Going to the hospital for a stroke is no place for the uninsured

It happens because hospitals and physicians have to recoup costs from somewhere. Between getting abused by both medicare/caid and private insurers on reimbursements, as well as providing largely FREE emergency care to indigents, the uninsured, and assorted alcoholics and druggies all the time, hopsitals and physicians are feeling the squeeze like never before.

I’m not saying that huge mark-UPS are proper, but let’s be realistic about the situation– and the situation is that nobody in this country– not even those who coudl reasonably afford to pay for care up to a certain point– want to pay for care provided by trained professionals; this entitlement mentality is entirely opposite what we witness in other professional fields; physicians and hospitals have allowed their bottom lines to be undercut DRASTICALLY precisely BECAUSE they are ethical. You think a lawyer or stockbroker or mutual fund manager would have stood by while their profession’s standards and compensation declined so precipitously?

My solution? Insurance should be catastrophic coverage only, with sliding deductibles based on income bracket on a per year basis. A single male earning $75K per year can afford to pay up to $1600 per year (not per incident, per year) for his care. Likewise, a person earning $140K can afford to pay up to $8-10K per year for medical costs SHOULD THEY INCUR IT (not a mandatory charge, only if they avail themselves of that amount of services, which would be comparatively rare). A person earning, say, $20K could have something like a $400 yearly deductible, which would be at least enough for a several visits to the family doc and perhaps some blood work. After these deductibles were met by paying CASH (which there is currently a scarcity of in the system, leading to such heavy-handed measures as this article speaks of), insurance would pick up the tab for the rest of the year.

In addition, people would still be insured, so they would have to pay monthly premiums, same as they do now; however, these premiums would likely be significantly lowered, as insurance companies would now bear less responsibility to cover primary care of all sorts, decreasing their expenses (which would necessitate a drop in rates).

The only impediment to such a sensible system is that the American populace has sadly fallen victim to an entitlement culture– in many spheres, but most notably in healthcare. They’d bristle at such a proposal. “What!? Me have to pay out of pocket up to $2500 per year!?”, the single person earning $80K would say, totally oblivious to common sense. Yet these same people have no problem dropping $1200 on a TV, or $500 when they take their pet to the vet, or spending $150 per week to eat out at nice restaurants, or pay their mechanic $1000 when the coils blow on their car– yet these same people, by and large, want to be able to walk into a physician’s office– a physician, who is the most competent, knowledgeable, and dedicated of professionals– and hand them an insurance card and a $10 co-pay. That’s not justice, and at some point, the American people should be spoken to in plain terms, just as I have here, and these realities should be made eminently clear to them.

It’s never going to happen, obviously, but it would be the most practicable solution we could hope for, for both providers AND patients (primary care doctors won’t have to rush through patients assembly-line style in order to keep their practices solvent anymore; increased primary care among the indigent would obviate the need for more costly care later etc.), that is mor ein keeping with our capitalistic, meritocratic ethic (which is slowly being eroded due to feelings of entitlement– my point is that somebody should just put their foot down and explain these things to people on a national stage).

Realize this: NO OTHER PROFESSIONAL goes through as rigorous training, is more dedicated to their craft, and is more valuable than a physician. They deserve to be compensated accordingly; they currently are NOT being so compensated. Mean income for pediatricians, FP’s and internists hovers around $140K now. Yeah, that’s a lot of money, you may say, but think about what they have to do to get there, the nature of their profession, and also what we tolerate paying other professions such as lawyers, accountants, high level programmers, investment bankers and fund managers etc.

A physician of ANY sort– I don’t care if it’s an FP or a neurosurgeon– does not deserve to be making less than $180K after their years of training and sacrifice and dedication. Yet, sadly, many are nowadays, and that is unjust. People just need to be told this bluntly, because, really, there’s no room for argument about that. Healthcare is not a “right”, and doctors should not have to be social workers and provide charity care all the time (though, to their credit, a great many DO provide free care on their own time DESPITE their rapidly falling incomes– that says a lot about the character of these professionals that the American people tend to take for granted).

Obviously, there’s much more I could say, but this should suffice.

