Medical doctors are highly paid professionals. They earn more money—a lot more money—than your average American. What’s more, American doctors get paid more than doctors in any other country. Given how much of health care is financed either directly (Medicare, Medicaid, Veterans Affairs, public-sector workers) or indirectly (tax subsidy for employer-provided insurance) by the federal government, it’s natural to make restraining doctors’ income part of any program for making health care more affordable. So when you read stories about doctors whining that Affordable Care Act exchange plans don’t pay them enough, please throw up a little in your mouth and proceed to ignore the doctors’ complaints. The only practical reason to worry about low compensation for doctors in the ACA exchanges is it may cause them to boycott exchange patients. If that happens, the solution is to reduce doctors’ payment rates elsewhere in the system. If we ever reach the point where American doctors have been squeezed so badly that they start fleeing north of the border to get higher pay in Canada, then we’ve squeezed too hard. Until that happens, forget about it.
But also spare a thought for the journalists. The Affordable Care Act is a big deal. ACA implementation is a big deal. People should write stories about how much doctors get paid in ACA plans. But people who write stories on this subject without noting the yawning pay gap between American doctors and doctors in Canada, France, Germany, etc. are doing their readers a disservice.
What we really ought to be doing is working to further pressure the incomes of doctors through supply-side reforms. That means letting nurse practitioners treat patients without kicking a slice upstairs to an M.D., letting more doctors immigrate to the United States, and opening more medical schools. Common sense says that since the population both grows and ages over time, there should be more people admitted to medical school today than were 30 years ago. But that’s not the case. Instead we produce roughly the same number of new doctors, admissions standards have gotten tougher, and doctors have become scarcer.
