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Comment by analog31 | Hacker News Reader

As I understand it, salaries are only one of the many ways that doctors make money. Many "providers" are doctor-owned. Perhaps a more general statement would be that decreasing the cost of medical care will unavoidably decrease the income and/or wealth of doctors.

I don't see a problem with this, so long as doctors can earn a decent living. An idea I've thought about is that medical school is free, but doctors primarily earn their income by working for the government, for a salary. It might attract different people, who stand to benefit from that bargain.

What I've noticed about the debate is that everybody who is getting rich, is pointing the finger of blame at everybody else. Chances are, they're all gouging us.

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> I don't see a problem with this, so long as doctors can earn a decent living.

There's an enormous opportunity to disrupt doctors. Doctors, particularly in the US, are grossly overpaid for the value they deliver. As I said below, there's an extra $100-$250 billion a year that gets sucked up by doctors. Frankly, the vast majority of what doctors end up doing -- collecting information, analyzing it, prescribing a course, repeat -- does not warrant the salaries doctors commandeer.

The industrialization of healthcare can't be done inside the existing system and the government certainly won't help which is what makes things tricky. But it's why you see Amazon, JP Morgan, Google and Uber starting their own healthcare companies and pushing into this industry more and more. [1] There's a great deal of money to be saved here while potentially improving outcomes. The current system, where a single doctor works obscene hours while spending 15 minutes with each patient, is just dumb.

[1] https://www.vox.com/technology/2018/3/6/17071750/amazon-heal...

This is just a secondary effect. The primary issue is the principal agent problem. There's effectively no limit to what doctors can charge because demand isn't limited by price. So they charge a lot.

You say that doctors are overpaid. What do you think is a reasonable salary for, say, a cardiac surgeon?

Out of curiosity, what are they paid in other countries?

> As I understand it, salaries are only one of the many ways that doctors make money. Many "providers" are doctor-owned.

No, nowadays, private practices are a dying breed. Most physicians are, in fact, salaried. And that salary isn't actually all earnings, because a large chunk of their business and professional expenses (insurance, continuing education, various licenses, etc.) all have to be paid out-of-pocket. These expenses are not generally tax-deductible, because of the AMT thresholds, so doctors' actual disposable income is dramatically less than you would think just by looking at the raw salary number. It's very different from other fields (like software engineering) in this regard.

But the earnings aren't all salaries either. As I understand it, doctors earn salaries from employers, but as I understand it, they are also leading investors in provider systems and in the malpractice insurance system.

They're not getting poor. The only thing I'm suggesting is that reducing the cost of care will make them poorer, but that could be offset by attracting people to be doctors who don't come from the most affluent backgrounds.

> But the earnings aren't all salaries either. As I understand it, doctors earn salaries from employers, but as I understand it, they are also leading investors in provider systems and in the malpractice insurance system.

Your understanding is very, very gravely mistaken. Most doctors do not have any of the kids of investment stakes you describe.

> but as I understand it, they are also leading investors in provider systems and in the malpractice insurance system.

You're completely wrong. There's actually the Stark law (https://en.wikipedia.org/wiki/Stark_Law) set up to prevent doctors from owning industry-related materia or self-referring to any entity with financial relationship. Not only that, but out of my network (100+ other physicians) very few are the 'leading investors' in provider systems, and zero have any skin in the malpractice insurance system. The MBAs run the numbers game, the MDs just work long hours.

When did that law go into effect? The provider network that my employer's insurance plan used for a while advertised on a billboard that it was "doctor owned." What I don't know is how the specific financial or legal relationship worked.

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