Additionally Anon, do you not ever wonder what type effect your negativity of your own profession has on med students who may be reading what you write? I think medical physicians get treated with much respect from the majority of the population. You are not royalty! You choose your career out of a need to help people or maybe you choose it for the money you throught you would be making? Maybe you should reevaluate your reasons for becoming a physician and stop asking people who live on 40,000.00 a year to understand how mistreated you are because you only make 175,000 per year…

To elaborate a bit more on my above (long-winded) comments:

First off, under the plan I proposed, people would have a REASONABLE deductible based on income bracket, but insurance would pick up anything beyond that. Here are what I feel would be reasonable deductibles for single folks (this is INDIVIDUAL income, not household/family income; further details would have to be thought about):

$15K per year: $250 deductible.
$25K per year: $350 deductible
$45K per year: $900-1000 deductible
$65-70K per year: $1500-1800 deductible
$85K per year: $2200-2500 deductible
$110K: $4000 deductible
$200K: $12,000-15,000 deductible
$500K: $60-75K deductible

Note that the deductibles do not increase proportionally with income; this is due to sustenance costs which more greatly affect those in lower income brackets. Point being, those who earn $200K per year without question have $10K+ in disposable income each year, and that disposable income should go towards PAYING THOSE WHO RENDER A SERVICE. Alternately, a person making $20K likely DOESN’T have more than $300-400 in disposable income. Point being, that those who cannot afford care should NOT be forced into bankruptcy due to healthcare costs, while those who CAN afford it should pay it, WITHIN REASON; certainly it cannot be reasonably argued that a person making $110K per year is going to go bankrupt or suffer serious consequences if they are put out $4000 in one year. Yet I would never ask the person earning $110K to pay a $40K deductible, because that WOULD put a severe strain on such a person. The deductibles I proposed strike me as the most reasonable I can come up with. If anything, they’re a bit low on the high-end, but they’ll do.

Another thing to keep in mind is that these deuctibles are ONLY PAID IF ONE AVAILS THEMSELVES OF THAT AMOUNT OF SERVICES. In other words, the person earning $85K is not paying out $2500 whether or not they actually spend that much on healthcare (visits to their primary care doc, blood work, tests etc.), but rather ONLY if they spend that much. The customer/provider financial relationship should hold as far as is REASONABLE, and this is all I’m arguing for, as in no other sphere and with no other professional do we expect otherwise.

Secondly, realize that in addition to these deductibles (which would not necessarily be reached every year, as stated above), people would still be covered by insurance, which would pick up the tab each year for any costs exceeding the pre-set deductibles. Obviously, this means that people would still have to pay insurance premiums that have to be paid; however, keep in mind that these premiums would, in all likelihood, be dramatically reduced (particularly if public and political pressureis brought to bear on the insurance companies due to the new market realities), and this is due to insurance companies’ DECREASED liability for all sorts of primary care (i.e., many people visit their primary care physician nowadays and pay ZERO, or a co-pay, despite the fact that they can afford to; since insurance companies would be picking up less of the tab, up to the deductibles, their premiums would almost of necessity have to be lowered).

Also, we should concomitantly attempt to address the REAL reasons for rising costs (and such a plan as I’ve proposed, if implemented nationwide, would go a LONG way towards lowering costs, believe you me), which include bloated administrative, clerical, and legal costs, as well as defensive medicine costs. As I’ve mentioned, physicians made SEVERAL times more money in the 80′s and early 90′s, and are currently making the LEAST amount of money relative to cost of living, inflation, and the exorbitant costs of practice (malpractice insurance, overhead etc.), that they have EVER made– yet our healthcare costs NOW are the highest they’ve ever been, with seemingly no end to the increase in sight. It’s time that people wake up to the real issues at play here and stop demonizing professionals who BY ALL RIGHTS deserve to earn livings commensurate with their expertise, value, and dedication, same as we allow for EVERY OTHER profession. All I argue is for consistency; if we are to change society into some communist/socialist utopia, as some people would seem to wish (what with all their carping about physicians’ salaries) then we should start with the MOST egregious examples of capitalist excess– and those examples DO NOT INCLUDE PHYSICIANS, who are dramatically UNDERPAID in most instances currently. Consistency is all I ask for. The REAL reasons for rising costs should be addressed so that– at the same time that a more sensible system of professional/patient interaction is instituted (as described above)– costs will actually DECREASE, leading to more service for those same deductibles (assuming one availed oneself of that amount of service). Is this clear? I know I tend to ramble…

Lastly, to clarify a broader point that I made in passing, about how society’s values are reflected in how well certain jobs/professions are compensated– indeed, in our entire compensation/wage scale, from top to bottom:

