Will ObamaCare Make Early Retirement More Difficult?

[EnjoyIt]

For some reason, in the U.S. healthcare has been singled out as this thing that most people seem to agree should be paid for privately by individuals and their insurance companies. I propose that we rethink this fundamental assumption and reclassify healthcare as something we provide to everyone living in our country equally and without charge.

Right now, in the U.S. we're paying ~20% of GDP for healthcare. Part of the cost of providing healthcare in our country is billing and collecting money from a byzantine network of individuals and private insurance companies, each of which has its own little eccentricities: Medicare will only pay so much for a certain treatment but nothing for this other treatment. Medicaid will pay for this but not for that. Blue Cross/Blue Shield will pay for some things but not others...

If doctors and hospitals didn't have to bill patients and their insurance carriers, and they didn't have to worry about trying to collect overdue payments, etc., they could focus their energy and resources on providing quality healthcare to everyone, rather than worrying about the money. If implemented properly, this would lower healthcare costs overall.

Read the following two scenarios, and think about why one of them should be paid for by individuals and their private insurance carriers and why it's generally accepted in the U.S. that the other case is just provided free of charge as a benefit of being a resident:

Scenario A:

A young family living in Seattle has a 6 year old child. One day while both parents are at work and their child is being cared for by a nanny, the child is kidnapped by a pedophile from a local play park and driven across state lines to the pedophile's hideout in Idaho.

Over the next two weeks SPD and the FBI manage to track down the sinister pedophile at his lair in a bunker somewhere in rural Idaho. LEO's successfully coordinate a massive raid on the bad guy's hideout, rescue the terrified child from the clutches of the pedophile and reunite him with his grateful parents.

On the news, an SPD spokeswoman mentions that the coordinated rescue effort to save the child cost upwards of $1MM. Would any Americans expect that the young family who were the victims of this horrible crime should be held personally responsible to pay for the expenses incurred by SPD and the FBI to rescue their child? Probably not, right?

Police protection is considered a right that all residents are entitled to receive regardless of how rich or poor they are, regardless of whether they're unemployed, working, have insurance or not...

Scenario B:

A young family living in Seattle has a 6 year old child. One day while both parents are at work and their child is being cared for by a nanny, the little boy gets hit by a car driven by a drunk driver while crossing the street in a marked crosswalk.

The nanny immediately calls 911 to activate the EMS. An ambulance arrives on scene in under 3 minutes and whisks the child off to the local ER, where doctors perform emergency surgery saving the child's life. The child spends the next week in the ICU and then another week in a regular hospital room before finally being released to his loving parents and their grateful nanny.

The total costs for the ambulance, surgery and 2 week hospital stay add up to just over $1MM. How many Americans would think that this young family should be held personally responsible for paying all of their child's medical bills? No insurance? Aww, too bad they'll just have to sell their house and car and declare bankruptcy so they can pay the hospital bills. WTF! Why?


Think about it for a moment. Why is there a difference between people's attitudes about who should pay the bills in these two scenarios? Why is there this disconnect? If you get sick and have big medical bills, that's all on you as an individual to figure out how to pay for them. On the other hand, an individual or a corporation that has been the victim of a crime can receive unlimited amounts of law enforcement resources at no charge. Why?

My proposal is that we reexamine how we think about health care. People aren't getting sick or going to the hospital because they want to. It sucks worse for the people who are sick than it does for the rest of us who are usually healthy and just have to pay a little bit higher taxes to ensure that everyone who lives in our country has access to the same high quality medical care and never has to worry about how he's going to pay for it.

I am assuming you are wanting single payer type system. Basically medicare for all. Most doctors are cutting medicare if they can.  Payout is too low.

You can say doctor's can then not worry about the money but it is a business. It might be healthcare to you but to the doctors, nurses and receptionist at your doctor's office, they are in it to make money.

Doctor's also have to go to school for a ridiculous number of years and many come out with $250K-300K in student loans. They are going to want to get paid for taking on that debt and spending all of their 20s and early 30s either in school or working 70 hours a week in a residency for $40K a year.

I don't know if there is one single answer to the problem.  I do know that simply changing how you pay for it does not change the fact health care costs themselves are going up. No matter who pays for it, individual, insurance, government, rising health care costs will bankrupt whomever is paying.

Being a physician and speaking on behalf of all physicians, for many, Medicaid pays less than what it costs to offer the services to begin with which is why many providers either cap their Medicaid patients, or just do not accept it.  The reason why so many people fight the single payer system is because we as physicians fear that we will all be relegated to Medicaid prices.  Many private offices would go out of business with that model.

I know it may seam unreasonable to most that a physician's average income is $250K/yr, and that maybe we can afford to get paid less, but the reality is that we come out of school hundred's of thousands in debt.  It is not uncommon for some physicians to be $350K+ in the hole.  I was well over $300K.  We have given up the best, youngest years of our lives, and we want to get compensated for it.  While many on this site can claim they are retiring in their early 30's, physicians would be lucky if they are even close to $0 net worth at that age.

Also, physicians are unable to strike or revolt against the Medicaid payment system, unless the issues I brought up above change, no physician is willing to accept massive pay cuts as would be expected by a single payer system.

I can tell you this much.  Over my few years of practice, the government has made my practice of medicine harder though regulations and bureaucracy.  A process that used to take 5 minutes now takes 10 to accomplish, literally cutting my productivity.  It is sad as I love working with patients, treating them, and explaining to them their disease process in the hopes that they get it and live a better life. But over the years the regulations are making want to work less and less.  If this continues I will just quite, which would be such a shame since there are just not enough doctors in the US to cover all the needs of the American people.

[forummm]

Tell you what, when I hit retirement age, just give me back the $150,000+ I paid in Medicare taxes on a middle class salary and we'll call it even. I can manage my healthcare better than the government can.

You're going to make over $10.34 million dollars? That doesn't seem to be middle class. Even if you work 40 years, that's still over $250k/year.

Medicare tax is 1.45%. $150k/1.45% = $10.34M.

Medicare tax is 2.9%. I just did some basic math, based on what that I could get in a safe, risk-adverse savings portfolio. $70,000 * .029 = $2,030 per year. Throw that into a calculator based on a 2% super conservative interest rate to meet inflation, added monthly, for 45 years and it comes out as almost $150,000. Assuming that my taxable income remains constant at $70,000 for 45 years of contributions.

Let me know if my math sucks, I tried to keep it relatively conservative.

You said the Medicare tax that *you* paid--which is 1.45%. But if you want to include the what your employer paid as well, fine. Regardless, you're ignoring the eroding power of inflation. So if you started working at age 20 in 1970, earned $70k (which is above the median household income of $50k), and invested the 2.9% at a rate to match inflation, and you did this in a tax free account, you'd end up with about $90k in today's dollars. If you did this in a savings account, you'd have much less. Medicare beneficiaries spend about $11,500 per person per year. So that would last you about 8 years (age 73).

I can manage my healthcare better than the government can.

The government doesn't manage your healthcare if you're on Medicare. You and your doctor do. And you certainly couldn't find private insurance coverage that would cost less than that amount for a person that age. Medicare Part C (which is privately administered) costs more than A+B combined (which is government administered).

As much faith as you have in your own abilities regarding healthcare, and as much disdain as you have for anything "government", you are just wrong here. Medicare is an amazing program with incredibly low overhead.

[EnjoyIt]

The government doesn't manage your healthcare if you're on Medicare. You and your doctor do. And you certainly couldn't find private insurance coverage that would cost less than that amount for a person that age. Medicare Part C (which is privately administered) costs more than A+B combined (which is government administered).

As much faith as you have in your own abilities regarding healthcare, and as much disdain as you have for anything "government", you are just wrong here. Medicare is an amazing program with incredibly low overhead.

Actually the government dictates how doctors practice medicine all the time.

[jim555]

Medicaid is basically a loan that can be recovered with estate recovery, so they will get their money back eventually.  The ACA is a gift for ER.  The hostility towards it amazes me since this is a board for those who want to ER.  You guys are cutting your own throats.

Exactly! How do you get people to take a stance on something even if morally wrong when it affects their own wallet.

Morally wrong?  To have access to reasonably priced healthcare?  LOL

Morally wrong to choose to not work and have others pay your healthcare for you.  You are a parasite on the system causing the cost of health insurance to be higher for everyone else.

BTW, cost of healthcare has gone up for the middle class that don't qualify for subsidies making it even harder for them to retire.  But hey, at least you get to sit on your couch and not work.  Good for you.

"Morally wrong", to be in a system I am required to be in by law?  Don't think so. 
Just because you think it is "morally wrong" doesn't make it so, that is your opinion. 
So if everyone gets health insurance it is a bad thing?   I thought the price goes down since the risk is spread more widely.

[EnjoyIt]

"Morally wrong", to be in a system I am required to be in by law?  Don't think so. 
Just because you think it is "morally wrong" doesn't make it so, that is your opinion. 
So if everyone gets health insurance it is a bad thing?   I thought the price goes down since the risk is spread more widely.

You prove my point.  Using the excuse that the government made me do it.

Reality is, you will sit on your ass and force other hardworking Americans to pay for your healthcare.  The cost of their health insurance goes up to pay for yours.  How is that morally right?

For the low income employee the cost of healthcare goes down due to subsidies.  This cost is offset by the majority of Americans who are middle class by having their insurance premiums go up.  I am not arguing that helping the poor pay for healthcare is wrong.  I am arguing forcing the middle class to pay for an early retirees healthcare is morally wrong.  Yes it is the current law, but it still doesn't make it morally right.

In essence the early retiree is a parasite on the hard work of middle America who now has to work longer and harder to retire since their disposable income is cut to pay for you to not work. I don't blame early retirees for taking advantage of the system as I would do the same.  But lets not kid ourselves on what is actually happening here.

