Perhaps one of the bigger problems in healthcare these days revolves around the way the US trains and pays it's physicians, as well as the sentiment that has developed among doctors about what specialties are worth the time and effort. As pointed out in this new york times article, there's a growing shortage of primary care physicians and nurse practitioners in this country. The economics of the problem are quite simple. The average medical school debt for most students is ~139,000. The average salary of a pediatrician is ~125,000 a year. So put yourself in a med student's shoes. You're 27, done with school, have no savings to speak of, and a 100k debt earning 8% compounded interest. To add insult to injury you need to complete a residency which is at a minimum 3 years long and pays somewhere between 30 and 40,000 a year. Most other college grads in at your age have been working for 2 to 3 years, have savings in a 401k or IRA, and you're only familiar with the acronyms MRI and COPD. So should it be any surprise that by the time you are in your early 30s you might want to head to a specialty that pays 200 to 300,000? This would at least allow you to pay down your loans in a reasonable time before you have to take out yet more money when you want to get married, buy a house, have kids, save for their college, etc. Let's just pretend you also aren't carrying any undergraduate loans to throw on top of the six figure debt of medical school.
So I'm sure to the non-medically inclined this sounds slightly ridiculous. So doctors have to choose between 100 or 200 grand a year, big deal, that's still a lot of money; but we haven't even touched on malpractice. For an internist in Chicago, you could be paying 41,000 dollars a year. That's 125,000 minus 41,000 all before taxes which leaves some medical students feeling like they should have just become a plumber and forgone the decade of education.
This highlights three problems, only one of which I hear politicians talking about:
1) Medical school is too expensive. In 1984 my school's tuition was 7,000. Today it's closer to 33,000. Including living expenses, my school's financial aid office projected that I would need 71,000 for my 3rd year of school.
2) Malpractice insurance is out of control. There are too many lawyers that game the system and shoot for settlements which cost less than defending yourself in court.
3) Insurance companies and Medicare reimburse at painfully low rates to primary care physicians. Most of them actually lose money when they take medicare patients.
What are the solutions to this problem? For one, the government needs to stop paying out huge tuition to medical schools. It looks to me like medical schools will keep raising tuition as long as the government is willing to cover it with federal loans. If the government just said no, either medical schools would face a sharp drop in enrollment, or wise up and stop fleecing students. As for malpractice, the system is simply broken. Litigation has hardly improved medicine, it's only driven doctors out of highly litigious states, which is bad for patients and doctors. At least the current administration seems to be on the right track when it comes to primary care reimbursements, but only time will tell if it's enough or too little too late.
