Kevin Drum thinks he has found the smoking health care gun - US doctors are paid more than everyone else. That is why we have too-expensive medical care! A few quick thoughts
- I am the last one to argue that doctors salaries are set anywhere like at a market clearing price. Our certification system, crazy third-party payer systems, lack of price transparency, and absurd arguments over the "doc fix" and Medicare reimbursement rates all convince me that doctor salaries must be "wrong"
- The charts he shows have absolutely no correction for productivity, at least as I read the methodology. Per the text, they don't even have correction for hours worked. A McKinsey report several years ago found that US doctors made more, but also saw a lot more patients in a day. GP care cost more than expected vs. other country's experience, but is due mostly to number of visits, not cost per visit.
- There is no correction for doctor expenses. Malpractice insurance, anyone? We have the most costly malpractice insurance in the world because we have the most broken system. Doctors pay that out of their salary
- US GP salaries in Drum's linked report are actually falling, unlike all the other countries studied. Seem to have fallen 6% in 10 years (page 18), whereas France, for example, has increased more than 10%.
To the last point, I have a hypothesis. When you first overlay a government health care / price control regime, you get an initial savings. Doctors are forced to work for less and they still, out of habit and momentum, abide by past productivity standards. But over time, productivity, like any government-captured function falls. And over time, doctors, like other civil service groups, become better at organizing and lobbying and begin to get increasing pay packages. After all, if teachers and fire-fighters can scare Californians into absurd pay and benefit packages, what do you think doctors will be able to do once they learn the game?