Lets also not cloud the picture about roads bridges and police.  We pay for roads and bridges via registration fees and gasoline taxes.  Fire department and police via property taxes and sales taxes.  BTW, I am in a no state tax state.

[forummm]

The government doesn't manage your healthcare if you're on Medicare. You and your doctor do. And you certainly couldn't find private insurance coverage that would cost less than that amount for a person that age. Medicare Part C (which is privately administered) costs more than A+B combined (which is government administered).

As much faith as you have in your own abilities regarding healthcare, and as much disdain as you have for anything "government", you are just wrong here. Medicare is an amazing program with incredibly low overhead.

Actually the government dictates how doctors practice medicine all the time.

But not significantly differently based on whether you have Medicare or private insurance. There are incentives to do certain things in Medicare (incentives which are quickly being emulated by private insurers to cut costs). But those incentives like VBPM are still limited to around 2% of the reimbursement rate--hardly "dictating". And there are certain things that Medicare will or won't pay for (generally because of evidence against its use or lack of evidence to support its effectiveness)--but that you could still provide if the patient or their supplemental insurance will pay for it.

[Sailor Sam]

I know it may seam unreasonable to most that a physician's average income is $250K/yr, and that maybe we can afford to get paid less, but the reality is that we come out of school hundred's of thousands in debt.  It is not uncommon for some physicians to be $350K+ in the hole.  I was well over $300K.  We have given up the best, youngest years of our lives, and we want to get compensated for it.  While many on this site can claim they are retiring in their early 30's, physicians would be lucky if they are even close to $0 net worth at that age.

I agree that anyone going into a profession with the expectation of earning a high salary would feel awesomely betrayed if that salary didn't appear. But the root of the problem isn't the loans, it's that medical students start training with the expectation of a high salary and agree to take the loans. Students (theoretically, though we are not rational actors) wouldn't continue flocking to 6 figure loans, if the expectation for a high salary after graduation was removed. Medical students choose to go into the belly of the beast, and choose to take loans, and there's no moral reason that choice should automatically be rewarded with a high salary.

The moral imperative to be compensated for working hard and slogging through school isn't a great argument, either. In comparison, I also sacrificed a huge part of my 20's and 30's to working long hours, in remote places. I missed birthdays, weddings, funerals, and countless everyday moments. I've never been offered, or expected, $250/year. It's just not realistic in my field. 

I do believe when you say that the govt is making the practice of medicine harder, and that things still need adjustment. I don't personally know if the adjustment should be means testing, or some other route. I think it would be interesting and fun to have that debate with other smart people. But dude, once you start throwing around the term 'morally wrong', the debate is over. You've made up your mind, and the hell with what anyone else has to say.

[jim555]

"Morally wrong", to be in a system I am required to be in by law?  Don't think so. 
Just because you think it is "morally wrong" doesn't make it so, that is your opinion. 
So if everyone gets health insurance it is a bad thing?   I thought the price goes down since the risk is spread more widely.

You prove my point.  Using the excuse that the government made me do it.

Reality is, you will sit on your ass and force other hardworking Americans to pay for your healthcare.  The cost of their health insurance goes up to pay for yours.  How is that morally right?

For the low income employee the cost of healthcare goes down due to subsidies.  This cost is offset by the majority of Americans who are middle class by having their insurance premiums go up.  I am not arguing that helping the poor pay for healthcare is wrong.  I am arguing forcing the middle class to pay for an early retirees healthcare is morally wrong.  Yes it is the current law, but it still doesn't make it morally right.

In essence the early retiree is a parasite on the hard work of middle America who now has to work longer and harder to retire since their disposable income is cut to pay for you to not work. I don't blame early retirees for taking advantage of the system as I would do the same.  But lets not kid ourselves on what is actually happening here.

Lets also not cloud the picture about roads bridges and police.  We pay for roads and bridges via registration fees and gasoline taxes.  Fire department and police via property taxes and sales taxes.  BTW, I am in a no state tax state.

Those school kids are parasiting off my property tax so by your logic we should not have a public school? 

I could argue that any taxation is theft and taxation is morally wrong.  At least that makes sense.
Why not have people hire guards, pay tolls on roads, hire a fire house all privately?  The logical conclusion to libertopia is anarchism.
I do not want a society where people are literally dropping dead since the safety net does not exist.

[Shane]

For some reason, in the U.S. healthcare has been singled out as this thing that most people seem to agree should be paid for privately by individuals and their insurance companies. I propose that we rethink this fundamental assumption and reclassify healthcare as something we provide to everyone living in our country equally and without charge.

Right now, in the U.S. we're paying ~20% of GDP for healthcare. Part of the cost of providing healthcare in our country is billing and collecting money from a byzantine network of individuals and private insurance companies, each of which has its own little eccentricities: Medicare will only pay so much for a certain treatment but nothing for this other treatment. Medicaid will pay for this but not for that. Blue Cross/Blue Shield will pay for some things but not others...

If doctors and hospitals didn't have to bill patients and their insurance carriers, and they didn't have to worry about trying to collect overdue payments, etc., they could focus their energy and resources on providing quality healthcare to everyone, rather than worrying about the money. If implemented properly, this would lower healthcare costs overall.

Read the following two scenarios, and think about why one of them should be paid for by individuals and their private insurance carriers and why it's generally accepted in the U.S. that the other case is just provided free of charge as a benefit of being a resident:

Scenario A:

A young family living in Seattle has a 6 year old child. One day while both parents are at work and their child is being cared for by a nanny, the child is kidnapped by a pedophile from a local play park and driven across state lines to the pedophile's hideout in Idaho.

Over the next two weeks SPD and the FBI manage to track down the sinister pedophile at his lair in a bunker somewhere in rural Idaho. LEO's successfully coordinate a massive raid on the bad guy's hideout, rescue the terrified child from the clutches of the pedophile and reunite him with his grateful parents.

On the news, an SPD spokeswoman mentions that the coordinated rescue effort to save the child cost upwards of $1MM. Would any Americans expect that the young family who were the victims of this horrible crime should be held personally responsible to pay for the expenses incurred by SPD and the FBI to rescue their child? Probably not, right?

Police protection is considered a right that all residents are entitled to receive regardless of how rich or poor they are, regardless of whether they're unemployed, working, have insurance or not...

Scenario B:

A young family living in Seattle has a 6 year old child. One day while both parents are at work and their child is being cared for by a nanny, the little boy gets hit by a car driven by a drunk driver while crossing the street in a marked crosswalk.

The nanny immediately calls 911 to activate the EMS. An ambulance arrives on scene in under 3 minutes and whisks the child off to the local ER, where doctors perform emergency surgery saving the child's life. The child spends the next week in the ICU and then another week in a regular hospital room before finally being released to his loving parents and their grateful nanny.

The total costs for the ambulance, surgery and 2 week hospital stay add up to just over $1MM. How many Americans would think that this young family should be held personally responsible for paying all of their child's medical bills? No insurance? Aww, too bad they'll just have to sell their house and car and declare bankruptcy so they can pay the hospital bills. WTF! Why?


Think about it for a moment. Why is there a difference between people's attitudes about who should pay the bills in these two scenarios? Why is there this disconnect? If you get sick and have big medical bills, that's all on you as an individual to figure out how to pay for them. On the other hand, an individual or a corporation that has been the victim of a crime can receive unlimited amounts of law enforcement resources at no charge. Why?

My proposal is that we reexamine how we think about health care. People aren't getting sick or going to the hospital because they want to. It sucks worse for the people who are sick than it does for the rest of us who are usually healthy and just have to pay a little bit higher taxes to ensure that everyone who lives in our country has access to the same high quality medical care and never has to worry about how he's going to pay for it.

I am assuming you are wanting single payer type system. Basically medicare for all. Most doctors are cutting medicare if they can.  Payout is too low.

You can say doctor's can then not worry about the money but it is a business. It might be healthcare to you but to the doctors, nurses and receptionist at your doctor's office, they are in it to make money.

Doctor's also have to go to school for a ridiculous number of years and many come out with $250K-300K in student loans. They are going to want to get paid for taking on that debt and spending all of their 20s and early 30s either in school or working 70 hours a week in a residency for $40K a year.

I don't know if there is one single answer to the problem.  I do know that simply changing how you pay for it does not change the fact health care costs themselves are going up. No matter who pays for it, individual, insurance, government, rising health care costs will bankrupt whomever is paying.

Being a physician and speaking on behalf of all physicians, for many, Medicaid pays less than what it costs to offer the services to begin with which is why many providers either cap their Medicaid patients, or just do not accept it.  The reason why so many people fight the single payer system is because we as physicians fear that we will all be relegated to Medicaid prices.  Many private offices would go out of business with that model.

I know it may seam unreasonable to most that a physician's average income is $250K/yr, and that maybe we can afford to get paid less, but the reality is that we come out of school hundred's of thousands in debt.  It is not uncommon for some physicians to be $350K+ in the hole.  I was well over $300K.  We have given up the best, youngest years of our lives, and we want to get compensated for it.  While many on this site can claim they are retiring in their early 30's, physicians would be lucky if they are even close to $0 net worth at that age.

Also, physicians are unable to strike or revolt against the Medicaid payment system, unless the issues I brought up above change, no physician is willing to accept massive pay cuts as would be expected by a single payer system.

I can tell you this much.  Over my few years of practice, the government has made my practice of medicine harder though regulations and bureaucracy.  A process that used to take 5 minutes now takes 10 to accomplish, literally cutting my productivity.  It is sad as I love working with patients, treating them, and explaining to them their disease process in the hopes that they get it and live a better life. But over the years the regulations are making want to work less and less.  If this continues I will just quite, which would be such a shame since there are just not enough doctors in the US to cover all the needs of the American people.

