If the insurance companies disappeared tomorrow, presumably all medical care is paid for at point of use by patients? That would mean stochastically facing catastrophic bills from providers. I am sympathetic to the idea that healthcare providers and systems here should be making no more than in, say, Europe, but an orthopaedic surgeon being paid the $300k USD-equivalent in Germany instead of his $750k USD income today at median would be very unhappy.

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wqaatwt 2 hours ago | parent | next [-]

> would be very unhappy.

Significantly increasing the supply of doctors would solve that, though.

	▲	nradov 2 hours ago \| parent [-]
		There are certainly some things that we could do to increase the supply of physicians by reducing the cost of education, expanding access to combined BS/MD programs, and increasing the number of residency slots. But those measures will have marginal effects, and take years to show up in supply numbers. There just aren't a lot more people who are mentally and physically capable of doing this work. Part of the problem is that we force physicians to waste too much time on administrative work. Some of this could be delegated to cheaper employees or not done at all, thus effectively increasing supply. Administrative overhead is also one of the factors driving physicians to quit and pivot to other careers or retire early, which further constrains supply. This part is controversial but we'll also have to shift a lot of primary care to Physician Assistants and Nurse Practitioners. Care quality might be lower in some cases but for routine conditions it's probably better to see a PA/NP today instead of waiting weeks for a physician.

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ToucanLoucan 2 hours ago | parent | prev [-]

> but an orthopaedic surgeon being paid the $300k USD-equivalent in Germany instead of his $750k USD income today at median would be very unhappy.

I'm sure he'll manage.

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nradov 2 hours ago | parent [-]

Sure, but the rare type of person capable of becoming an orthopedic surgeon has other career options. There are some who are drawn to it as a calling because they love caring for patients and would do it regardless of wages. But most respond to economic incentives, so at the margins some will choose to go into technology or finance or something and make more money there.

When we fix the price of something below the market clearing price then there will always be a shortage. This is inevitable. We might decide that having a shortage of orthopedic surgeons is acceptable but let's not pretend that there are no trade-offs.

Germany has a stagnant economy so it's easy for their healthcare system to pay doctors lower wages because they have few other options. Baumol's cost disease is a real factor in healthcare, and it impacts the USA more than most other countries precisely because our overall economic growth has been so robust.

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ToucanLoucan 2 hours ago | parent [-]

If you as a person are turned off of a career because you can only make a mere, paltry peasant wage of $300k per year, then I think that's really a you problem there.

And as to your comments about shortages, we already have shortages.

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nradov an hour ago | parent [-]

Feel free to moralize all you like about the maximum wages other people should earn if that makes you feel better but that won't solve any of the actual problems. In the real world, most people respond to economic incentives. Shortages can always get worse. (I am not a physician.)

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ToucanLoucan an hour ago | parent [-]

> In the real world, most people respond to economic incentives.

Then why is there a shortage? Are you telling me the $750,000 yearly compensation still isn't enough?

	▲	nradov 41 minutes ago \| parent [-]
		Are you telling me that $750K yearly compensation still isn't enough for an NBA player? Maybe they should be nice and agree to play for less because they love the game and want to entertain people. If we're talking about orthopedic surgeons specifically, a good one is essentially an elite athlete. A single tiny error can leave a patient dead or crippled. It takes a rare combination of intelligence, ability to focus for hours, physical strength, and fine motor control. So only a minuscule fraction of people even have the necessary potential. And the training pipeline is necessarily long because they need a lot of reps to build up the mental and physical skills, and to weed out those who aren't suited. Sure, you can find some people who are willing to do the work for lower wages but will they be the right people? Beyond the wage issue, supply for all physicians is artificially constrained by training system capacity limits, as I already explained above. There are things that could be done to make training a bit cheaper and maybe two years shorter. But the easiest win would be to make more efficient use of the existing supply by optimizing workflows, and automating or eliminating administrative tasks.