They(AMA and APA) are top lobbyists that entrench themselves using monopolistic practices.
Sure school can cost 500k, but with 200 to 300k+ per year salaries, they can kill that debt. (This is their common defense)
Health insurance CEOs make, in some cases, literally hundreds of times my salary, while literally killing people for profit.
I'm going to go out on a limb and say you've misidentified the problem.
Now, certainly bringing down the cost of medical education, and allowing people with less education (i.e. nurse practitioners) to do more, would both help lower the cost of healthcare. But if we're talking about who we should consider "the enemy", it's certainly not doctors.
The entire raison d'être of capitalism is that it's supposedly meritocratic. Are you really claiming that curing illness and sometimes saving people's lives isn't meritable?
I think you'd pretty easily get trounced making that argument. People would much rather be alive to do something less efficiently than to... not be alive at all. This argument is a bit insane to me.
because "helping many people allocate their time towards activities they actually value" was an important premise I stated in the post you originally replied to? I deliberately excluded stuff that merely improves productivity at work (although not everyone is fortunate enough to have a job where they can just leave at five if the work isn't done).
Meanwhile, median life expectancy has skyrocketed, in large part due to new medical treatments and early detection methods. Unless your father was spending 20-30% of each day paying bills, I don't think that's going to do it. I remain unconvinced.
Let's also not forget the drain on interpersonal relations that software has brought about. If your father would have spent that time ok on FB instead I'm not sure we gained anything.
The only way increased productivity lets people spend more time for themselves is if it is on menial tasks outside of work, and most individual consumers won't pay for software, so then you're often into violating people's privacy to sell ads, which again is pretty hard to justify.
But I'm still going to stand firm on my stance that a doctor, even if they only save a few lives in their career, is providing a more valuable service than I am. There's just no way the time I've saved people has added up to even a few lifetimes.
If we look at the software industry as a whole, it's just very obvious. We're an industry that likes to think we're saving the world, but the reality is that the results of software have been a very mixed bag. Facebook, for example, is pretty much just bad, and there isn't a major company out there that I wouldn't look at as being in some grey area, where it's hard to tell if they are a net positive or negative.
It's a classic licensing scheme to restrict competition. Doctors may not be the enemy, but they are financially benefitting from their monopolistic practices, and it is reducing quality of care for Americans.
An engineer's impact on a single person might be low, but at scale, it can add up to a lot.
As noble as being a doctor is, their individual contributions can never scale beyond a few people.
While I am at it, can someone explain why being a doctor needs a person to go through 4 years of undergrad in field completely useless in their domain ?
> The entire raison d'être of capitalism is that it's supposedly meritocratic
Not it is not. It may be sold to us like that, but it is more like : "Those who succeed in Capitalism, do so only by the means of their merit....and the infinite privilege or luck that might have instead put them there. "
> As noble as being a doctor is, their individual contributions can never scale beyond a few people.
Nonsense. If you only scale into saving hundreds of users a few minutes each, you're maybe approaching one lifetime, and that's assuming that your time saving actually improves those users' lives. The vast majority of engineers don't scale beyond that.
Meanwhile, some doctors absolutely make contributions that scale, such as finding cures or vaccines, preventing spread of infectious diseases, or discovering ways to detect diseases earlier. Looking at percentages of world population, the black death killed more people than any of the FAANG companies have users, and that's only one of the diseases cured by the discovery of penicillin. If antibiotics resulting from penicillin didn't exist, it's quite reasonable to guess that more people would die of bacterial infections than FAANG has users.
The smallpox vaccine? A test for detecting HIV? Quarantining the Ebola outbreaks? Each of these saved millions of lives.
And let's not forget that the highest-scale engineers are pretty hit or miss as far as whether the way their work touches lives is even positive. Big pharma isn't innocent, but I don't think anyone would argue we should get rid of them entirely. In contrast, it's pretty unambiguous that the world would be better off without Facebook, and each of the AANG companies has some pretty large negative effects on i.e. small businesses, worker rights, attention, privacy.
In short, you're just comparing the highest-scale engineers to the lowest-scale doctors, and assuming that what engineers are doing is as positive as what doctors do.
and many engineers have invented machines that have saved millions of lives. Let alone the fact that most of the things you mention were discovered either by academics or pure science researchers.
Doctors : Medical scientists :: Engineers : Physicists & mathematicians.
Doctors aren't doing the inventing. They are applied practitioners of their profession. The sycophancy around worshiping doctors is one I can never get my head around. Sure, it is a difficult job to learn and an essential part of any system, but just being the medical profession doesn't give a doctor any moral high ground in their choice.