Any transition to a single payer healthcare system would need to include changes to the way that doctors pay for their educations. Just as it makes no sense to me that individuals be held personally responsible to pay for their own medical care, it also makes no sense that individuals who choose to dedicate their lives to becoming doctors have to take out hundreds of thousands of dollars in loans in order to do so.

If doctors were able to graduate from medical school with zero debt, wouldn't that eliminate some of what appears to be their need to maximize their incomes in order to pay off their loans?

Recently I met a doctor who was originally from Sweden but now practices medicine in the U.S. He told me that doctors in Sweden are well respected and earn a solidly upper-middle class income, but he said they don't expect to "get rich" like some doctors in the U.S. do. He said in Sweden doctors can make "hundreds of thousands of dollars" per year, but not millions like some doctors in the U.S.

[EnjoyIt]

But dude, once you start throwing around the term 'morally wrong', the debate is over. You've made up your mind, and the hell with what anyone else has to say.

Okay, lets change "morally wrong" to "in my opinion it is morally wrong"

So let my new comment state "In my opinion it is morally wrong to sit on your ass expecting hard working middle class Americans to pay for your healthcare when you can easily go to work and pay for it yourself."

I even go so far as to say that if given the opportunity I would make the same choice and take free health insurance if given to me.  Why? because I am human like the rest of us here and very few humans would turn down free money.

[EnjoyIt]

Those school kids are parasiting off my property tax so by your logic we should not have a public school? 

I could argue that any taxation is theft and taxation is morally wrong.  At least that makes sense.
Why not have people hire guards, pay tolls on roads, hire a fire house all privately?  The logical conclusion to libertopia is anarchism.
I do not want a society where people are literally dropping dead since the safety net does not exist.

This is the classic response to transition the discussion to something else that is mildly relevant.  School kids can't pay for their own education.  You can pay for your own healthcare. 

And yes, kids are parasites with nothing to offer today, but their future earning potential is well worth nurturing.

[Yaeger]

I can manage my healthcare better than the government can.

The government doesn't manage your healthcare if you're on Medicare. You and your doctor do. And you certainly couldn't find private insurance coverage that would cost less than that amount for a person that age. Medicare Part C (which is privately administered) costs more than A+B combined (which is government administered).

As much faith as you have in your own abilities regarding healthcare, and as much disdain as you have for anything "government", you are just wrong here. Medicare is an amazing program with incredibly low overhead.

So you're saying that the government, by taxing 2.9% of my earnings for life, spending it, then allowing me to buy plans in a structured program as a result of that isn't 'managing' my healthcare? I fail to see how anyone could not see that as managed. Can I withdraw my estimated net liability and toss it into an outside investment? Can I blow it on hookers and booze if I have a HSA, or a net worth >$1 mil? Can I pass it on to my heirs if I die prior to collecting? Nope. Nope. Nope.

I have incredible disdain for anything the government provides at a promise and these programs are a cancer in our society shackling generations of Americans to perpetual poverty.

[Shane]

"Morally wrong", to be in a system I am required to be in by law?  Don't think so. 
Just because you think it is "morally wrong" doesn't make it so, that is your opinion. 
So if everyone gets health insurance it is a bad thing?   I thought the price goes down since the risk is spread more widely.

You prove my point.  Using the excuse that the government made me do it.

Reality is, you will sit on your ass and force other hardworking Americans to pay for your healthcare.  The cost of their health insurance goes up to pay for yours.  How is that morally right?

For the low income employee the cost of healthcare goes down due to subsidies.  This cost is offset by the majority of Americans who are middle class by having their insurance premiums go up.  I am not arguing that helping the poor pay for healthcare is wrong.  I am arguing forcing the middle class to pay for an early retirees healthcare is morally wrong.  Yes it is the current law, but it still doesn't make it morally right.

In essence the early retiree is a parasite on the hard work of middle America who now has to work longer and harder to retire since their disposable income is cut to pay for you to not work. I don't blame early retirees for taking advantage of the system as I would do the same.  But lets not kid ourselves on what is actually happening here.

Lets also not cloud the picture about roads bridges and police.  We pay for roads and bridges via registration fees and gasoline taxes.  Fire department and police via property taxes and sales taxes.  BTW, I am in a no state tax state.

The difficulty I have with your reasoning is where do you draw the line? You say that "early" retirees are parasites on the system. Using your logic, does everyone who physically can continue working have a moral obligation to keep on working, as retiring would be seen as a moral failure? At what age is it okay to stop working? 65? 67? 70? 78?

We have a self-employed friend who is in his early 80's now. He gets up and goes to work every single day. The guy is amazing. He doesn't need to work, but he loves it, so he just keeps on going. If our friend were to decide to retire, even though he obviously could continue working, would he then become a leech on the system, sucking hard-earned tax dollars away from hard working young families?

[jim555]

Those school kids are parasiting off my property tax so by your logic we should not have a public school? 

I could argue that any taxation is theft and taxation is morally wrong.  At least that makes sense.
Why not have people hire guards, pay tolls on roads, hire a fire house all privately?  The logical conclusion to libertopia is anarchism.
I do not want a society where people are literally dropping dead since the safety net does not exist.

This is the classic response to transition the discussion to something else that is mildly relevant.  School kids can't pay for their own education.  You can pay for your own healthcare. 

And yes, kids are parasites with nothing to offer today, but their future earning potential is well worth nurturing.

They can be nurtured, I just don't want to pay for it.  Let them do estate recovery to get the money back from them.  Or have the parents billed.

[EnjoyIt]

Any transition to a single payer healthcare system would need to include changes to the way that doctors pay for their educations. Just as it makes no sense to me that individuals be held personally responsible to pay for their own medical care, it also makes no sense that individuals who choose to dedicate their lives to becoming doctors have to take out hundreds of thousands of dollars in loans in order to do so.

If doctors were able to graduate from medical school with zero debt, wouldn't that eliminate some of what appears to be their need to maximize their incomes in order to pay off their loans?

Recently I met a doctor who was originally from Sweden but now practices medicine in the U.S. He told me that doctors in Sweden are well respected and earn a solidly upper-middle class income, but he said they don't expect to "get rich" like some doctors in the U.S. do. He said in Sweden doctors can make "hundreds of thousands of dollars" per year, but not millions like some doctors in the U.S.

There are very very few medical specialities and physicians in the US that make the money you just described.  The Average wage for a physician is $250K/yr last I read.  I may be slightly off.  Yes, feel free to provide us with free education and decrease our wages by an equitable amount.   Also, there is nothing wrong to be adequately compensated for the work you put in.  There are very few people in the world who have the aptitude and perseverance to become physicians.  Therefor due to supply and demand, it is fair to expect a high compensation for those services.  Most physicians in the US go into that field for 3 reasons.  Because they enjoy medicine and what it brings, they will likely have secure employment for their entire life, and appropriate compensation for their efforts.  Without the appropriate compensation part, many of our brightest would go into other fields and make their money elsewhere.

[EnjoyIt]

The difficulty I have with your reasoning is where do you draw the line? You say that "early" retirees are parasites on the system. Using your logic, does everyone who physically can continue working have a moral obligation to keep on working, as retiring would be seen as a moral failure? At what age is it okay to stop working? 65? 67? 70? 78?

We have a self-employed friend who is in his early 80's now. He gets up and goes to work every single day. The guy is amazing. He doesn't need to work, but he loves it, so he just keeps on going. If our friend were to decide to retire, even though he obviously could continue working, would he then become a leech on the system, sucking hard-earned tax dollars away from hard working young families?

Let me draw the line clearly.  If you are not at retirement age, and choose to stop working why can you siphon money from hard working Americans to pay for your health insurance.  This is something you can work for today.  You can easily work an extra year or two and save enough money to pay for your own health insurance in retirement.

[EnjoyIt]

They can be nurtured, I just don't want to pay for it.  Let them do estate recovery to get the money back from them.  Or have the parents billed.

I'm okay with that.  I am all for privatizing our education system with subsidies provided to poor families.  But that is not the point of this discussion so lets stick to the point and stop throwing in non relevant examples of other areas of government taxation and expenditures. 

[Yaeger]

Any transition to a single payer healthcare system would need to include changes to the way that doctors pay for their educations. Just as it makes no sense to me that individuals be held personally responsible to pay for their own medical care, it also makes no sense that individuals who choose to dedicate their lives to becoming doctors have to take out hundreds of thousands of dollars in loans in order to do so.

If doctors were able to graduate from medical school with zero debt, wouldn't that eliminate some of what appears to be their need to maximize their incomes in order to pay off their loans?

Recently I met a doctor who was originally from Sweden but now practices medicine in the U.S. He told me that doctors in Sweden are well respected and earn a solidly upper-middle class income, but he said they don't expect to "get rich" like some doctors in the U.S. do. He said in Sweden doctors can make "hundreds of thousands of dollars" per year, but not millions like some doctors in the U.S.

I'm actually thinking the cheapest, most effective, and more efficient option to go the other way. Go back towards a private healthcare model with repealing the ACA, rolling back Medicare and Medicaid expansions that have expanded through the decades, roll back on regulatory burdens and price controls in the healthcare market, make it easier to start up clinics and hospitals by reducing the licencing burdens. Stop making it more affordable through transfer programs, towards being more affordable by lowering the prices in a free market system. Prior to major government involvement in healthcare starting in 1965's Great Society programs, the U.S. had better, cheaper healthcare than anyone else in the world.

I think single-payer is better than the hybrid crap we have now. However, even in single payer systems they seem to slowly moving towards privatization as costs overwhelm the system and a national health service is unable to adapt quickly enough to changing market conditions. Don't go where Europe has been, and don't give up on what has made healthcare in the U.S. perhaps the most widely recognized, though declining, healthcare market in the world.