This point is illustrated most clearly in the constant screaming about how teachers aren’t paid enough for the valuable function they serve, or how cops and firefighters aren’t paid enough, or nurses aren’t paid enough etc. (and these people AREN’T paid enough, but neither are physicians, and this goes to my larger point about society); people usually make the argument that society DOES NOT VALUE teachers’ contributions or else they’d be compensated more adequately. I largely agree. What jobs and professions are the most well-compensated has EVERYTHING to do with what we value as a society; this can nowhere be more clearly seen than in the fact that we DO NOT HAVE a liveable wage in this country, and thus do not inherently value an honest day’s work, or else would we ensure that anybody who desired to PERFORM that honest day’s work would not be left wanting, making $15-20K per year.

Unfortunately, it’s getting to the point in this country where you have to either work in finance/business or be an unscrupulous lawyer (the scrupulous ones don’t make $2M per year; however, tax lawyers for big corps’ DO make a lot, which goes to my point about working in the business world) to make any sort of good money. Do you agree with that? I don’t. It’s implicitly saying that the only VALUABLE (i.e., worthy, necessary) jobs and professions all have to do with big business. Do you believe that? I certainly don’t. I’d say that being a physician is likely the LAST worthy, noble, and decent profession/job one can undertake and still be reasonably assured of a comfortable life, financially. Yet even THIS comfort is being eroded due to the illogical and ill-considered opinions of those with big mouths who shout to the rooftops and make their voices heard with votes. Still doesn’t make them correct.

Like I said, a GREAT MANY professions and occupations deserve to be compensated better, and a GREAT many (CEO’s, mutual fund managers, stockbrokers, trial lawyers etc. ) deserve to be compensated LESS. The dictates of social justice demand such a shift, yet our society is loathe to place blame where it belongs, as opposed to attacking the most dedicated and knowledgeable of professionals (physicians), and does not endeavor to create such a shift. To be opposed to such changes is an entirely illogical and nonsensical stance.

Is it hard to believe that some people really DO desire to do good and to help people yet ALSO earn livings commensurate with their expertise and value? It’s not hard for me to imagine, because I’m one of those people. And I’ll be DAMNED if this country thinks that I’m going to slave away in medical school, and then through a torturous residence (earning minimum wage per hour, mind you, for those 3-5 years), only to come out making $90-100K, which is what a 2-year MBA graduate can make right away. Truly, this is a foolish double-standard; unfortunately, no pressure is brought to bear on the business world for THEIR malfeasance (which includes sky-high salaries) and financial gluttony, largely because the costs to society are somewhat hidden (yet easily discernible if one examines the issues). And yet people have the gall to think that ANYONE should undergo what a physician does and earn less than $180K. Yeah, ok. Real logical, that.

The reason that people carp about physicians and not CEO’s, however, is because they actually INTERACT with physicians and hospitals, and they see the costs on their bills. The costs that corporations and lawyers (tort costs consume 2.4% of our GDP according to the most recent Congressional report, as opposedto an average of .9-1.2% of GDP for all other industrialized nations; this amounts to a “tort tax” of $830 per person, per year– nevermind the $50-100B in defensive medicine it necessitates) exact on our society is a bit harder to see. Why aren’t these people railed against? Why is a noble professional not entitled to his JUST REWARDS while unscrupulous, less noble, and less valuable members of society are entitled to rewards that far outstrip their contributions and expertise? Makes ABSOLUTELY no sense to me, really. It’s an indefensible mentality to somehow “set physicians apart” in terms of the social/professional contract, and expect them to be GROSSLY undercompensated, just because health care happens to be very important (which it is). Illogical.

Look, like I said, I am concerned with social justice for EVERYONE, not just physicians (though that is who I am largely concerned with here). IF it were the case that it was physicians’ incomes were the CONTRIBUTING FACTOR to our outrageously high healthcare costs (as opposed to the FACTS, which are that it’s the administrative/clerical costs, insurance companies, lawyers, and entitlement culture which leads to people not paying what they can for a service rendered WITHIN REASON– I’m not asking anybody to starve, or even come close)– but IF it were the physicians’ compensation that led to 40M Americans without healthcare, or to the bloated costs of healthcare, then YES, social justice MIGHT REQUIRE US to balance the compensation of physicians with the larger social good. However, in this case, one has nothing to do with the other, yet the one is constantly bemoaned, as though physicians should not be entitled to the same professional courtesy and compensation that ALL other professionals are.