Being in India, the biggest contributors to saving lives have been policy makers. Funding access to clean water, electricity and roads are far bigger life savers than someone who can do surgery. Google is probably saving more lives by letting doctors web search symptoms, than entire families of hospitals.
I have no delusions about my work. I do it because I like it. I would still do it if it was live saving, or completely irrelevant to society at large.
But, raising certain professions to an innate moral high ground makes no sense to me. Be it doctors, fire fighters, veterans or first responders. If a person needs continuous approval from society to do their job, then they should not be doing it in the first place.
That being said, I will always give every honest job a minimum level of respect and appreciate both hard work and tenacity. So, I am not advocating for being an ass to doctors. However, I respect those values, not some innate virtue of their profession.
It wouldn't surprise me if doctor pay was a larger factor in healthcare costs. But doctor pay is an inherent cost of healthcare, and while we can certainly lower their pay, it's not entirely clear to me what a fair pay would be.
Health insurance CEOs, and indeed most of what a health insurance company does, are not only not inherent costs, but active blights on the healthcare system. A fair pay would be zero, with fines for literally killing people. So they're much higher priorities than doctors for the axe.
There are many problems comparing software pay to healthcare pay.
- A large portion of software jobs are in the Bay Area, you are not being paid for your software job, you are being paid a giant CoL premium that gets taken away by landowners.
Doctors on the other hand have jobs available all across the country and need not live in super-expensive areas. Further, their pay usually goes UP as they go to less expensive areas .
- Medical salaries/jobs are not cyclical and do not suddenly disappear in droves as tech jobs did in 2001-2003 (countrywide) / 2008-2009 (NY+).
With tech jobs, your low six figure pay is also paying you a hazard premium which i'm hoping youre saving for the next down cycle.
- Many software engineers will tell you about age discrimination -- supposedly it gets harder and harder to find a job as you age. It is an unlicensed field, so there is theoretically unlimited supply. Further, there isnt a cartel-like mechanism (i.e., AMA and residency programs) to constrict supply. Thus, you are like a less extreme football player -- you make low six figures and then you pleateau or go down over time.
Doctors make more with experience and there is no age discrimination that is spoken of.
Depending on how many workers get imported on any given year, there are 300-500% more tech workers imported (e.g., with H1b) than all medical school graduates per year: https://www.aamc.org/data-reports/students-residents/interac...
There are near zero imported medical specialists in the US. There are imported primary care workers, but those arent where the big billings are coming from. There is literally no downward pressure on medical salaries like there is in the US for tech.
The multiplier of my salary to get a health insurance CEO's salary is also now, what, 200 or 300 instead of 100?
- SWE: Much of the premium might be CoL premium
- SWE: There is a downward slope on earning potential
- SWE: No cartel and constantly expanding pool of workers
I'd argue that SWEs should make more given all these negative aspects.
- SWE: Much of the premium might be CoL premium
There are non-SF/NYC software jobs. Before I was a freelancer, I worked only one salary job in NYC. The rest of the time I worked and lived in much lower-CoL areas. And as a freelancer I work remote, getting paid NYC/SF money in a much cheaper place.
- SWE: There is a downward slope on earning potential
There may be a downward slope on earning potential, but that's in part because the SF/NYC markets bump you up pretty high pretty early, without much real justification. These places seem to fetishize the young hotshot "10x" programmer who is willing to work 70 hour weeks, but the reality is that that isn't sustainable, and the work done by kids isn't actually very high quality. That only works for a fail-fast startup model, but most companies outside the NYC/SF bubble aren't actually like that. There are plenty of old greybeard programmers working boring jobs at Dunder Mifflin-type companies in the Midwest, making wages increasing by 3% over inflation every year. Maybe they never peak as high as their SF/NYC counterparts, but they're still making more than a lot of other jobs in their areas. And the workloads of these jobs themselves are more sustainable.
- SWE: No cartel and constantly expanding pool of workers
There's also an expanding job market. Sure, there are cyclical downturns, but the overall trend is up.
One thing that trips a lot of people up is a failure to specialize. If your job is writing Django/Angular apps, that only gets so difficult, and there's not really a reason to pay for someone with more experience beyond a certain point. But Django/Angular apps aren't the peak of software engineering--there are much more complex systems out there which actually do need someone with more experience. I see a lot of people hit the point where they can't progress further with LAMP/.NET/whatever-common-stack and get stuck instead of going back to school or finding a job that will teach them cryptography or networking or FPGA programming or whatever.
