American physicians deserve to be paid well for their work. As a physician, myself, I know what it takes to become a doctor in the U.S. Four years of late nights in the college library in hopes of achieving a GPA commensurate with medical school admission; then four years of medical school, which makes the college work load feel light in retrospect; then, in my case, three years of residency training, where an 80-hour work week begins, making everything before feel like a vacation. And in the case of more specialized physicians than me, like orthopedic surgeons or cardiologists, clinical training continues another handful of years. Moreover, becoming a physician in the U.S. carries enormous financial costs, with many Americans graduating from medical school with six-figure debt. So I support paying American physicians well for their labors. But how well? Is more than $535,668 the right amount for the average — the average! — orthopedic surgeon to make? Should dermatologists — whose training is far less intense and prolonged than many other physicians — make a average of $400,898? The U.S. has a health care spending problem, and soaring health care incomes are partly responsible. Importantly, those incomes are by no means limited to physicians. In 2014, the CEO of Aetna, an American health insurance company, brought home more than $15 million. In 2012, the CEO of the nonprofit Atlantic Health System in Morristown, New Jersey made more than $10 million. With so much money spent on medical care in the U.S., there are many people involved in the health care marketplace who are doing very well by doing good. Consider pharmaceutical companies, historically one of the most consistently profitable industries in the private sector. These companies make a disproportionate share of their profits in the U.S., where they charge significantly higher prices for their products than they do in most other markets. Device companies also garner significant profits in U.S. markets. I don’t begrudge anyone who makes a lot of money doing honest, legally sanctioned work. But all this money, all the health care spending that leads to these high incomes, comes either from the pockets of individual patients, or from the people enrolling in private health insurance plans, or from the employers subsidizing those plans or from taxpayers who fund programs like Medicare and Medicaid. And all this money — all these personal expenses and taxes — are posing a very heavy burden on the American public. High health care spending burdens state and federal governments. Health care spending in the U.S. has risen faster than inflation for most of the last 70 years. State governments, which help subsidize costs for low-income citizens, have therefore seen an increasing portion of their budgets go toward health care, making it harder to pay for other basic services like infrastructure and education. Health care expenditures are the fastest growing part of the federal budget, a budget that is consistently overdrawn. Indeed, with Medicare expenses expected to continue to grow faster than inflation for many years to come, the federal government faces the kind of debt burden that will force us to make very difficult decisions about how much more to tax the American people or how much to reduce the size and scope of other government activities. In 2016, health care expenditures accounted for more than 25 percent of federal spending, money that ultimately came from U.S. taxpayers. The future fiscal solvency of the U.S. government depends on health care spending more than on any other federal function. High health care spending also burdens employers, at least the ones who are trying to contribute to their employees’ health care benefits. In the U.S., many employers pay for the majority of their workers’ health insurance. These health insurance costs put American companies at a competitive disadvantage compared to non-U.S. companies that do not bear these costs. High healthcare spending also burdens people who purchase private health insurance. In 2012, the average family insurance plan cost over $15,000 in the U.S. For people with insurance through their jobs, some of that cost is borne by their employers. But all that employer financial support reduces employee income: the more money going into health insurance, the less money available for take-home pay. The cost of health insurance is especially burdensome for self-employed people, and for those whose employers do not provide health care benefits. In short, high health care costs means lower take-home pay. As we debate how to replace or, better yet in my opinion, fix Obamacare, we need to take a close look at the price of health care products and services. We need to promote better pay for rural hospitals struggling to keep afloat, and for clinicians like primary care pediatricians who are underpaid relative to their peers in other specialties. But we also need to promote policies that combat the high price of specialty drugs and specialty care. In the case of physician pay, it’s time to make a deal. In return for asking highly paid physicians to accept lower pay, we should: Reform the malpractice system, so neurosurgeons and obstetricians and other physicians are not sued simply because their patients experience tragic and often unpreventable disability. Subsidize medical education, so physicians leave medical school with only modest debt, making it easier to accept more modestly paid jobs. Remember that physician pay isn’t the only, or even the primary, cause of high health care prices in the U.S. Physicians need to play their part in bringing down high U.S. health care prices. But we shouldn’t forget about the many other sectors of the health care industry benefiting from high prices — pharmaceutical companies, device manufacturers, medical technology companies, and the like that know they can rely upon the U.S. health care system to pay generously for their services. Health care is a public good, regardless of whether it is financed by the government or private insurers. People who work in health care should be paid well for their work, but not so well that they bankrupt our country. Source