Need proof? Go walk into your accountant’s office and tell him that you’re only going to pay 25% of what he charged, and see how he takes it. Try the same with a lawyer– especially the one who recently charged a friend of mine $1000 just to write a small letter and notarize it in a will dispute, which took all of 10 minutes. Think that behavior will fly with everyone else? Think again; the reason physicians continue to do their jobs in the face of such an OUTRAGEOUS mentality is because, by and large, they are NOT in it solely for the money– people who ONLY want to make money don’t go through medical school and residency, they just go to law school for 3 years, or get their 2 year MBA, both of which are infinitely easier. It’s much easier, less stress, less debt incurred, and the risks are lower. Yet we reward these more clearly greedy people (not all such people are greedy, some honestly like law/business, but speaking of the averages) at the expense of largely non-greedy ones (physicians). Desiring proportionate, sensible compensation DOES NOT EQUAL greed. These distinctions are of the utmost importance, yet they are all too often glossed over in our public discourse on these matters. Sadly, I fear for our nation’s sanity.

I will ask you what I ask everybody else who discusses such issues: if a physician does not deserve to make $180K or more, WHO DOES? And how do you measure compensable factors? I ask this in all candor, because unless one is a communist– that is, so long as one admits that everyone should NOT make equivalent wages, as is our general sentiment in a capitalist, meritocratic society– I honestly don’t see how its implications can be argued against. Certainly it is neither philosophically sensible nor productive for society to assert that only business/finance-related jobs deserve adequate compensation, because then what does that say about our values as a society, and what eventual state will that lead to, where we won’t have excellent minds in any other sphere save for finance? Because believe me when I tell you that most intelligent, well-grounded people are not going to invest 7-10 years of their lives, incur $120-200K in debt, and go through the hell that is medical school and residency, only to come out making $100K. It’s not going to happen, nor SHOULD WE ASK IT TO OR PERMIT IT TO HAPPEN as a society. Yes, there will always be some purely altruistic souls out there who would do it regardless of compensation, and I honestly admire them. But how can someone like myself– who desires money only for his future family’s sake, and even then not a tremendous amount– rightly be called “greedy”? I just don’t see it. However, this is besides the point, as the larger point I am making is concerned with societal values and how they relate to compensation, which is an issue not relegated to the health care field, but which is affecting our society in myriad ways in every sphere.

Our society is not sensible, and that’s all I’ll say about that.

I’m the verbose “anonymous” who posted the above two long-winded rants:

I agree that a return to fee-for-service would be reasonable (and proper, seeing as how third-party payment is not the norm in ANY other industry, due to the inherent conflicts of interest; i.e., insurance companies’ desire to make a huge profit vs. physicians’ right to be justly compensated). However, the industry (and the populace and the government) must simultaneously move to reduce or eliminate the causes of our current sky-high prices. Obviously, there mere infusion of cash into the system again– which would happen under a system as I proposed above or as you’re proposing– would go a long way towards lowering costs, but other reform must also be undertaken; namely, tort reform, administrative reform (administrative costs would necessarily lessen once insurance companies were marginalized in the system), and, yes, pharmaceutical costs. Saying that a physician should be compensated fairly does not preclude one from speaking out against the ABSURD profits of big pharma, and also against how we are currently subsidizing the entire world’s drug supply, due to socialist price controls in those countries. Nobody is saying that we should bleed the pharm companies– but is it really “fair” (i.e., just, sensible) to have them realize profit margins 3-5 times those of other Fortune 500 companies? I think it’s gotten a bit out of hand. I’d like to see a breakdown of how much pharmaceutical costs contribute to our overall healthcare expenditures, but I’ve yet to find one.

At any rate, fee-for-service is fine (and preferable). The problem is two-fold: physicians cannot unionize, nor can even give the slightest WHIFF of collusion about fees or the conditions of their practice (this is what I’ve heard; I’m not a physician– feel free to correct me if I’m mistaken). Therefore, how will you spark such widespread reform without violating the law (the law is ridiculous, btw, but that’s besides the point– it must be respected)?