It wouldn't surprise me if doctor pay was a larger factor in healthcare costs. But doctor salaries are an inherent cost of healthcare, and while we can certainly lower their salaries, it's not entirely clear to me what a fair salary would be.
Health insurance CEOs, and indeed most of what a health insurance company does, are not only not inherent costs, but active blights on the healthcare system. A fair salary would be zero, with fines for literally killing people. So they're much higher priorities than doctors for the axe.
As far as I can tell, there does not exist a sufficient quantity of healthcare supply to meet the demand, hence the high prices. Without increasing the supply of healthcare, the conversation is moot.
Which is basically impossible for somebody to do for themself, because that's most people's goal in how they use money. If somebody said, "The value of a healthy and enjoyable life for me or my loved one is $X," that'd mean they wouldn't spend their money if it cost over $X. Which is a ridiculous idea, and we've all seen it play out where people or their families shell out most of their wealth for the chance of living another month.
The only two ways I can see around this are:
1. Have an objective evaluator of life (maybe even accounting for differences in each person's value to society, if you really want to be accurate and don't mind the mobs with pitchforks).
2. Drop the idea of including health in the regular economy. Not totally possible, but public healthcare might be close enough.
I don't believe that salaries tell the whole story of doctor income. Doctors are well positioned as insiders to make investments in the medical industry, ranging from ownership of clinics and diagnostic equipment, to owning entire provider networks.
An effect of the cost of doctor education is that it favors students from wealthy families, who are also positioned as investors.
Meanwhile, every interest group in the system will cry poor, and claim that someone else is gouging us, which is an almost certain sign that they're all gouging us. I've got a lot of doctors as friends, and I don't pity them.
But it's also true, and I think well-known at least in a vague sense, that one can make a pretty good living in the medical field.
For-profit insurance companies come in for the most hate since they are in the position to deny care. But their profit margins are not sky-high. Whether or not one believes that private health insurance is a terrible idea, the facts are pretty clear that there is a lot more to the high cost of U.S. healthcare than just private insurance.
There is a lot of cost everywhere in the medical system... that's the other side of those professionals making a good living.
I'm not going to pretend I have a good answer to this.
don't take this personally, but: this is an oft repeated meme that, in my experience, not really true, at least for MDs and nurses (to include doctors, specialists and surgeons). it certainly contributes to the sort of hero status of health care workers though.
physicians in the US earn a ton for a high-prestige, high social power, high earnings, generally safe career. in return they must sacrifice these earnings and social status for most of their 20s due to ridiculous quotas and standards in medical school, propped up by AMA; this makes the system higher prestige and sought after, a nice vicious (or virtuous for them) cycle.
the AMA also has them on the hook in a debt-slavery sort of way, because normal wages would never repay their ridiculous medical debt (see e.g. mid/low tier lawyers and law school outcomes when that got popular)
nursing, likewise, is seen as a j o b that offers some safety/consistency in return for investing time into education.
that these individuals """help people""" is generally of tertiary or lesser concern; much more "help" could be done by opening an affordable grocery store in a food desert. all but the most naive students either readily admit this or cop to it once asked.
Anesthesiologists $267,020 Surgeons 255,110 Obstetricians and gynecologists 238,320 Psychiatrists 220,380 Family and general practitioners 211,780 Physicians and surgeons, all other 203,880 Internists, general 196,490 Pediatricians, general 183,240
Doctors go through 4 extra years of school and then 5-7 years as a resident where they are paid an average of 60k and work ridiculous hours. During that period they're always on call, work twice as much as average workers in other industries, and don't get regular holidays. I have a surgical resident friend who regularly works over 100 hours a week, sometimes having as much as three 24 shifts in a week--and frequently he'll have <8 hour periods to go home and rest before returning to work. Plus, doctor's expenses can include medical malpractice insurance premiums if not provided by their place of work, which, depending on state and specialization, can range up to several hundred thousand dollars (!!!)[2].
I just don't see how doctors are overpaid considering the amount of training they have to go through, their work conditions, and the risks involved.
1. https://www.bls.gov/ooh/healthcare/physicians-and-surgeons.h...
2. https://www.gallaghermalpractice.com/blog/post/how-much-does...
Their pay is in now way comparable to doctors, who have a structural advantage due to the limited number of new doctors each year.
edit: https://www.commondreams.org/views/2019/08/18/ama-gets-out-w...