RoadWarriorFromLP

Fair point. But you should have also noted that they don't have to service medical school debt and don't have to pay high malpractice insurance premiums, while much of their income is exempted from certain tax, so the net pay won't be so disparate.

You should also note that French costs are substantially lower than ours. If they had costs similar to ours and allocated those costs to salaries, their compensations could be increased accordingly.

Going back to the UK for a moment, according to the NHS website, a GP will earn £80-120,000 per year. (I think y'all know how that converts to US dollars.) Meanwhile, the Bureau of Labor Statistics reports that the average US GP earns $149,850.

Which means that GP in the UK actually earns more than his US counterpart. At the current exchange rate, a new GP in the UK is earning more than the average GP in the US. (To be fair, I'll guess that with the dollar-pound exchange rate at normal values that the UK doc would end up with about the same or slightly less after purchase power parity and taxes are accounted for, but that would be true with just about any profession.) Maybe it pays to be a government worker, after all.

Tracym

I did not the medical school debt and malpractice bit. Thing is though - medical school debt is temporary (paid off after some years) while salary is permanent. Malpractice insurance - yes that makes some difference, but not enough to equalize it. And I don't see how changing the payment system here would remove the requirement for malpractice insurance here in the US.

As far as the NHS doctors salaries - the problem with that is that you cannot use the exchange rate to determine income in different currencies. I cannot remember it right now, but there is some formula somwhere (maybe I'll find it later) - but basically you have to look at what a dollar or a pound buys in the country where it's being paid.

i.e. what does a house cost, what does a gallon of milk cost, etc. - like you mentioned, purchasing power.

Also - most of our doctors are not GPs. The percentage of GPs is much lower here thank the UK - partially because of the *low* pay, we have a shortage - most docs want to be something else.

fatbrit

Well as long as we're shortchanging the patients and not the doctors, I'm totally with this. We can't move to any system where a US doctor fails to earn enough to drive a Porsche -- we'd be the laughing stock of the world!

elfman

no, you prefer to jump to conclusions based on individual anecdotes.

And the waiting times I provided upthread were for cancer treatments (the time between diagnosis and treatment).

fatbrit

With or without suitable methodology?

RoadWarriorFromLP

Have you ever had student loans of that amount? Loans of those balances are typically 30-year loans. People will spend virtually their entire careers paying those off.

In any case, across the board, French wages are generally lower than are American wages. A rough comparison of average household incomes suggests that US household incomes are about 25% higher than in France. So it's a bit facile to forget that practically job in France will involve a lower level of wage compensation than would the same job in the US, this is not just limited to doctors.

And please, don't backpedal with the NHS compensation data. Even if the dollar was strong, at £1=$1.50, the average GP in the UK would be earning exactly what a US GP is earning. So it takes a strong dollar in order for the US to match the UK in this regard.

I know it's tempting, but you can't cherry pick your facts in the same way that a US insurance company cherry picks its patients. Let's just face it -- your generalizations about these foreign systems are not supported by the facts.

lapin_windstar

Although, to be fair, working conditions are better in France, childcare is cheaper, vacations are longer, healthcare is cheaper etc. I don't know what taxes are like in France.
Ooh, you're making me think now...in a nutshell, labor mobility is desireable because it means workers can follow market signals (i.e. price of labor) in leaving one job and finding a new one.

Some barriers to labor mobility are inevitable, some are less desireable: "Closed shop" union workplaces are a barrier to labor mobility (because it's hard to get in), legislation that impedes employers' ability to hire and fire is one, but language and social ties are also barriers to labour mobility (e.g. not many Torontoans are going to move to rural Quebec for an extra $5 an hour if none of their mates are there and they can't speak Quebecois - although plenty of immigrants come to the US and tough it out, so...).

The best example (IMO) of health coverage being a barrier to labor mobility and damaging the economy is Michigan. It's not the whole story, but over the past twenty years, Michigan's economy has been consistently declining while the economies of the SE USA have been growing and even unskilled laborers have been making good money. Many unionized Michigan workers have been offered huge severance packages (sometimes 2 or 3 years' salary at one go!), but some still haven't left, when the "economic" choice would be to quit, take the money, and head to Arizona.

I believe a major cause of that reluctance has been the fact that the new Arizona jobs don't have health coverage and people are scared to move and take a chance when they could end up not having health insurance and losing their whole nestegg paying for L'il Logan's broken leg at Little League (or whatever). The result of that is that Michigan is filled with people that have a bleak economic future but still can't leave, the SE USA has become reliant on illegal immigrant labor with little protection from dangerous and exploitative conditions, and the unions have failed to expand in new/flexible/service industries - all three things that are going to be Very Bad News for US workers and taxpayers in the coming years.

Tracym

Yes, I have had student loans. Which is irrelevant. I strongly suspect doctors pay them off before 30 years. But I suppose it's possible they stretch it out. Since the loan is a fixed amount, and salaries go up - even if a loan went on a long time, the increasing salary would still make a lot of difference.

No idea what you're on about with backpedaling - if you want to explain, I can respond.

Apparently you don't understand - the exchange rate is completely irrelevant when comparing salaries. You have to look purely at how the salary compares to buying power IN THE COUNTRY they work in, and compared to other people in THAT COUNTRY. Exchange rate vs. another country makes do difference at all.