The other issue is that, looking at society more broadly, the real problem is that it’s not just physicians who are feelings the squeeze, but EVERYONE is feeling the squeeze. Real wages have stagnated for decades. Minimum wage in 1965 adjusted for inflation would be $10.75 right now, yet it’s currently $5.15 here in NY. Corporations and the private sector reap record profits each year, and a TREMENDOUS amount of wealth has been created in this country between 1965 and now, yet that wealth has been hoarded by the few, and concentrated into fewer and fewer hands. Consequently, pople have a hard time making ends meet, giving their own expenses (housing, education, food/clothes, insurance etc.). I am cognizant of this, and I feel that any person who has given these issues any thought would be as well– that’s why I said that I AM concerned with social justice for the many, not just for physicians.

People always argue against raising the minimum wage by saying that it would lead to increased prices etc. Gullible people buy this stuff hook, line, and sinker. All one has to do to demonstrate how faulty and, indeed, backwards that reasoning is is to point out the following:

A certain good (product B, let’s say), cost, say, $10.00 in 1965; as a percentage of average yearly income, let’s assume for argument’s sake that it cost .1% (one-tenth of one percent) of a person’s yearly income. That same product nowadays costs (hypothetically, but the generalization holds) a relative .3% of the average yearly income. Now, the price of goods and services has FAR outpaced inflation (moreso in certain sectors than in others, but across the board, it definitely has). Assuming that the production costs of goods and services has mostly dropped due to mechanization, increased efficiency, and outsourcing (another scourge, but that’s for another time), it can CLEARLY be seen that the companies producing said goods are reaping profits MANY TIMES in excess of what they did 30-40 years ago. Assuming that fixed costs remained the same (labor costs, production costs etc.), they STILL would be making a great profit (as a percentage of total revenue) than they were in 1965. BUT, as has been shown, many of those “fixed” costs, such as the cost of labor and production (labor may be a variable cost– it’s been a while since econ 101 ), have dropped dramatically, while the PRICE of those goods has risen faster than inflation. The only conclusion is that vast amounts of wealth have been created and are currently SOMEWHERE….just not in the employees’ hands to any appreciable extent.

So if labor costs (as measured by minimum wage) have DROPPED (since minimum wage today is but HALF of what it would be adjusted for inflation from 1965), and the production costs have ALSO dropped, and the prices of said goods and services have RISEN dramatically (faster than inflation), it stands to reason that these companies can MORE than afford to pay their staff a more adequate minimum wage while STILL generating SENSIBLE profit margins along the lines of those 30 years ago (it would be higher, even, since the cost of goods has outstripped inflation, while minimum wage would just be raised to ACCOUNT FOR inflation; this is ignoring gains in production costs, economies of scale etc.).

The point is that YES, if we kept everything else as-is, if we allowed our corporate gluttons to continue to enjoy their $30M per year salaries and $40M stock options, to have their $2B net worths; if neither government nor the populace ever brought any pressure to bear on these corporations to CHANGE the status quo vis-a-vis wages (and any such effort MUST come from the citizenry, because our gov’t was bought out long ago by corporate interests), then an increase in minimum wage would be followed by increased prices. As I have shown, however, this is not a NECESSARY relationship; rather, it is contingent on the very greed and gluttony and influence-peddling of corporations and the super-rich. This is not an exercise in demonization– these are facts. The PURPOSE (that is, the goal, or “end”) of a functional, sensible economy should not be to concentrate 70% of the wealth in the hands of 1-2% of the people, but rather to provide a sensible, just standard of living for ALL out citizens. These people would still be super-rich under such a system as I propose, they just wouldn’t be AS super-rich…and that’s why it’s threatening to them and why they protect the status quo at all costs by putting out misinformation and obfuscating the issues in order to deceive less-able reasoners who are either inherently unable to see through their sophistry, or are too busy working two jobs to feed their families to honestly give a shit. That’s why they have cadres of political lobbyists and attorneys (i.e., sophists) on retainer. This is a terribly unjust state of affairs; our country has been overrun by callous, selfish men.

The point of that tangent is to illustrate that it very well MAY NOT BE THE CASE that people would be able to afford fee-for-service, UNLESS we also address the root causes for inflated healthcare costs and concomitantly push for a more sane and equitable society in terms of compensation across the board (as spoken to above). I, myself, was a very sickly child, and had chronic asthma and allergies; I was in the hospital every other weekend for a couple of years, and for about 10 years I received allergy shots weekly or bi-weekly. I was also at my pediatrician frequently. My parents afforded it, despite not in ANY way making a lot of money (we would have been considered lower-middle class back then). The point is that peoples’ wages and incomes have not kept up with the cost of EVERYTHING, not just healthcare; however, the income of the top 1% has FAR exceeded inflation, and their % of the total wealth in the nation has grown from roughly 30-35% in 1965 to roughly 55-60% now. That’s not justice. I am sympathetic to the plight of the average person; like I said, I’m not arguing in a vacuum. However, those same people need to start putting REAL pressure on politicians and employers for fairer compensation.

