Thanks for the comment!

I agree with your view on poverty & socialized medicine. Thanks for the clarification!

I agree that earning potential is not the most important attribute of a job for most people. But it is an important attribute for many people, which is enough here. One native South Dakotan to another, we see generation after generation of young people leave our state because of an inability to provide high-paying jobs to them. Incentives matter.

I agree that a reform of how doctors are paid would be useful. A sort of ‘medical fed,’ along with scientific evidence-based medicine, will be needed.

I stand by my third point: most individuals do not undertake any profession based purely on earning potential. As an attorney myself, I am sure that I could make more money doing something else, however I doubt I would like doing that something else as much. I realize that money is a large part of the equation, but it is not the only important thing about a career. Most doctors are doctors because they want to be, not because it is the highest paying job. I do believe that we would be better off to filter out doctors who are mercenary with regards to their profession. The difficulty is that doctors are not paid and retained based on their performance. Instead, they are paid for performing a service irrespective of the result. Under most current healthcare plans, people are not allowed to switch to an out-of-network doctor if they do not think their doctors are competent. Therefore, until we have true choice of which doctors to choose, only those that truly want to be physicians should be engaged in such a practice.

Great comment!

The current system of taxing health coverage is nonsensical. Before Reagan, all spending on health insurance (by individuals and companies) was tax-deductable. He needed a way to lower marginal rates, however, so he gave that up for individuals.

Now we have a corporat welfare plan.

I have a feeling that Half Sigma’s ideas for America’s economic system are radical. He is better as a critic than he is as a proponent.

(2) Real health-insurance reform: Tax employer-provided
Health-care benefits and return the money to the employee with a government check to buy his own medical insurance, just as he buys his own car or home insurance……

He also states that:

……The health-care benefit exemption is the largest tax break in the entire U.S. budget, costing the government a quarter-trillion dollars annually. It hinders health-insurance security and portability as well as personal independence. If we additionally eliminated the prohibition on buying personal health insurance across state lines, that would inject new and powerful competition that would lower costs for everyone.

Half S’s idea is pretty idealistic in my opinion. He’s assuming a lot of large bureaucracies can be rebuilt from the ground up (medical school and even undergraduate education) and also assuming that the medical profession would continue to attract top talent if the salary was limited to 150k a year. I think we’d just wind up with a lot more people getting PhDs and going into medical research instead of getting MDs.

[1] http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080602933.html?hpid%3Dopinionsbox1&sub=AR

Thank you for your comment.

I agree with your first paragraph.

I am not sure what you mean by the second paragraph. The health care available to the poor is both (a) expensive for society to produce and (b) not particularly helpful to the poor. obtaining a professional job with health insurance, under the present system, is much better than having to rely on the emergency room.

Your third paragraph is even poor puzzling. You are pushing two ideas, both of which make little sense. The first is that the rate at which people enter the medical professional, and the prestige the medical profession has, are independent of salary. Especially considering the burden of medical school loans, this seems unlikely! The second point is that professionals who would leave if they were paid less are a net-detriment to a profession. Really? By that logic, let’s cut all science funding that goes to salaries, assistantships, etc!

In conclusion, your comment started off strong, but made less sense the longer it continued.

As stated in this post, the only people getting shortchanged by the current system is the middle-class. An unfortunate turn of health could, and many times does, completely bankrupt the uninsured middle class. For those in poverty, there is little incentive to reach for the middle class if they are going to lose their healthcare. Obviously, this is contrary to the best traditions of the Republican Party.

Individuals are still going to enter the medical professions for the same reason that people continue to become lawyers even though the pay is not as glamourous as others think: it is prestigious. And perhaps, they actually want to be doctors. Besides, aren’t these the kind of people that we want caring for us anyways?

Something similar for doctors — as well as increased medical immigration – probably would be a good thing.

Thank you for your comment.

A similar argument could have been made against a program against our free-trade programs with Japan, with respect to auto workers. What about those who had just joined the union, and so had been planning to enjoy the benefits of that industry, but lacked seniority and experience?

The medical profession is coddled by one of the largest unions in the country (the American Medical Association), which limits the supply of doctors and hence increase the salary of doctors.

As medicine is subjected to science and mathematics [1,2] the skill required for many doctors will of course go down, as their gut becomes less important than following best practices.

[1] http://www.newsweek.com/id/187006
[2] http://science.slashdot.org/article.pl?sid=09/03/01/2224207&from=rss