Sara Robinson explores this question. Canadian doctors are paid less, but with the benefits of roughly half the medical school debt and lower malpractice insurance costs.
Any talk about comparing or reducing American physicians salaries has to be accompanied by accompanying proposals to reduce medical school debt and malpractice insurance, and I’m simply not hearing that.
Related posts:
- Would you accept a lower salary if you could graduate from medical school debt free?
- My take: Physician salaries, the Massachusetts trap
- Why do health policy experts and wonks hate doctors?
- What is responsible for high health care costs?
- How much money should doctors make?
- The obstacles against single-payer
- Single-payer and the Indian Health Service
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Uhhhhh…. yeah. She lost me when she said that her doctor in California works 70 hours a week. 35 hours goes to patient care and the other 35 hours goes to fighting with the insurance company. I hardly ever talk to insurance companies. I have someone hired to do that that doesn’t cost me 35 hours a week of my income. Now, she might be saying that in Canada they don’t have to chart? Will I not have to keep patient records anymore if there is universal healthcare? That seems very unlikely.
Don’t confuse “benefits” of the single-payer system in Canada with the overall practice burdens of their system. Canadian doctors have a less predatory legal climate and lower malpractice premiums, which has nothing to do with their system being a single-payer design, Likewise, the typical Canadian university tuition rates are lower across the board, not just for medical education. Relative debt burden has nothing to do with their single-payer system, only with greater Canadian tax-funded subsidies to Canadian universities. Similarly, Canadians cannot deduct their home mortgage payments interest which presumably affects their relative personal income tax burden, but again, has nothing to do with state-operated single payer-style medical insurance, beneficial or not.
So you can’t say they are or aren’t hurt. You are comparing apples to oranges.
If things were so great in Canada we would see an exodus. My expat friends were tired of being compensated less than a plumber.
I would argue (and did, in fact, in the article) that the single-payer system does create a far less predatory legal environment. When an injury is highly likely to cost someone their home, their access to care, and their middle-class status (as too often happens in the US), they will go to court to fight like hell for it. When there’s not nearly so much on the line — and especially when they’re assured of getting good care — they’re far more likely to accept the situation, and negotiate reasonably.
I also think middle-class families in the US have come to see a big award as a legitimate upward mobility route — an ethically shady belief that’s become more acceptable as the middle class has been hollowed out. Given the huge role that medical-related bankruptcies have played in that hollowing, it’s not surprising that some people would eventually decide it’s OK to bleed a system that’s bleeding them.
The adversarial nature of the US system has drained away much of the trust between doctors and patients — and that, I’d submit, is the reason malpractice is so high. The very structure of single-payer, which aligns the interests of doctors and patients far more closely on the same side, changes that climate by restoring the trust. And that makes it a lot harder for ambulance chasers to gain a foothold.
Anon 10:41
The example may be exaggerated, but the point does remain — the administrative burden and cost of a single payer is very efficient, In the ER, I never have to interface with the insurance Co’s, but the average ER doc does have to pay 7-13% of gross revenue for someone else to do the billing and coding.
It’s not a wash; docs clearly get paid less there. And I agreee with most of the points anon 10:44 makes.
The issue isn’t where docs make more money. It is one of freedom. Single payor violates the liberties of doctors and patients to freely contract with each other within the doctor-patient relationship, and is just plain immoral.
Sara Robinson: You can argue it all you want. The fact that the US is more ligitious in all areas from product liability to personal injury, not only medical malpractice, strongly suggests that the high rate of malpractice lawsuits here isn’t an exception caused by the need to recover health care costs. Rather it is simply a manifestation of a system that is more litigious in every area. I honestly don’t believe single-payer would affect medmal lawsuits at all.
Actually, doctors are not paid less in Canada. Canada is a smaller country and does not have the phenomena of tiered medical care and the cost differences involved in that. There will be more doctors earning more, but that is because the US is larger and again the private market lets SOME doctors earn a lot more. Most, earn less than Canadians.
A matter of freedom? Um. You mean like answering to some clerk at the insurance company office?
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