[jim555]

Europe spends so much less per patient it is not funny.  The private system here has given the most bloated expensive system in the world.

[Shane]

Any transition to a single payer healthcare system would need to include changes to the way that doctors pay for their educations. Just as it makes no sense to me that individuals be held personally responsible to pay for their own medical care, it also makes no sense that individuals who choose to dedicate their lives to becoming doctors have to take out hundreds of thousands of dollars in loans in order to do so.

If doctors were able to graduate from medical school with zero debt, wouldn't that eliminate some of what appears to be their need to maximize their incomes in order to pay off their loans?

Recently I met a doctor who was originally from Sweden but now practices medicine in the U.S. He told me that doctors in Sweden are well respected and earn a solidly upper-middle class income, but he said they don't expect to "get rich" like some doctors in the U.S. do. He said in Sweden doctors can make "hundreds of thousands of dollars" per year, but not millions like some doctors in the U.S.

There are very very few medical specialities and physicians in the US that make the money you just described.  The Average wage for a physician is $250K/yr last I read.  I may be slightly off.  Yes, feel free to provide us with free education and decrease our wages by an equitable amount.   Also, there is nothing wrong to be adequately compensated for the work you put in.  There are very few people in the world who have the aptitude and perseverance to become physicians.  Therefor due to supply and demand, it is fair to expect a high compensation for those services.  Most physicians in the US go into that field for 3 reasons.  Because they enjoy medicine and what it brings, they will likely have secure employment for their entire life, and appropriate compensation for their efforts.  Without the appropriate compensation part, many of our brightest would go into other fields and make their money elsewhere.

I totally agree that doctors deserve to get paid lots of money for their work. How much is enough is kind of hard to say, though. It seems to me like the least we can do for doctors is to pay off their student loans for them so they don't have to start of their working lives in debt.

[Yaeger]

Those school kids are parasiting off my property tax so by your logic we should not have a public school? 

I could argue that any taxation is theft and taxation is morally wrong.  At least that makes sense.
Why not have people hire guards, pay tolls on roads, hire a fire house all privately?  The logical conclusion to libertopia is anarchism.
I do not want a society where people are literally dropping dead since the safety net does not exist.

This is the classic response to transition the discussion to something else that is mildly relevant.  School kids can't pay for their own education.  You can pay for your own healthcare. 

And yes, kids are parasites with nothing to offer today, but their future earning potential is well worth nurturing.

They can be nurtured, I just don't want to pay for it.  Let them do estate recovery to get the money back from them.  Or have the parents billed.

So you're suggesting a more ACA solution. Tax a portion of the populace (the rich and companies mostly) to transfer that money to the parents so they can afford to pay for education?

Instead of treating schools as a public good, where everyone can attend, regardless of income or net worth from a general pool of taxpayers money, which the parents contribute to?

Those are two very different scenarios.

Europe spends so much less per patient it is not funny.  The private system here has given the most bloated expensive system in the world.

We don't have a private system. Government spending on healthcare is roughly equal to private spending on healthcare. Healthcare has gotten more expensive as government has expanded into healthcare since 1965.

[Cassie]

Europe has a single payor system and they still have doctors. So obviously they are paying enough to keep medicine an attractive field. We can do the same.

[Shane]

Any transition to a single payer healthcare system would need to include changes to the way that doctors pay for their educations. Just as it makes no sense to me that individuals be held personally responsible to pay for their own medical care, it also makes no sense that individuals who choose to dedicate their lives to becoming doctors have to take out hundreds of thousands of dollars in loans in order to do so.

If doctors were able to graduate from medical school with zero debt, wouldn't that eliminate some of what appears to be their need to maximize their incomes in order to pay off their loans?

Recently I met a doctor who was originally from Sweden but now practices medicine in the U.S. He told me that doctors in Sweden are well respected and earn a solidly upper-middle class income, but he said they don't expect to "get rich" like some doctors in the U.S. do. He said in Sweden doctors can make "hundreds of thousands of dollars" per year, but not millions like some doctors in the U.S.

I'm actually thinking the cheapest, most effective, and more efficient option to go the other way. Go back towards a private healthcare model with repealing the ACA, rolling back Medicare and Medicaid expansions that have expanded through the decades, roll back on regulatory burdens and price controls in the healthcare market, make it easier to start up clinics and hospitals by reducing the licencing burdens. Stop making it more affordable through transfer programs, towards being more affordable by lowering the prices in a free market system. Prior to major government involvement in healthcare starting in 1965's Great Society programs, the U.S. had better, cheaper healthcare than anyone else in the world.

I think single-payer is better than the hybrid crap we have now. However, even in single payer systems they seem to slowly moving towards privatization as costs overwhelm the system and a national health service is unable to adapt quickly enough to changing market conditions. Don't go where Europe has been, and don't give up on what has made healthcare in the U.S. perhaps the most widely recognized, though declining, healthcare market in the world.

A friend of mine's dad was a physician in Wisconsin a long time ago. My friend says he remembers when he was a kid in the 1950's that his dad would deliver a baby or provide some health care to a sick patient and the patient would pay for his services some months later with a steer or part of the harvest of whatever crop they were growing.

I'm not sure exactly when it changed, but I think the days when individuals could hope to save up their money and pay cash or trade some livestock for their medical care have passed. It would be interesting to see the look on a modern hospital administrator's face if a patient offered to trade a few head of livestock to pay off her medical bills. :)

[the_gastropod]

Also, there is nothing wrong to be adequately compensated for the work you put in. There are very few people in the world who have the aptitude and perseverance to become physicians.

...Look. Yes. It takes a lot of work the become a physician. Give yourself a round of applause for being such a badass. But feeling like ~$250k is "adequate compensation for the work you put in" is really quite arrogant. The average salary for a Physics researcher with a PhD in Physics, for example is $103k. Nothing against Physicians, but I doubt many Physicians have the mental chops to study physics at that level. $250k is a spectacular amount of money that those with exceptional privilege (and obviously hard work) are able to earn.

Therefor due to supply and demand, it is fair to expect a high compensation for those services.

Here's the crux of the issue. Healthcare is not subject to true supply/demand. "Buyers" (patients) are not truly given a choice. If I break my femur in a car accident, I'm taken to a hospital. I cannot shop around for the best price. I cannot negotiate for a better price on morphine. I'm a hostage to whatever prices that hospital happens to charge. Healthcare is so obviously not subject to the same "suppy/demand" forces that buying a new cell phone is.

[EnjoyIt]

Those school kids are parasiting off my property tax so by your logic we should not have a public school? 

I could argue that any taxation is theft and taxation is morally wrong.  At least that makes sense.
Why not have people hire guards, pay tolls on roads, hire a fire house all privately?  The logical conclusion to libertopia is anarchism.
I do not want a society where people are literally dropping dead since the safety net does not exist.

This is the classic response to transition the discussion to something else that is mildly relevant.  School kids can't pay for their own education.  You can pay for your own healthcare. 

And yes, kids are parasites with nothing to offer today, but their future earning potential is well worth nurturing.

They can be nurtured, I just don't want to pay for it.  Let them do estate recovery to get the money back from them.  Or have the parents billed.

So you're suggesting a more ACA solution. Tax a portion of the populace (the rich and companies mostly) to transfer that money to the parents so they can afford to pay for education?

Instead of treating schools as a public good, where everyone can attend, regardless of income or net worth from a general pool of taxpayers money, which the parents contribute to?

Those are two very different scenarios.

Europe spends so much less per patient it is not funny.  The private system here has given the most bloated expensive system in the world.

We don't have a private system. Government spending on healthcare is roughly equal to private spending on healthcare. Healthcare has gotten more expensive as government has expanded into healthcare since 1965.

I am done discussing this non healthcare related issue with you on this post. Please feel free to start a post regarding our education system and I will gladly participate with you.

[EnjoyIt]

Also, there is nothing wrong to be adequately compensated for the work you put in. There are very few people in the world who have the aptitude and perseverance to become physicians.

...Look. Yes. It takes a lot of work the become a physician. Give yourself a round of applause for being such a badass. But feeling like ~$250k is "adequate compensation for the work you put in" is really quite arrogant. The average salary for a Physics researcher with a PhD in Physics, for example is $103k. Nothing against Physicians, but I doubt many Physicians have the mental chops to study physics at that level. $250k is a spectacular amount of money that those with exceptional privilege (and obviously hard work) are able to earn.

Therefor due to supply and demand, it is fair to expect a high compensation for those services.

Here's the crux of the issue. Healthcare is not subject to true supply/demand. "Buyers" (patients) are not truly given a choice. If I break my femur in a car accident, I'm taken to a hospital. I cannot shop around for the best price. I cannot negotiate for a better price on morphine. I'm a hostage to whatever prices that hospital happens to charge. Healthcare is so obviously not subject to the same "suppy/demand" forces that buying a new cell phone is.

Rebuttal:
A physician does not just go to grad school they also require years of residency therefor put in my time than a physics doctorate. Also, the promise of solid compensation is one reason we choose medicine. I loved physics and was good at it, but I also knew that I had a better chance of financial success in medicine and chose that route.

As for supply and demand. I meant there is not enough physicians in the US and the market is forced to pay hem more to service an underserved region. It is why a physician makes twice as much in the midwestern US as compared to NYC or Bay Area.

Lastly,  I could have chosen a specialty in pediatrics making $100k-$120k a year but I knew it would not even come close to paying my loans and chose a more lucrative profession. The market makes its choices and if we cut salaries to physicians enough they will instead choose to do something else.

There is a reason why rich foreigners from all over the world come to US hospitals for medical care. We have some of the best doctors and technology in the world if you can afford it.