Didn't that article say French doctors made about ONE THIRD of US docs? that's a difference of 200%, not 25%. Perhaps you need to keep your facts straight as well.

And that is a very important fact - if you think doctors here will be content to work for 1/3 of what they get now - or even 1/2 (taking a rough guess considering loans, that's probably still too much) - well... I certainly don't think they would.

tamms_1965

My stepdad and all three stepbrothers are veterans (one still serves). Their experience with the VA med services around the US has been basically CRAP. My stepdad has private ins. through his employer and has only used VA services as a last resort/backup plan. For many vets they are for the last place any vet wants to go for medical services unless you are in D.C., a big AFB, etc.

On the other hand, they have not had any emergency needs or surgeries there. The VA may fair better in these areas. I also thinkthat care has improved (once you get it) in the past decade, but the bureaucracy stuff is still bad.

snowbunny

Salaries don't always go up. Salaries in my field have peaked and fallen due to globalisation. Age discrimination is rampant, and every year I work past age 50 will be a blessing.

US doctors have already seen their income fall due to two factors: 1) they are already being told how much they can charge by the insurance companies; 2) up until recently any foreign-trained doctor could apply to practise in the US so long as they worked in an under-served area (eg rural areas) for a few years.

Anecdotes? Well, I will give you my own former GP's. He left to become a hospital administrator, which was a shame because he was an excellent doctor. He'd seen his pay fall and insurance hassles rise. He wanted universal healthcare through a single-payer system. He also felt left out of the growing network of foreign-trained doctors, who he said would refer only to other foreign-trained doctors.

Giantaxe

A perfect example of how to contradict oneself in the space of three short paragraphs.

snowbunny

There is also a huge wage differential between GPs and specialists. This has prompted more students to become specialists, leading to a scarcity of GPs and a glut of specialists.

I'd support federal scholarships for students training to become GPs with the condition that they practise as GPs for at least ten years following medical school. I'd support a similar debt forgiveness program.

We MUST invest in our people instead of outsourcing everything so that the richer continue to grow richer. Hell, a contractor with Blackwater in Iraq makes more than a doctor working in the US.

RoadWarriorFromLP

What basis do you have for supporting this strong suspicion? If you have data that shows that doctors have a propensity for making early payoffs of their student loans, I'd like to see it.

According to the AMA, the average physician graduates with more than $130k in student loans. I see no indication that early loan payoffs are the norm.

You pick and choose your salary data at your convenience. It's pretty clear that NHS doctors earn more than do their average US counterparts. This pay disparity in favor of non-US doctors shouldn't be occurring at all, according to the rationing argument.

We can do that. And when we consider these societies, we see that physicians are relatively well compensated compared to the mean in their societies.

Americans tend to have higher gross incomes, irrespective of profession, so it wouldn't surprise me to see American doctors grossing more in many instances. If you want to consider PPP (purchase power parity), the US tends to have higher per capita PPP than does virtually every other country in the world, no matter how you earn your money.

However, this same income disparity could be found among accountants, lawyers and a whole host of other professionals abroad, so it's not meaningful to single out doctors as if they are some glaring exception. If you live in the US or Europe and you'd like to have a better than average income, then being a doctor will provide that in all of these countries, not just the US.

As for French salaries, you missed that most French doctors are exempt from a tax that others have to pay. Combine that tax savings with the lack of student debt or high malpractice premiums, and you end up with a far lower disparity in incomes between physicians in the two countries.

And apparently, it must be pretty good, because they manage to have lower costs and get better results than does the US. Even Business Week, not exactly a bastion of liberalism, can recognize this.

elfman

what the article actually says is:

To make all this affordable, France reimburses its doctors at a far lower rate than U.S. physicians would accept. However, French doctors don't have to pay back their crushing student loans because medical school is paid for by the state, and malpractice insurance premiums are a tiny fraction of the $55,000 a year and up that many U.S. doctors pay. That $55,000 equals the average yearly net income for French doctors, a third of what their American counterparts earn. Then again, the French government pays two-thirds of the social security tax for most French physicians—a tax that's typically 40% of income.

Read that carefully - it only becomes a 200% difference if you compare the net French Dr income with the gross US Dr income:

the article implies that average US Dr income is in the region of $165,000: and this seems to agree, subtract tax (off the top of my head say 30% overall) and malpractice premiums of $50,000, and all of a sudden the US Dr's net income is around $65,000.

RoadWarriorFromLP

Perhaps we should consider why we have the current system in the first place.

Originally, these benefits were provided for the sake of employee retention and employer negotiation power -- only a few companies offered them, which made it harder for employees to leave their jobs because of the accompanying loss of benefits. As time went on, these benefits became the norm for the white-collar professionals. (We can see Starbucks offering a more contemporary version of this retention-through-benefits effort.)

Initially, the cost of these benefits were manageable, so it was relatively easy for companies to provide them. Now, they've become a major expense while benefits have become more of a burden than a marketing/HR tool, which may drive the demand for change. I believe that if the public doesn't shape health care "reform", major corporations will be doing it for us. Dial the insurers into the mix, and I'm guessing that you'll end up with the national catastrophic care plan, administered by the insurance companies (for a nice fee, of course.) We may end up with more care, but the costs of administering it won't be falling anytime soon.