<p>1.)
[quote]
many doctors would argue that cutting salaries would only persuade talented, college graduates to pursue better-paying professions.
[/quote]
Probably true, regardless of debt, although debt of course makes the impetus more severe.</p>
<p>2.)
[quote]
“I don’t have a view on whether doctors take home too much money or not enough money,” Dr. Bach said. “The problem is the way they earn their money. They have to do stuff. They have to do procedures.”
[/quote]
Amen. And this is coming from an aspiring surgeon.</p>
<p>3.)
[quote]
“The whole health-care system is set up to pay for services that are rendered,” he said, “when the patient, and society, is interested in health.”
[/quote]
Payments today are the equivalent for paying a car manufacturer for putting in an engine without paying attention to whether the thing actually runs.</p>
<p>4.) Specialty compensation is determined largely by how much insurance companies are willing to pay for certain things. Of course a doctor can always work more, too, but there's a limit on how many hours there are in a day. If insurers decide that what a pediatrician does is less valuable than what a surgeon does, then the surgeon gets paid more.</p>
<p>5.) Since Medicare has what's called market power (it's a monopsony, the converse of a monopoly), its prices determine (often, not always) the prices that other insurers pay as well.</p>
<p>So if Medicare decides that a pediatrician gets paid less than a surgeon, everybody does.</p>
<p>6.) Of course, Medicare is a government bureau. So it's vulnerable to the usual push-pull involved in government decision-making through no fault of its own. So for the system to work right, the government has to pick a good payment scheme.</p>