[MoonShadow]

Here's the crux of the issue. Healthcare is not subject to true supply/demand. "Buyers" (patients) are not truly given a choice. If I break my femur in a car accident, I'm taken to a hospital. I cannot shop around for the best price. I cannot negotiate for a better price on morphine. I'm a hostage to whatever prices that hospital happens to charge. Healthcare is so obviously not subject to the same "suppy/demand" forces that buying a new cell phone is.

I really don't want to get sucked into this thread, but I'm going to respond to this one anyway.  While it's true enough that, per an individual situation or event, emergency healthcare is not directly subject to market forces, in the sense that you can't really show up at the Emergency Room after an automobile accident and ask for an estimate to see if you want to take your business elsewhere.  However, that does not mean that healthcare isn't subject to market forces generally.  First and foremost, most healthcare is not emergency care, but chronic care & lifestyle management; and by definition, emergency care demands a higher service price than chronic care.  Even basic family care is subject to market forces, even the pediatrician.  If your kid gets a cold, do you take him/her to the doctor?  Probably not.  The flu?  Maybe, but you also know that if they have a healthy immune system, all the doctor is going to do is verify that it's Influenza and perhaps prescribe some meds for comfort.  What if you have several kids?  Do you take the rest to get that last minute flu shot you have been putting off?  Probably, but there is also the nurse practitioners' clinic at the pharmacy, so you might get in quicker there for just a flu shot, and if you are paying your own money (perhaps through an HSA) maybe it's also cheaper.  There are many contributing factors to why the US medical system is so expensive, but a lack of competitive market forces isn't the primary one, because real competition does exist in some forms.  If our system had more of a de-regulated market in payments & services, that would not guarantee that prices would go down; but there is plenty of evidence that given the opportunity to trade a bit of quality for price across the board (such as the pediatrician's office versus the nurse-prac "wellness" clinic at the pharmacy), that many American's will often trade a bit of quality for better prices and/or speed of services.  That isn't necessarily a bad thing, because the market would naturally seek out the most value of services, not the greatest quality.  As another person pointed out, health care in the US has been regulated for a long time, and in many steps, the Great Society being a big one.

[EnjoyIt]

Here's the crux of the issue. Healthcare is not subject to true supply/demand. "Buyers" (patients) are not truly given a choice. If I break my femur in a car accident, I'm taken to a hospital. I cannot shop around for the best price. I cannot negotiate for a better price on morphine. I'm a hostage to whatever prices that hospital happens to charge. Healthcare is so obviously not subject to the same "suppy/demand" forces that buying a new cell phone is.

I really don't want to get sucked into this thread, but I'm going to respond to this one anyway.  While it's true enough that, per an individual situation or event, emergency healthcare is not directly subject to market forces, in the sense that you can't really show up at the Emergency Room after an automobile accident and ask for an estimate to see if you want to take your business elsewhere.  However, that does not mean that healthcare isn't subject to market forces generally.  First and foremost, most healthcare is not emergency care, but chronic care & lifestyle management; and by definition, emergency care demands a higher service price than chronic care.  Even basic family care is subject to market forces, even the pediatrician.  If your kid gets a cold, do you take him/her to the doctor?  Probably not.  The flu?  Maybe, but you also know that if they have a healthy immune system, all the doctor is going to do is verify that it's Influenza and perhaps prescribe some meds for comfort.  What if you have several kids?  Do you take the rest to get that last minute flu shot you have been putting off?  Probably, but there is also the nurse practitioners' clinic at the pharmacy, so you might get in quicker there for just a flu shot, and if you are paying your own money (perhaps through an HSA) maybe it's also cheaper.  There are many contributing factors to why the US medical system is so expensive, but a lack of competitive market forces isn't the primary one, because real competition does exist in some forms.  If our system had more of a de-regulated market in payments & services, that would not guarantee that prices would go down; but there is plenty of evidence that given the opportunity to trade a bit of quality for price across the board (such as the pediatrician's office versus the nurse-prac "wellness" clinic at the pharmacy), that many American's will often trade a bit of quality for better prices and/or speed of services.  That isn't necessarily a bad thing, because the market would naturally seek out the most value of services, not the greatest quality.  As another person pointed out, health care in the US has been regulated for a long time, and in many steps, the Great Society being a big one.

Well said sir. Thank you for your contribution.

[Spork]

If you do that... does the subsidy not still apply when you file taxes?  (Not trying to start a political firestorm again... trying to understand how it works.)

Nope. If you buy direct from any insurance company, or from a company or independant agent, you will not get any subsidy. To get the subsidy when you file, you have to buy the policy through either the Federal exchange or your state's exchange (if your state has one). And, I'm pretty sure, it has the be a Silver policy.

Not true.

Yeah, I was believing that all along the way until the word Silver showed up.  There are definitely subsidies from top to bottom.  Silver is special... but not in that way.

[Gin1984]

Also, there is nothing wrong to be adequately compensated for the work you put in. There are very few people in the world who have the aptitude and perseverance to become physicians.

...Look. Yes. It takes a lot of work the become a physician. Give yourself a round of applause for being such a badass. But feeling like ~$250k is "adequate compensation for the work you put in" is really quite arrogant. The average salary for a Physics researcher with a PhD in Physics, for example is $103k. Nothing against Physicians, but I doubt many Physicians have the mental chops to study physics at that level. $250k is a spectacular amount of money that those with exceptional privilege (and obviously hard work) are able to earn.

Therefor due to supply and demand, it is fair to expect a high compensation for those services.

Here's the crux of the issue. Healthcare is not subject to true supply/demand. "Buyers" (patients) are not truly given a choice. If I break my femur in a car accident, I'm taken to a hospital. I cannot shop around for the best price. I cannot negotiate for a better price on morphine. I'm a hostage to whatever prices that hospital happens to charge. Healthcare is so obviously not subject to the same "suppy/demand" forces that buying a new cell phone is.

Rebuttal:
A physician does not just go to grad school they also require years of residency therefor put in my time than a physics doctorate. Also, the promise of solid compensation is one reason we choose medicine. I loved physics and was good at it, but I also knew that I had a better chance of financial success in medicine and chose that route.

As for supply and demand. I meant there is not enough physicians in the US and the market is forced to pay hem more to service an underserved region. It is why a physician makes twice as much in the midwestern US as compared to NYC or Bay Area.

Lastly,  I could have chosen a specialty in pediatrics making $100k-$120k a year but I knew it would not even come close to paying my loans and chose a more lucrative profession. The market makes its choices and if we cut salaries to physicians enough they will instead choose to do something else.

There is a reason why rich foreigners from all over the world come to US hospitals for medical care. We have some of the best doctors and technology in the world if you can afford it.

And a researcher with a PhD does a postdoctoral fellowship, just like residency is done for MDs so there is no time difference.

[Letj]

I think obamacare will be means tested in the future due to it not being medicaid and nobody is paying into it unless a member.

I hope that's never the case. It will be inefficient and very difficult to do requiring much more employees to enact.  That's why a national health insurace scheme is so much better. Nothing is means tested in those social democratic countries in Europe; so much easier to implement and the whole society including the rich pay generously for those benefits so they benefit equally.

[Yaeger]

I think obamacare will be means tested in the future due to it not being medicaid and nobody is paying into it unless a member.

I hope that's never the case. It will be inefficient and very difficult to do requiring much more employees to enact.  That's why a national health insurace scheme is so much better. Nothing is means tested in those social democratic countries in Europe; so much easier to implement and the whole society including the rich pay generously for those benefits so they benefit equally.

Maybe it's just me, or maybe I'm getting caught up around some obscure points in this discussion. Are you saying that if we decide to implement a national health insurance scheme that everyone will benefit proportionally to their input? For example, your benefits will be determined by how much healthcare tax you pay?

The reason I find ideas like this as being highly skeptical is that the onus to float a national healthcare program is put onto the rich and the less risky. The rich would not benefit equally since they're paying far more than what they receive in benefits. When you're talking about a 'fair' program where people benefit equally, you match the inputs to the output as equally as possible. THAT is equal medical care, THAT is something that the private market can do far more efficiently than the government and I feel that the only reason people prefer the single payer system is that they can use the government to force the minority into providing a net benefit to the majority. In my opinion that does not exemplify America's values and the principles of the Constitution.

[Sailor Sam]

Yeager, under your ideal system, how would the market address the folks who ended up on the margins of the pre-ACA system? The people who couldn't get insurance due to pre-existing conditions, or who were dropped by their insurance for having cancer, etc. Do you envision the market becoming competitive enough that such people could afford to self-insure? Or would they just be the unfortunate grease that would keep the free market bearings turning without friction?

I'm not building steam to attack you, I'm just curious. I'll say straight up that I'm not sure we'll come to an agreement, but I promise not to claim the moral high-ground.

[Yaeger]

Yeager, under your ideal system, how would the market address the folks who ended up on the margins of the pre-ACA system? The people who couldn't get insurance due to pre-existing conditions, or who were dropped by their insurance for having cancer, etc. Do you envision the market becoming competitive enough that such people could afford to self-insure? Or would they just be the unfortunate grease that would keep the free market bearings turning without friction?

I'm not building steam to attack you, I'm just curious. I'll say straight up that I'm not sure we'll come to an agreement, but I promise not to claim the moral high-ground.

Sure, it's not problem. Firstly, pre-ACA in America we didn't have a market where effective methods were instituted to place downward pressure on healthcare prices. We still don't today. The ACA mostly addressed affordability to applying new taxes to pay for expansions of Medicaid and broadening the risk pools (making the healthy young pay more). What we had prior to 2014 was mostly a result of 50 years of regulation, licensing requirements, restrictions upon private pricing, and a growing percentage of public healthcare funding distorting the market. I don't think there was any malice but it's no surprise that as we expand government programs, most recently the ACA, there's a greater feeling of helplessness regarding our system providing affordable care without assistance from the government. Despite their best intentions, the only culprit I can think of it being is the unintended side-effects of government intervention. Companies, providers, hospitals that run off a profit motive aren't suddenly more 'greedy' today than they were 50 years ago and they have even less influence as public spending continues to outgrow private spending.

