"They'll live": Doctors will just have to take a massive pay cut for the US to be more like Canada

We’re going to make it clear up front that Vox’s Dylan Matthews isn’t responsible for the study showing that American doctors would have to take massive pay cuts to bring U.S. health care costs in line with Canada’s — but the line, “That’s fine, they’ll live”? He owns that.

https://twitter.com/dylanmatt/status/1026545556733059072

Yeah, you might also not want to undersell the difficulty of telling your surgeon he needs to take a 52 percent pay cut, effective immediately. But this is coming from the guy who back in 2015 wanted “to ban human drivers ASAP,” so he doesn’t have a history of getting what he wants.

The Vox children are mighty nonchalant about cutting other people’s income by government fiat. https://t.co/ZZViYCtpik

— Will Collier (@willcollier) August 7, 2018

Surely this will do nothing to change the incentive structure that motivates people to go through >8 years of post-secondary education and training and become doctors. https://t.co/PJRdug99bC

— N. Bourbaki (@d08890) August 7, 2018

I'm sorry — but this is more than just a "political difficulty." If you think wage cuts of this amount wouldn't hurt the quality of individuals seeking out being a doctor then you're blind to reality.

You can say you don't care about the quality tradeoff, but it's there. https://t.co/s5tFN9WC0r

— Craig Garthwaite (@C_Garthwaite) August 6, 2018

https://twitter.com/JesseKellyDC/status/1026647090590560256

https://twitter.com/MetricButtload/status/1026629729871261697

https://twitter.com/pizzapolitico/status/1026630925323567104

I like how he wants to tell people what they should earn https://t.co/rGtx5xAQZe

— Kurt Schlichter (@KurtSchlichter) August 7, 2018

Here is the funny part:

Cutting doc pay? IS THE EASY PART! ?

Now, imagine cutting nurses pay 33%. Or Med techs. Or PAs. And all the ancillary staff, including secretaries and administrators.

All of their pay would have to drop.

Docs are the tip of the spear. Nothing more. https://t.co/NQQHt4XlFk

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

When people talk about cutting reimbursements…people forget doctors and hospitals RUN BUSINESSES.

They aren't the only employees involved.

My group has SEVENTY ancillary staff. They'd all have to cut their pay too to make this work. Many would lose their jobs.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

Do people think docs would take a 1/3 pay cut…and not pass that pay cut on to their staff?

Same with hospitals:you think you could magically maintain staffing pay at current levels, with a 40% cut?

Everyone downstream would take that pay hit…if they kept their jobs at all.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

Cutting docs pay in 1/2 is one thing.

Cutting a secretary who makes $18/hour in half…how do liberals like the idea of that? Because that is what they are proposing.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

The late, great Uwe Reinhardt spoke about this in length:

"Cutting doctors’ take-home pay would not really solve the American cost crisis."https://t.co/5CoAeDjzQ8

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

"The total amount US pay their physicians collectively represents only about 20% of total national health spending. Of this total, close to half is absorbed by the physicians’ practice expenses, including malpractice premiums, but excluding the amortization of college…debt."

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

This makes the physicians’ collective take-home pay only about 10% of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent…"

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

"… in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy."

And Uwe was not exactly a conservative leader on health care…but he did have immense common sense.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

On a personal note? I've always expected some kind of horror show would come to health care.

That is why I am prepared.

I could literally quit tomorrow. Sure, I'd make a lot less money, but I'd survive. I can tell you that I wouldn't work my current hours for 1/2 the pay.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

We bet Resistance doctor Eugene Gu — or one of his online aliases — would do it.

The trade off here would be would the cost reduction set off the reduction in productivity you'd see.

Because…I guarantee you'd see a massive reduction in productivity. There is no way you could maintain the high productivity rate in health care we have today.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

For example: do you really believe nurses that made $100k a year (in one of the toughest jobs in the world!) would work that hard…making $70k?

Good luck with that.

Its not just us 'rich' doctors that would have to pay the price.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

I haven't even talked about the WORST PART!

The worst part isn't that you would demoralize and cause dysfunction among HC professionals.

The worst part is…you'd probably wipe out 10-20% of hospitals that currently exist.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

Many hospitals (especially those in rural areas and poor urban communities) are largely holding on by a thread as it is.

How would they fare under a system that cuts reimbursements 40%?

You don't need to be an economist to answer that question.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

Of course, the govt wouldn't let that happen…so would provide subsidies.

Which is fine…except…there goes your cost savings.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

In short, this points to one of the key things about the US health care systems' costs:

We are costlier because we pay our people more, and our hospitals are more expensive to run, than many hospitals around the world.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

So what it comes down to is this entire concept is fine as far as a math problem goes.

As far as reality…consumers would have to quickly face a system that may be decent, but is not anywhere near the system they have today.

As always…everything is about trade offs.

— Pradheep J. Shanker, M.D., M.S. (@Neoavatara) August 7, 2018

Remember this, the people that push this agenda truly believe the services our medical professionals provide to be a "right." I assume they would think they can force you to continue your practice whether you want to do so or not, because its a right. ?.

— OldSoldier21 (@OldSoldier21) August 7, 2018

Yep, just like an apartment of your own is a right or a guaranteed minimum income whether you work or not is a right or broadband Internet access is a right. Everything except carrying a firearm, which the Founders never intended.

Related:

How progressive! Vox’s Dylan Matthews committed as ever to screwing the working class https://t.co/AFbHqGGzTo

— Twitchy Team (@TwitchyTeam) April 25, 2017