The problem, as mentioned, is that nobody wants to play hardball with these corporations, because government has long been bought out by them. Government is no longer looking out for YOUR best interests, and I think we can all agree on this. If tomorrow the Congress passed a minumum wage hike to $9/hour, the threats of relocation from corporations would be immediate, make no mistake. Ditto for if we compelled the astounding 95% of US-based corporations who PAY NO INCOME TAX to finally do so (wouldn’t we, the plebeians, be thrown in jail for such a thing, or our assets frozen? Something to ponder) “We’ll relocate to another country!”, they’ll say, where labor costs are lower and the government coddles them with insane tax breaks. If we had a just and righteous government, they’d say “ok, you go do that. You’ll no longer be able to sell your goods in our market”. The US market constitutes 45% or greater of nearly EVERY major corporation’s business. I SERIOUSLY doubt that if our government threw down the gauntlet (which will never happen, but hypothetically ), they’d be willing to swallow the loss of over half their revenues instantly. And even if they did move– in the new sensible society that would obtain, I am sure that many new American companies would spring up, manned by people who were willing to know their place, and to not be gluttonous about their profits and their incomes. People who wanted a fairer society for everyone while still making a good life for themselves. We’d have CEO’s who were actually CONTENT to make $1-5M per year instead of $20-30M. Companies who were CONTENT to realize modest profits in favor of treating their employees well and seeing to their social obligations (taxes, wages etc.). Believe me, it’s possible, but it would take a hell of a lot of work on all our parts, and the government is not our ally in this instance. The American spirit would prevail– you know, that same American spirit that our presidential candidates always pay lip service to while being bought off by multinational corporations. Industrious Americans who desired a better life for themselves would start businesses or expand the ones they already had, and would be content knowing that they made both themselves AND their communities and the society rich. Would we have people earning $70M per year? Likely not, but then again, why is that sensible? To assert that capitalism sans limits is insensible is NOT equivalent to communism (which says that all people should earn the same wages, which I STAUNCHLY disagree with). There’s a pretty big range, and a pretty recognizable lifestyle difference, between $40K per year and $50-60M per year (which is where I happen to feel a cap should be placed on income, with the excess being put back into sicla programs and infrastructure; if an entrepeneur earned over $50M in one year and desired to “invest the money back into the economy”, by starting/expanding a business, as all these sophistic “economists” will always tell you the rich people do, which is utterly false. But anyway, if they desired to do that, all they’d have to do is submit a brief to the government with the detailed plans for that expansion or that new business. Problem solved). Hoarding riches, to the point that we now have nearly 20 BILLIONAIRES (perhaps more) in this country, should not be tolerated, because that money is SOLELY used to buy POWER AND INFLUENCE and to win absurd concessions from government, to the detriment of the ALL OF US. The wants (not “rights”, not “needs”, but “WANTS”) of the (very) few should never take precedence over the needs and rights of the many (the need to cover cost of living, the right to proper employer/employee treatment etc.). The situation we have now is unsustainable in the long run, and anybody who disagrees is welcome to get back to me in about 20-30 years. Totally unsustainable.

It’s just a very sad situation all around. Sorry for rambling, but I just wanted to make it clear that I CAN sympathize with the plight of the average American, because the situation far too many of them find themselves in is totally unjust. Without larger systemic reform– both in the healthcare field (to reduce overall costs) as well as society-at-large (to ensure fair compensation), true social justice will not be realized, and our society will, I fear, continue its downward spiral.

Dr. Steve here.

An interesting rant no doubt. But I long ago gave up worrying about what people “deserve” to be paid. A one of those physicians who make about $140k all I have to do is call my friend Trey, a PhD in neuroscience who has 2 year MORE training than me and made about HALF what I do until he lost his job.

You get money by going where the money is. A mutual fund manager makes millions becuase he or she handles billions. A CEO makes $20 M because the company make $20B. An athlete makes $10M because his presence makes the team 5 or 10 times that. Medicine decided a long time ago to let someone else handle the money, and we are still paying for it.