I think people tend to view this in two different ways: support the ACA and the movement towards a single-payer healthcare system as a means to transfer income from the wealthier taxpayers via subsidies to lower healthcare costs for those that 'need' it, OR reduce and eventually plan on eliminating substantial government involvement in healthcare in an effort to allow market forces to lower the price of healthcare to make it affordable to everyone. I think healthcare in the short term for emergencies tends to be very inelastic, but in a private market with fewer restrictions on insurance services the consumer has more bargaining power in the long run.

Also, a large part of it is understanding capitalism and private enterprise rather than leveraging direct inputs you may have on government healthcare control which makes people uncomfortable. They don't understand how marketplace cost controls work and how subjective value is better able to be controlled at a lower level, closer to the individual, than by a larger entity like the government. Despite this being America, I don't think the public in general has a strong grasp on the benefits of capitalism and free market policies and how even in countries with national healthcare they're moving towards or emulating private healthcare strengths as healthcare costs as a percentage of GDP continue to rise. Indeed, the Netherlands healthcare system is consistently ranked as the BEST healthcare system in Europe, and it's a largely private system which resembles our system more than other more socialist systems.

Finally, as a Constitutionalist I tend to view healthcare as more of a role of the States, not the federal government, per the 10th Amendment. I believe things like SS, Medicare, Medicaid, Welfare are unlawful expansions of the federal governments power as a result of the abuse of the 16th Amendment and the 'general welfare' clause of Art. 1 Sec. 8. So I'm not opposed to government provided healthcare, or targeted healthcare for the poor, but not at a federal level. I can move out of a state that I think is too draconian on taxes, but I can't as easily leave the federal government which makes me opposed to any sort of National healthcare.

[Telecaster]

I want to raise the age of eligibility for Social Security to from 67 to 78, and index it to the average life expectancy like it was when it was started in the 1930s. It's not meant to provide retirement, it's supposed to supplement your savings if you outlive your retirement savings. That should tell you where I stand in regards to Social Security.

SS is meant to keep elderly people out of poverty.  In the 1930s about half of elderly people were in living in poverty.  Today, about half would be in poverty except for SS.  It is almost like human behavior hasn't changed all these years.

Next, you are looking at life expectancy at birth.  But the only logical, sensible thing is to look at life expectancy at age 65.  Those are the people primarily collecting SS, right?  People who died before the age of five didn't pay into the system and never collected.  So it is misleading and nonsensical to include them. 

In 1940, life expectancy at age 65 was 77.7 for males.  By 1990, it was 80.3.   On the flip side though, the age for full benefits has increased from 65 to 67, which is almost the same delta. 

In other words, after all these decades, the number of years people can expect to collect full benefits has remained basically the same.   

https://www.ssa.gov/history/lifeexpect.html

[Yaeger]

I want to raise the age of eligibility for Social Security to from 67 to 78, and index it to the average life expectancy like it was when it was started in the 1930s. It's not meant to provide retirement, it's supposed to supplement your savings if you outlive your retirement savings. That should tell you where I stand in regards to Social Security.

SS is meant to keep elderly people out of poverty.  In the 1930s about half of elderly people were in living in poverty.  Today, about half would be in poverty except for SS.  It is almost like human behavior hasn't changed all these years.

Next, you are looking at life expectancy at birth.  But the only logical, sensible thing is to look at life expectancy at age 65.  Those are the people primarily collecting SS, right?  People who died before the age of five didn't pay into the system and never collected.  So it is misleading and nonsensical to include them. 

In 1940, life expectancy at age 65 was 77.7 for males.  By 1990, it was 80.3.   On the flip side though, the age for full benefits has increased from 65 to 67, which is almost the same delta. 

In other words, after all these decades, the number of years people can expect to collect full benefits has remained basically the same.   

https://www.ssa.gov/history/lifeexpect.html

I agree. I was somewhat wrong. However, from that same link in 1940 the male cohort over the age of 21 would have a 53.9% chance to make it to 65 compared to 72.3% in 1990, a 34% increase reaching 65. I'm assuming that number is higher today and we should adjust the program to reflect that change. Social Security was designed around contributing taxpayers dying prior to 65 to maintain solvency, and they're not.

Also, what mostly drives the severity of the tax burden is the worker to retirees ratio. We need to adjust the program to maintain some sort of parity to alleviate the burden of that shrinking ratio on the relatively fewer workers. We should be caring about the increasing impact on the today's workers as much as the welfare of the elderly and increasing the full retirement age can adjust that ratio to maintain the parity for the worker.

[ooeei]

Let me draw the line clearly.  If you are not at retirement age, and choose to stop working why can you siphon money from hard working Americans to pay for your health insurance.  This is something you can work for today.  You can easily work an extra year or two and save enough money to pay for your own health insurance in retirement.

It's also not fair for a poor person to siphon money from hardworking americans, not sure why you make the distinction for early retirees.

Then again, it's not fair that some people are born into families with money where they would have to try REALLY HARD to ever fail and be poor, while others are born into families where poverty is almost a certainty.

Life isn't fair.  If you try to make everything fair to everyone, you'll drive yourself crazy.  The best I think we can hope for is to make life a little bit more fair, and to incentivize good behaviors where we can and where it's practical.  The average early retiree (which makes up a tiny portion of the population) has put a lot into the system, and will continue to do so in numerous ways.  I'm not too concerned with the healthcare subsidy they get because of their lack of income (and therefore, lack of spending). 

If you want to add means testing and net worth cutoffs to these programs, you're disencentivizing savings and spending more money, which I assume we can all agree is not a good thing.

I know, I know, morally it's wrong to take from the rich and give to the poor.  If I live in a village where 99 people are starving and 1 person lives in a house of gold with chocolate fountains, the 1 person should get to keep all of their stuff if they want if it was acquired legally.  It would be wrong to steal from the rich guy.  Then again, is it also wrong to watch the poor die if you could do something to help them?   It's kind of like the trolley problem (https://en.wikipedia.org/wiki/Trolley_problem).  There's no right answer, and the way you view the world philosophically determines which way you lean.

[FIRE me]

Healthcare fundamentally isn't a right.

Yes it is. Per the UN, Healthcare is a fundamental human right. Just not yet recognized by certain backward nations.

Article 25.
http://www.un.org/en/universal-declaration-human-rights/

https://en.wikipedia.org/wiki/Right_to_health

No it's not, despite what the U.N. wishes it could turn into rights, it's a meaningless declaration. The U.N's Declaration of Human Rights throws in 'adequate' medical care with clothing, housing, social services, security from unemployment, widowhood, and other pie-in-the-sky ideals. You can argue equal access to healthcare is a right, and I'd agree, but you don't have a fundamental right to demand someone's labor or the results of that labor without compensating them. Ultimately a provider of healthcare has the right to define and charge what he/she thinks their service is worth.

Maybe the rest of the world will get in line with that and move away from this socialist marxism attitude that seems to think that 'rights' entitle you to other people's stuff, but maybe that's just my uniquely American viewpoint.

And I in turn, disagree with your conclusion.

What about if you maximize your pretax 401k / Traditional IRA contributions? Aren't you shifting your burden to another taxpayer?

What if you don't spend every dollar you make? You're dragging down our consumer powered U.S. economy.

Last, your position is anything but “uniquely American”. It is pure Ayn Rand, whose self serving fraud was discredited long ago.

[FIRE me]

If you do that... does the subsidy not still apply when you file taxes?  (Not trying to start a political firestorm again... trying to understand how it works.)

Nope. If you buy direct from any insurance company, or from a company or independant agent, you will not get any subsidy. To get the subsidy when you file, you have to buy the policy through either the Federal exchange or your state's exchange (if your state has one). And, I'm pretty sure, it has the be a Silver policy.

Not true.

Do you please have a good citation to back it up? Or is it from personal experience?

http://obamacarefacts.com/ contradicts you and says it has to be second cheapest Silver, and has to be bought through the federal or state exchange (whichever applies to the buyer).

From:

http://obamacarefacts.com/obamacare-subsidies/

“The amount of cost assistance you can get is based on the second-lowest-cost Silver plans in your state’s Marketplace.”

“Cost sharing reduction subsidies are only Available On Silver Plans.”

This is a dot com, not dot gov site, so I don't take it as gospel. If you have a .gov site reference that says it doesn't have to be Silver, I will gratefully stand corrected.

[geekette]

Your tax credit is based on the second lowest silver plan, but you are free to buy any plan shown on the healthcare.gov site to get that credit.

The silver plans are the only ones that offer the cost sharing subsidies, though. Those lower your copays and oop max, depending on your income.

[EnjoyIt]

Let me draw the line clearly.  If you are not at retirement age, and choose to stop working why can you siphon money from hard working Americans to pay for your health insurance.  This is something you can work for today.  You can easily work an extra year or two and save enough money to pay for your own health insurance in retirement.

It's also not fair for a poor person to siphon money from hardworking americans, not sure why you make the distinction for early retirees.

Then again, it's not fair that some people are born into families with money where they would have to try REALLY HARD to ever fail and be poor, while others are born into families where poverty is almost a certainty.

Life isn't fair.  If you try to make everything fair to everyone, you'll drive yourself crazy.  The best I think we can hope for is to make life a little bit more fair, and to incentivize good behaviors where we can and where it's practical.  The average early retiree (which makes up a tiny portion of the population) has put a lot into the system, and will continue to do so in numerous ways.  I'm not too concerned with the healthcare subsidy they get because of their lack of income (and therefore, lack of spending). 

If you want to add means testing and net worth cutoffs to these programs, you're disencentivizing savings and spending more money, which I assume we can all agree is not a good thing.

