That's an interesting throwaway on making all doctors salaried employees. What percentage of the profession does Noah think will submit to it? They didn't spend eight ball busting years in pre-med and medical school, plus a sleep deprived residency, and incur all that debt just so they could be civil servants.

Second question, that has to be applied to all universal health coverage plans. Since the demand for health care that you don't pay for by procedure outstrips any conceivable supply, who will set priorities? In our current non-system the ability to pay does it, which is why there are plenty of cardiologists and cosmetic surgeons in West LA while kids in South Central go without a pediatrician. Any state paid system has to decide who gets what, which means taking responsibility for saying who has to wait or go without.

Ideally doctors should work for large integrated providers like Kaiser who compete using salary and benefits for their services the same way that airlines compete for pilots. These integrated providers that compete for members on price, quality and health outcomes.The idea that spending "eight ball busting years in pre-med and medical school, plus a sleep deprived residency" creates a special sense of entitlement is the source of the fountain of narcissism that permeates the profession.

I certainly won't dispute the "narcissism that permeates the profession." But that narcissism is an economic and political fact. Plenty of physicians think of themselves as entrepreneurs who control the level of their income by what patients they take, what procedures they do, and what sources of reimbursement they accept. They went into medicine to make a good living. They will fight any proposed health care system that takes away the opportunity to make all they can.

Twenty-five years ago, Paul Starr pointed out in The Social History of American Medicine that the tendency of modern reimbursement -- whether government or managed care -- was to push doctors away from the model of independent businessmen exercising professional judgment towards the model of salaried employees doing only those procedures that the payor will pay for. That trend has continued. The doctors hate it.

What if they were high? For that matter, what if the government paid for all or part of their schooling itself so that they didn't have to carry that massive debt?

In other words, because doctors worked so hard to get their MDs, they deserve to make as much money as possible, whether or not they are serving their patients and improving their health.

I'm all for paying doctors well, but the current fee for service payment system encourages bad medicine. Physicians should be well paid under any system. I say, let them keep the $600 billion they're now making, but redistribute it so that primary care physicians, the backbone of good health care, make more money, and proceduralists make less. And we take away the financial incentive to do more rather than do better.

Shannon Brownlee, author of Overtreated; Why Too Much Medicine is Making Us Sicker and Poorer

oh please...

Most nations that have universal coverage also pay for that expensive medical education and have a two-tier system--one social and one private--so patients who have the means can pay for the physicians and procedures of their choice.

Once we decide that health care is a universal right and not a privilege, then the majority of physicians will be acting as de facto civil servants since the government is likely the only entity powerful enough to provide that service whether directly or indirectly.

If that prospect should deter some from entering the medical profession, then perhaps we are all better off. I would not my health-care provider more concerned for her stock portfolio than my health. But if that same person also happens to be the best in her field, then I would gladly pay for her services if my life depended on it.

The VA already does this, as do many HMOs. And doctors aren't all that upset by it, since it gives them a way to start earning $$ without having to go even deeper in debt either in setting up a practice or in buying into an existing practice.

And if the payoff was a complete elimination of the multiplicity of forms overhead that they face today, I'm fairly certain most primary care MDs would actually make the switch. Sure, specialists with existing practices would resist - but then they are already being "gate kept" by the Primary Care MDs.

And the Single Payer could provide a $$ incentive to refer patients to those specialists who have switched to a Salary mode.

In Great Britain when they salaried all the physicians, many of them selected to move to the states and work where they could make a decent wage for the amount of time they spent studying...

It is precisely that... those places are where physicians get their start. Not where they still hope to be in 10 years or so. Believe me, I would not select a field that I have to invest approximately 11-13 years of advanced education to only make $75K for the rest of my life.

Well... I doubt if there would be many organ transplants, unless a person is one of the more equal of the pigs....:)

I guess that is only allowed if you are a politician, an attorney, an actor, or a professional sports figure? Give me a break...

Personally, I think a large amount of health care cost could be reformed with medical malpractice reform... but how many politicians (aka attorneys) are going to agree to that? Plus, I think in spite of the fact people chose to be physicians that they still are entitled NOT to be bankrupt.

If she is the best in her field... will you also pay to go to another country to receive her services if she felt she could no longer get a decent wage here?

don't suppose you would be interested in making more money for those doctor bills, would you?

Anny:

Personally, I think a large amount of health care cost could be reformed with medical malpractice reform... but how many politicians (aka attorneys) are going to agree to that? Plus, I think in spite of the fact people chose to be physicians that they still are entitled NOT to be bankrupt.

Believing and thinking are not the same. The data on malpractice rates and settlements indicates that it has been at steady state on a per/capita basis for some 30 years. Yet we have seen an explosion in health care costs in those same 30 years. So your "thinking" suggests that something that hasn't increased in the amount of cost it drives into the system, is the cause of a Year on Year health care inflation rate that quadruples or quintuples the base inflation rate.

This is "thinking"???