Solving the problem of care that a person can’t afford is a completely different issue than fixing the problem of routine affordable care being exorbitantly expensive.
According to Wikipedia, there are only .5% of all physicians in the US who can perform neurosurgery. So it's probably safe to say the demand for brain surgery is much higher than the supply.
This incentivises people to become doctors that perform such complecated procedures as it takes a lot of time and a lot of money to be able to do those things.
If you were to force doctors to perform work on people that can't afford it, then presumably they will earn less money. If they earn less money, there is less incentive to do that kind of work as they will pick something easier and more profitable.
You will end up with fewer people to do brain surgery.
There are two parts here that are not clear, and potentially misleading for folks unfamiliar with how doctors are minted in the US. The first is the cost to the individual to become a neurosurgeon. The second is around the supply side of the health market.
First, to become a practicing doctor of any sort one first completes med school then a residency and (depending on specialty) fellowship. The med school part is more or less the same for all physicians from your GP to brain surgeons to psychiatrists. Many folks take out loans to cover med school.
The residency and fellowship parts are paid. In practical terms this means a person becoming a neurosurgeon needs no more loans or upfront cash than a person becoming a GP. (I assume everyone is familiar with opportunity cost so will leave that part unsaid)
As an aside, much of the funding for these programs comes from the public (via Medicare).
All this means, the cost of becoming a neurosurgeon is about the same as any other specialty.
As for the supply side entry to med school and selection to residency programs are the big bottlenecks.
Med schools are accredited via doctors trade bodies. This means doctors (not market forces) decide how many new folks can become doctors.
As previously mentioned, residencies are largely funded via Medicare already. However, the number of residents has been capped since 1996. In that period of time the US population has grown by about 60 million (25%).
You may have been familiar with all this, but I think the context is important for discussing market solutions to healthcare — there are a lot of distortions around the US having anything resembling market behaviors.
I suppose that the amount of doctors graduating each year is below the supply-demand equilibrium, and this us because the artificial supply-side limitation. Most doctors are overworked, despite their very high throughput and medical offices' efficiency.
This gives doctors a way to pay out their colossal student debt, though!
This article suggests that there is a gap, and is widening. Only 1 to 61,000 people. It also mentions that they tend to be clustered in more populated areas, leaving some places without any coverage.
If money were the only incentive tons of people would become school teachers because school teachers make significantly more than the average. Other incentives, like having to deal with kids and get a degree, is what keeps people out.
Entry-level teachers earn over $40,000 according to Payscale. Median income for the lower class is about $25,000. Anecdotally, it's not unreasonable to become a millionaire in real estate by the time you retire on a teachers salary.
That is true, but if you're the type of person that likes to help others it's much easier to become a teacher than doctor.
Also, if you are a doctor and your primary motivation is helping people, wouldn't you want to help many people with simple problems, than few people with highly complex problems (which most likely have a higher risk of failure)? There is already a shortage of doctors doing the easy stuff.
I just don't see the incentive for doing difficult procedures other than with money.
> Also, if you are a doctor and your primary motivation is helping people, wouldn't you want to help many people with simple problems, than few people with highly complex problems (which most likely have a higher risk of failure)?
Your analysis completely falls flat here. Not all doctors are motivated by the same things and yet most of them would consider their primary motivation helping people.
Neurosurgeons are a prime example. They would very much prefer few complex cases (not everyone gets a brain tumor thankfully) as their way to maximize benefit rather than manage cholesterol meds for 100s.
Speciality surgeons by their nature are motivated by a certain degree of risk.
The incentive for doing difficult procedures is often because they are challenging. Compensation for doctors in the US isn’t fully correlated with difficulty either... with no offense to my dermatology colleagues making more than most general surgery sub specialists.
> Not all doctors are motivated by the same things and yet most of them would consider their primary motivation helping people.
That's fair. I probably over-emphasized the money part of it.
> The incentive for doing difficult procedures is often because they are challenging.
We can assume that since doctors aren't doing this for free or at least cheap already, that they require at least some amount of compensation. To return to my original point, if you force doctors to perform procedures on people that can't afford them, and the amount they receive is less than they want, then there be a greater shortage of such doctors.
> Compensation for doctors in the US isn’t fully correlated with difficulty either... with no offense to my dermatology colleagues making more than most general surgery sub specialists.
Not directly anyway, it's probably more supply/demand. Low supply of neurosurgeon means high cost. Whether that's from artificially suppressing the supply of these doctors or because it's very challenging is up for debate.
I'd guess dermatologists make so much because people are more willing to spend money on that sort of work.
No, but alternatives and transparent pricing allow us to weigh alternatives and to have an adult conversation about all of us will die someday (save singularity). Then we get to negotiate about what it's worth to extend that date of death forward 1, 2 .. N days for $N .
Next we look to that "scorecard" (bank account) which is the value provided but not called upon and get to see if we can call in enough "favors" to afford the healthcare
As I see it, there are two solutions. Either all medical costs are "free" for the consumer and paid for via a tax, or you have a proper insurance system where consumers participate in a transparent market for non-urgent medical care and buy insurance only for things they can't afford. The latter needs some extra regulations for emergency care where you can't compare prices.