I know, I know, morally it's wrong to take from the rich and give to the poor.  If I live in a village where 99 people are starving and 1 person lives in a house of gold with chocolate fountains, the 1 person should get to keep all of their stuff if they want if it was acquired legally.  It would be wrong to steal from the rich guy.  Then again, is it also wrong to watch the poor die if you could do something to help them?   It's kind of like the trolley problem (https://en.wikipedia.org/wiki/Trolley_problem).  There's no right answer, and the way you view the world philosophically determines which way you lean.

Let's for one second ignore the actual number of people who FIRE. Mustachian beliefs of that actually exists is all about self reliance. MMM calls it badassity. Since when is badassity having someone else pay for your healthcare insurance when you can easily work an extra year or two and cover it yourself forever?

Also, although there are a very small percentage of rich people who are paying more for healthcare, the majority of the cost sits on the shoulders of the middle class. They get no subsidies and are now forced to pay higher premiums for worse coverage. This is a colossal failure for them. Yes increasing coverage for those who couldn't afford it or couldn't get it is indeed a benefit for those. Now when someone FIREs they and gets subsidies they are making it harder for every middle class American to save for their own retirement. This is a horrible system.  Being a physician I meet enough people on a regular basis who make just over the subsidies cutoff and now can't afford the higher cost of health insurance and opt for the penalty instead. I also meet people who get health insurance via subsidy but their deductibles are so high they can't afford to pay them making their insurance a useless plastic card in their wallets.

This is what usually happens in a socialist society. You find a few people who learn to game the system for their own selfish needs. This is indeed anti-mustachian. But how do I convince someone what they are doing is wrong when it will cost them an extra $250-$500 per month in health insurance costs. Impossible.

Lastly, people who FIRE add almost nothing into the system as they pay minimal taxes if any at all. Maybe they use their time to make their community better and maybe they don't but they definitely without a doubt add almost nothing via taxes. There is a great post on bogleheads how a family of two can live on $100k/yr and pay no taxes in retirement.

[forummm]

Also, there is nothing wrong to be adequately compensated for the work you put in. There are very few people in the world who have the aptitude and perseverance to become physicians.

...Look. Yes. It takes a lot of work the become a physician. Give yourself a round of applause for being such a badass. But feeling like ~$250k is "adequate compensation for the work you put in" is really quite arrogant. The average salary for a Physics researcher with a PhD in Physics, for example is $103k. Nothing against Physicians, but I doubt many Physicians have the mental chops to study physics at that level. $250k is a spectacular amount of money that those with exceptional privilege (and obviously hard work) are able to earn.

Therefor due to supply and demand, it is fair to expect a high compensation for those services.

Here's the crux of the issue. Healthcare is not subject to true supply/demand. "Buyers" (patients) are not truly given a choice. If I break my femur in a car accident, I'm taken to a hospital. I cannot shop around for the best price. I cannot negotiate for a better price on morphine. I'm a hostage to whatever prices that hospital happens to charge. Healthcare is so obviously not subject to the same "suppy/demand" forces that buying a new cell phone is.

Rebuttal:
A physician does not just go to grad school they also require years of residency therefor put in my time than a physics doctorate. Also, the promise of solid compensation is one reason we choose medicine. I loved physics and was good at it, but I also knew that I had a better chance of financial success in medicine and chose that route.

As for supply and demand. I meant there is not enough physicians in the US and the market is forced to pay hem more to service an underserved region. It is why a physician makes twice as much in the midwestern US as compared to NYC or Bay Area.

Lastly,  I could have chosen a specialty in pediatrics making $100k-$120k a year but I knew it would not even come close to paying my loans and chose a more lucrative profession. The market makes its choices and if we cut salaries to physicians enough they will instead choose to do something else.

There is a reason why rich foreigners from all over the world come to US hospitals for medical care. We have some of the best doctors and technology in the world if you can afford it.

And a researcher with a PhD does a postdoctoral fellowship, just like residency is done for MDs so there is no time difference.

And most PhD programs require more than 4 years of post-graduate work. So the time requirement is actually higher for PhDs than MDs unless the MD decides to get multiple specialties or to get very time-consuming specialties that require multiple residencies. And MDs tend to get paid more on their residencies than PhDs do in a post doc.

[EnjoyIt]

Also, there is nothing wrong to be adequately compensated for the work you put in. There are very few people in the world who have the aptitude and perseverance to become physicians.

...Look. Yes. It takes a lot of work the become a physician. Give yourself a round of applause for being such a badass. But feeling like ~$250k is "adequate compensation for the work you put in" is really quite arrogant. The average salary for a Physics researcher with a PhD in Physics, for example is $103k. Nothing against Physicians, but I doubt many Physicians have the mental chops to study physics at that level. $250k is a spectacular amount of money that those with exceptional privilege (and obviously hard work) are able to earn.

Therefor due to supply and demand, it is fair to expect a high compensation for those services.

Here's the crux of the issue. Healthcare is not subject to true supply/demand. "Buyers" (patients) are not truly given a choice. If I break my femur in a car accident, I'm taken to a hospital. I cannot shop around for the best price. I cannot negotiate for a better price on morphine. I'm a hostage to whatever prices that hospital happens to charge. Healthcare is so obviously not subject to the same "suppy/demand" forces that buying a new cell phone is.

Rebuttal:
A physician does not just go to grad school they also require years of residency therefor put in my time than a physics doctorate. Also, the promise of solid compensation is one reason we choose medicine. I loved physics and was good at it, but I also knew that I had a better chance of financial success in medicine and chose that route.

As for supply and demand. I meant there is not enough physicians in the US and the market is forced to pay hem more to service an underserved region. It is why a physician makes twice as much in the midwestern US as compared to NYC or Bay Area.

Lastly,  I could have chosen a specialty in pediatrics making $100k-$120k a year but I knew it would not even come close to paying my loans and chose a more lucrative profession. The market makes its choices and if we cut salaries to physicians enough they will instead choose to do something else.

There is a reason why rich foreigners from all over the world come to US hospitals for medical care. We have some of the best doctors and technology in the world if you can afford it.

And a researcher with a PhD does a postdoctoral fellowship, just like residency is done for MDs so there is no time difference.

And most PhD programs require more than 4 years of post-graduate work. So the time requirement is actually higher for PhDs than MDs unless the MD decides to get multiple specialties or to get very time-consuming specialties that require multiple residencies. And MDs tend to get paid more on their residencies than PhDs do in a post doc.

I doubt you had to work 80-100 hour work weeks not getting paid anything extra? I doubt you have to make decisions on people's lives on a daily basis where the wrong move will kill them. That you have to tell a family member their kid has leukemia or grandma is dead. Maybe that deserves a few extra dollars.

Maybe you made the wrong choice in a careers. Maybe you didn't. You could have also chosen to be an actor spending decades in training making no money at all when you are done. Nice job not choosing to be an actor.

I chose my profession knowing its effort and rewards. You chose yours so please stop griping that you make less. Accept your decision and move on.

[forummm]

What we had prior to 2014 was mostly a result of 50 years of regulation, licensing requirements, restrictions upon private pricing, and a growing percentage of public healthcare funding distorting the market.

In thread after thread you have made this claim, and said it's the reason our healthcare market is so expensive. I have challenged you to provide evidence several times, and you have not. The one time you responded (without evidence) I went through point by point to promote discussion on each of the points you raised. You never responded.

You have a fundamental problem with your argument. It's not true. The US has a huge private market component of the healthcare system. And it's crazy expensive. Doctors do need licenses, but those aren't hard to get (What do you call the person graduating at the bottom of their med school class? Doctor.). Prices in the private insurance market are set by negotiations between doctors/hospitals and insurance companies or private payers. The government is not involved in those. And even with public insurance (like Medicaid), the state (since Medicaid is a state-based program) frequently uses managed care (75% of Medicaid beneficiaries are in managed care) where they issue an RFP and private business bid for the contract to provide care for those beneficiaries. And Medicare has a large privatization program as well (guess what--it costs more).

On the other hand, every other major industrialized nation in the world has a MUCH more government regulated healthcare system. And every single one of them has DRAMATICALLY lower costs.

[forummm]

If you do that... does the subsidy not still apply when you file taxes?  (Not trying to start a political firestorm again... trying to understand how it works.)

Nope. If you buy direct from any insurance company, or from a company or independant agent, you will not get any subsidy. To get the subsidy when you file, you have to buy the policy through either the Federal exchange or your state's exchange (if your state has one). And, I'm pretty sure, it has the be a Silver policy.

Not true.

Do you please have a good citation to back it up? Or is it from personal experience?

http://obamacarefacts.com/ contradicts you and says it has to be second cheapest Silver, and has to be bought through the federal or state exchange (whichever applies to the buyer).

From:

http://obamacarefacts.com/obamacare-subsidies/

“The amount of cost assistance you can get is based on the second-lowest-cost Silver plans in your state’s Marketplace.”

“Cost sharing reduction subsidies are only Available On Silver Plans.”

This is a dot com, not dot gov site, so I don't take it as gospel. If you have a .gov site reference that says it doesn't have to be Silver, I will gratefully stand corrected.

obamacarefacts is not a reputable source of information. I have found many things wrong on that site.

[Schaefer Light]

Healthcare fundamentally isn't a right.

Yes it is. Per the UN, Healthcare is a fundamental human right. Just not yet recognized by certain backward nations.

Article 25.
http://www.un.org/en/universal-declaration-human-rights/

https://en.wikipedia.org/wiki/Right_to_health

No it's not, despite what the U.N. wishes it could turn into rights, it's a meaningless declaration. The U.N's Declaration of Human Rights throws in 'adequate' medical care with clothing, housing, social services, security from unemployment, widowhood, and other pie-in-the-sky ideals. You can argue equal access to healthcare is a right, and I'd agree, but you don't have a fundamental right to demand someone's labor or the results of that labor without compensating them. Ultimately a provider of healthcare has the right to define and charge what he/she thinks their service is worth.

