromise, but actually, considering they have to compromise with for-profit insurance companies now, it’s not clear to me that even their salaries would be hugely different.
ETA: I do worry about financial incentives for R&D in drug companies if there is price-fixing or more limited access to medication. I’m relatively ignorant of how this process works, however.
Some specialists could also choose to spend time doing procedures not covered by insurance, which we’ve been seeing increasingly as well, if they want to increase earnings.
It is not always the case that someone who has insurance or can pay is brought to the emergency room with proof of such or even consciousness to be able to inform the emergency room staff. For example, if someone is brought into the emergency room unconscious after:
Car crash, and his/her wallet/purse with insurance card was left in the car.
Robbery where his/her wallet/purse with insurance card was stolen.
Sports or other activity (e.g. swimming) where one often does not carry one's insurance card.
EMTALA currently requires emergency rooms to stabilize emergency patients first. Pre-EMTALA, some emergency rooms transferred unstabilized patients to other hospitals to reduce the financial risk of those without insurance or ability to pay. So, if EMTALA is repealed, patients in the above situations risk a delay in care if initially brought to an emergency room that does that, even if they really do have insurance or the ability to pay.
The fact that someone could be callous enough to actually proffer this as a viable option is precisely why the rest of the developed world has a hard time seeing the US as anything but barbaric. I’m truly aghast, and very, very glad that (A) the system doesn’t work this way and (B) I live in a country with excellent national healthcare for all.
Are specialists in even greater shortage than primary care physicians these days? Seems like that should be the case, given that most specialists are paid much more, even though they do not need as much breadth of knowledge that primary care physicians who may see a patient presenting with anything walk in.
A primary care physician’s $180,000 per year starting pay may seem like a lot (well, maybe not to some of the forum “middle class who do not get financial aid anywhere”), but when that is starting at age 30 with $300,000 of medical school student loan debt, the financial aspects may pressure some medical students and residents who would otherwise go into primary care into going into a specialty where they can pay off the debt more quickly and comfortably.
@doschicos - I’m not an expert, but there’s compulsory national health insurance. It’s affordable and sliding-scale (I pay a lot because my income is high. Quite fair) and everyone living here, citizen or not, is eligible. Medical treatment is very high quality and easy to get, and doctors make a very good living, if not as much as their counterparts in the US.
In order to go from a 3x to a 6x spread, you don't have to double the top end. We could add ~32% to the top end and reduce ~32% from the bottom end. Using a round number example, if the young people paid $100 and older people paid $300, make the young person's rate $68, and the older person's rate $396. You end up with a 5.82 ratio between top and bottom.
While you don't like to pay more, charging you more would be fair given the costs of your age group. The people who are being treated unfairly now are the young, who are paying more than their healthcare costs. Shouldn't they be the ones complaining? In essence, they are doing so by opting out of health insurance.
How much does medical school cost there? It is entirely possible that, in some countries, physician pay is lower, but the net after debt service is higher.
Exactly. (I’m sure that young males don’t like paying more for their auto insurance, but the fact is that they, like you, have an actuarial high risk.)
Again, I’m not an expert, but the national universities are far cheaper, more like state schools in the US used to be for in-state students. I don’t have the knowledge (or inclination to research haha) to answer questions about debt service/net ROI.
Who decides whether or not it is a choice?
Do you cut off a minor? I assume not. But then do you cut off someone who is 18? 19? In high school? College?
These questions (among innumerable other reasons) are the reason that the rest of the global north has universal health insurance.
You wouldn’t pay double what you pay now. You’d pay roughly the cost of someone in your age group, and it would be something like 20% bigger. Not sure yet, I’m playing with a spreadsheet, but it definitely wouldn’t be double.
Well, shouldn’t having a bigger pool help bring down costs somewhat anyway? All those youngsters who are currently not availing themselves of the system?
But the point is that the premium cost for 60+ is already too high,especially for those of us who have very low medical usage. I wouldn’t be able to afford insurance at at this point without the subsidy.
Everybody has reasons why someone else should pay. Everybody has reasons why their costs are too high and someone else should pay more. I can’t figure out a principled reason that 21-year-olds ought to subsidize 64-year-olds, but that’s what’s happening now.
Bringing in a healthier pool will bring down costs somewhat. Not a whole lot. Some.
Oh for goodness sake - all this “this age group should pay this amount,” or “we should just turn away people who don’t have insurance or demand payment up front,” and, “it’s not fair, I have to pay more,” blah, blah, blah…is the definition of childish. Do you all not see how ridiculous this sounds? Lets just have universal health insurance and be done with it - like every other country in the western world. Everyone is covered. From birth to death. Period. End of story.
Good question. Medicaid is supposed to turn into a block grant managed by states in whichever way they want, including changing conditions of eligibility.