1/
Quick thread re: @gottliebecon’s paper presentation that sparked some debate last night (and @Jabaluck’s livetweeting thread)
conference.nber.org/conf_papers/f1…
Quick thread re: @gottliebecon’s paper presentation that sparked some debate last night (and @Jabaluck’s livetweeting thread)
conference.nber.org/conf_papers/f1…
2/
First, the paper itself provides some great new descriptive work on physician salaries that should prove valuable for future research, but I don’t think it tells us much about the normative question of whether doctor pay is too high/too low.
First, the paper itself provides some great new descriptive work on physician salaries that should prove valuable for future research, but I don’t think it tells us much about the normative question of whether doctor pay is too high/too low.
3/
The comparison to lawyer salaries is interesting, but again there are a # of potential explanations beyond # of hours (in both directions).
On one hand:
- More night/weekend hours
- Probably higher stress
- More backloaded nature of the rewards, even beyond just pay
The comparison to lawyer salaries is interesting, but again there are a # of potential explanations beyond # of hours (in both directions).
On one hand:
- More night/weekend hours
- Probably higher stress
- More backloaded nature of the rewards, even beyond just pay
4/
On the other hand:
- Surer bet of wealth & job security
- More rewarding/higher status (i.e., ppl are willing to accept less $ for jobs they enjoy/find rewarding)
- Higher purchasing power given greater ability to locate outside of expensive metros
On the other hand:
- Surer bet of wealth & job security
- More rewarding/higher status (i.e., ppl are willing to accept less $ for jobs they enjoy/find rewarding)
- Higher purchasing power given greater ability to locate outside of expensive metros
5/
One interesting finding of @gottliebecon’s work is highlighting just how small school tuition is compared to lifetime earnings:
One interesting finding of @gottliebecon’s work is highlighting just how small school tuition is compared to lifetime earnings:
6/
So why do we care?
Physician incomes (along with almost all of health care costs) are largely paid for & determined by the government, rather than through market forces (and privately-negotiated rates are subject to lots of market power considerations).
So why do we care?
Physician incomes (along with almost all of health care costs) are largely paid for & determined by the government, rather than through market forces (and privately-negotiated rates are subject to lots of market power considerations).
7/
Given so much of doctor pay is determined by gov policy, key question is whether lower pay would adversely impact quality & access in a manner that more than offsets the consumer/gov financial savings from a welfare perspective.
Or similarly whether pay should be higher.
Given so much of doctor pay is determined by gov policy, key question is whether lower pay would adversely impact quality & access in a manner that more than offsets the consumer/gov financial savings from a welfare perspective.
Or similarly whether pay should be higher.
8/
That being said, doctor salaries only make up roughly 9% of total health spending.
I don’t think anyone is under any illusions that doctors don’t make lots of $ (outside of PCPs), but most ppl (myself included) also think docs should be well-paid.
That being said, doctor salaries only make up roughly 9% of total health spending.
I don’t think anyone is under any illusions that doctors don’t make lots of $ (outside of PCPs), but most ppl (myself included) also think docs should be well-paid.
9/
Saving maybe 1% of health spending isn’t nothing, but this is why price regulation discussions typically focus on hospital prices, a much greater driver of health care spending.
academic.oup.com/qje/article/13…
Saving maybe 1% of health spending isn’t nothing, but this is why price regulation discussions typically focus on hospital prices, a much greater driver of health care spending.
academic.oup.com/qje/article/13…
10/
Such discussions also need to focus on high admin costs throughout our system.
@Cutler_econ had a great piece recently focused on reducing admin costs: brookings.edu/wp-content/upl…
Smaller items like eliminating/replacing MIPS could help too: healthaffairs.org/do/10.1377/hbl…
Such discussions also need to focus on high admin costs throughout our system.
@Cutler_econ had a great piece recently focused on reducing admin costs: brookings.edu/wp-content/upl…
Smaller items like eliminating/replacing MIPS could help too: healthaffairs.org/do/10.1377/hbl…
11/
For doctors, I’d argue the focus should be on correcting clear market failures like surprise billing & local monopoly (or near-monopoly provider group) pricing, rather than on across-the-board concerns. Arguably we may want to increase PCP pay & Medicaid physician payments.
For doctors, I’d argue the focus should be on correcting clear market failures like surprise billing & local monopoly (or near-monopoly provider group) pricing, rather than on across-the-board concerns. Arguably we may want to increase PCP pay & Medicaid physician payments.
/fin