Maybe the rest of the world will get in line with that and move away from this socialist marxism attitude that seems to think that 'rights' entitle you to other people's stuff, but maybe that's just my uniquely American viewpoint.

And I in turn, disagree with your conclusion.

What about if you maximize your pretax 401k / Traditional IRA contributions? Aren't you shifting your burden to another taxpayer?

What if you don't spend every dollar you make? You're dragging down our consumer powered U.S. economy.

Last, your position is anything but “uniquely American”. It is pure Ayn Rand, whose self serving fraud was discredited long ago.

If health care is truly a human right, then what happens if we don't have enough doctors to serve everyone?

[Sailor Sam]

I doubt you had to work 80-100 hour work weeks not getting paid anything extra? I doubt you have to make decisions on people's lives on a daily basis where the wrong move will kill them. That you have to tell a family member their kid has leukemia or grandma is dead. Maybe that deserves a few extra dollars.

Maybe you made the wrong choice in a careers. Maybe you didn't. You could have also chosen to be an actor spending decades in training making no money at all when you are done. Nice job not choosing to be an actor.

I chose my profession knowing its effort and rewards. You chose yours so please stop griping that you make less. Accept your decision and move on.

People aren't responding to making less than you, they are responding to your supposition that you make more because doctors are a superior class of human being. They're trying to point out there's no inherent, moral reason to pay doctors a lot simply because MD's went to school for a long time, work long hours, and make very important decisions. Many jobs check all those boxes, and while many of those jobs are well compensated, few are compensated at the same level MD's are. There's some other market force at work.

[EnjoyIt]

What we had prior to 2014 was mostly a result of 50 years of regulation, licensing requirements, restrictions upon private pricing, and a growing percentage of public healthcare funding distorting the market.

In thread after thread you have made this claim, and said it's the reason our healthcare market is so expensive. I have challenged you to provide evidence several times, and you have not. The one time you responded (without evidence) I went through point by point to promote discussion on each of the points you raised. You never responded.

You have a fundamental problem with your argument. It's not true. The US has a huge private market component of the healthcare system. And it's crazy expensive. Doctors do need licenses, but those aren't hard to get (What do you call the person graduating at the bottom of their med school class? Doctor.). Prices in the private insurance market are set by negotiations between doctors/hospitals and insurance companies or private payers. The government is not involved in those. And even with public insurance (like Medicaid), the state (since Medicaid is a state-based program) frequently uses managed care (75% of Medicaid beneficiaries are in managed care) where they issue an RFP and private business bid for the contract to provide care for those beneficiaries. And Medicare has a large privatization program as well (guess what--it costs more).

On the other hand, every other major industrialized nation in the world has a MUCH more government regulated healthcare system. And every single one of them has DRAMATICALLY lower costs.

Out healthcare industry is very opaque. Although there is some semblance of free market, it is covered by a vaile of middlemen who like bookies take a piece of the action. A real free market has the cost for service readily available. Without knowing the cost how can we ever have a free market. Let's exclude emergency services which is a very small fraction of our healthcare dollars.

Also CMS dictates much of how medicine is practiced in the US. Often times wasting resources on regulations that do not increase patient safety. Such as forcing blood cultures on every pneumonia patient (research shows no benefit.) Or collecting patient satisfaction data and paying based on good satisfactory surveys (research shows happy patients don't get better care and actually some data shows poorer outcomes since increased unnecessary testing leads to better score.). One question in those surveys asks if pain has been adequately controlled. Today our healthcare system has created a narcotic drug dependence because we want to satisfy our patients.
Also, what CMS proposes as a payment model private health insurance follows shortly after.

Here is where I see the free market working. Where I live free standing Energency departments are popping up all over the city. They do not take Medicare/medicaid and they cost about 1/3 -1/2 the cost of a regular ER visit. Another example is some of these surgical centers that do not take insurance. Again these have transparent pricing and the cost of service is much lower than going to a regular hospital.

I wish we had more free market in our healthcare industry because I believe costs would decrease. (I will repeat that "I believe.") I am awaiting the day that a full hospital will open up that does not take Medicare/Medicaid. I do believe that is the future since the cost of doing business with government is becoming more and more expensive every year.

[Sailor Sam]

Yeager, under your ideal system, how would the market address the folks who ended up on the margins of the pre-ACA system? The people who couldn't get insurance due to pre-existing conditions, or who were dropped by their insurance for having cancer, etc. Do you envision the market becoming competitive enough that such people could afford to self-insure? Or would they just be the unfortunate grease that would keep the free market bearings turning without friction?

I'm not building steam to attack you, I'm just curious. I'll say straight up that I'm not sure we'll come to an agreement, but I promise not to claim the moral high-ground.

Sure, it's not problem. Firstly, pre-ACA in America we didn't have a market where effective methods were instituted to place downward pressure on healthcare prices. We still don't today. The ACA mostly addressed affordability to applying new taxes to pay for expansions of Medicaid and broadening the risk pools (making the healthy young pay more). What we had prior to 2014 was mostly a result of 50 years of regulation, licensing requirements, restrictions upon private pricing, and a growing percentage of public healthcare funding distorting the market. I don't think there was any malice but it's no surprise that as we expand government programs, most recently the ACA, there's a greater feeling of helplessness regarding our system providing affordable care without assistance from the government. Despite their best intentions, the only culprit I can think of it being is the unintended side-effects of government intervention. Companies, providers, hospitals that run off a profit motive aren't suddenly more 'greedy' today than they were 50 years ago and they have even less influence as public spending continues to outgrow private spending.

I think people tend to view this in two different ways: support the ACA and the movement towards a single-payer healthcare system as a means to transfer income from the wealthier taxpayers via subsidies to lower healthcare costs for those that 'need' it, OR reduce and eventually plan on eliminating substantial government involvement in healthcare in an effort to allow market forces to lower the price of healthcare to make it affordable to everyone. I think healthcare in the short term for emergencies tends to be very inelastic, but in a private market with fewer restrictions on insurance services the consumer has more bargaining power in the long run.

Also, a large part of it is understanding capitalism and private enterprise rather than leveraging direct inputs you may have on government healthcare control which makes people uncomfortable. They don't understand how marketplace cost controls work and how subjective value is better able to be controlled at a lower level, closer to the individual, than by a larger entity like the government. Despite this being America, I don't think the public in general has a strong grasp on the benefits of capitalism and free market policies and how even in countries with national healthcare they're moving towards or emulating private healthcare strengths as healthcare costs as a percentage of GDP continue to rise. Indeed, the Netherlands healthcare system is consistently ranked as the BEST healthcare system in Europe, and it's a largely private system which resembles our system more than other more socialist systems.

Finally, as a Constitutionalist I tend to view healthcare as more of a role of the States, not the federal government, per the 10th Amendment. I believe things like SS, Medicare, Medicaid, Welfare are unlawful expansions of the federal governments power as a result of the abuse of the 16th Amendment and the 'general welfare' clause of Art. 1 Sec. 8. So I'm not opposed to government provided healthcare, or targeted healthcare for the poor, but not at a federal level. I can move out of a state that I think is too draconian on taxes, but I can't as easily leave the federal government which makes me opposed to any sort of National healthcare.

Nope, we definitely don't agree. I've visited several places without a robust safety net, and the experiences left me very wary of letting the net fail. I think a completely de-regulated market would gleefully stomp the disadvantaged into absolute pulp.

I willingly admit I'm one of the ignorant Americans. You clearly have a better grasp of economics and the free market than I do. I can tell you that I'm a Federalist, but I can't match your vocabulary, or debate you on the same level. I just have a gut feeling that you're philosophy does not match mine. The Constitution is a cracking document, and one I swore to uphold, but it was written long ago and must flex to changing sentiments towards human worth.

On the bright side, I've become increasingly interested in politics and economics. Maybe in a few months we can wrangle, and be on a more level playing field.

[EnjoyIt]

I doubt you had to work 80-100 hour work weeks not getting paid anything extra? I doubt you have to make decisions on people's lives on a daily basis where the wrong move will kill them. That you have to tell a family member their kid has leukemia or grandma is dead. Maybe that deserves a few extra dollars.

Maybe you made the wrong choice in a careers. Maybe you didn't. You could have also chosen to be an actor spending decades in training making no money at all when you are done. Nice job not choosing to be an actor.

I chose my profession knowing its effort and rewards. You chose yours so please stop griping that you make less. Accept your decision and move on.

People aren't responding to making less than you, they are responding to your supposition that you make more because doctors are a superior class of human being. They're trying to point out there's no inherent, moral reason to pay doctors a lot simply because MD's went to school for a long time, work long hours, and make very important decisions. Many jobs check all those boxes, and while many of those jobs are well compensated, few are compensated at the same level MD's are. There's some other market force at work.

I apologize if I come off saying doctors are superior in some way or another. Definitely not my intention. We all make our choices in life as a career. Not everyone can become a physician just like not everyone can become a professional football player or a nuclear physicist. The market decides on what to pay the profession. At the end of the day, in the US there are not enough doctors to fill the need of the population. Therefor due to lack of supply they are paid more than other professions. Same goes for pro athletes and nuclear physicists.

I went to a college where just about every other person I met stated they were pre-med. Only a tiny fraction of them became doctors. Why? Maybe because even the person who graduated last in their Med school class is still one of the top in their undergrad university.

BTW, I know a few physicians who regret their choices of being doctors. They went in for all the wrong reasons and wish they did something else. It is unfortunate for them. It is much better to make less money in a career that you enjoy that making more and being miserable.