Sunday, September 29, 2013

Follow the Money: Healthcare

Americans spend a lot of time hating about how much other people make.  Throughout the financial crisis there was considerable scrutiny on banker's pay.  I get it.  The word "bonus" became a 4-letter word. "How can bankers get paid so much when they ruined the economy..." - we all remember the anger. 

There is a new crisis in America and its the healthcare industry. However, the tone is very different. 

There are many similarities between finance and healthcare.  They both require licenses, or degrees, or some form of expensive higher education.  They both require a massive amount of regulation and government oversight. They create highly lucrative jobs.  And my favorite: people will persistently overpay for advice, or services, related to both of them. People generally don't skimp on decent medical care or financial i right or am i right?

America loves to hate on the fat cat bankers (myself included) but as mad as everyone is about the healthcare gridlock our nation faces, you never hear about the fat cat doctors

I was browsing the website of the BLS (Bureau of Labor Statistics), cuz that's how I roll, and came across this table on average mean wages for all occupational groups in the US and it really got me thinking.


You can view the full list here:

See any themes here?  The highest paying jobs in America are healthcare jobs.  Is it a coincidence that health insurance and medical care is so expensive and the people in the industry are the highest paid earners in the US?  I'm no expert but I have to imagine there is a relationship there.

Here is the funny part: there isn't a finance related job in the top 25 (a "Financial Manager" was #29 on the list), though Wall St wages and bonuses are still (5 years later) volatile topics of discussion.  

No one ever says "this Doctor made $X and they should have to give it back because so many patients died along the way." It's part of the job. 

We are happy to blindly pay whatever cost a doctor or an insurer says because our health...our lives, our children's lives, are on the line.

Well, I think we are getting duped here.  The cost of medical care in the US is many times more than anywhere else in the world.  The system is riddled with middlemen and friction. Not to mention doctors have little incentive to keep people healthy.  Instead we over medicate, over treat, and over charge.

I know a guy who started a consulting business to help doctors "optimize" the numerical codes they submit on insurance claim forms to earn more money.  He basically finds similar procedures and treatments that the insurance company accepts to get the biggest bang for the buck.  I'd like to punch this guy in the face. 

The system sucks. It needs to change. Will there be a day when the doctors who have the fewest sick patients get paid the most?  Maybe.  i like that incentive system.   


  1. No doctors make $100million a year (that i know of), which happens in the hedge fund space just about every year. The media focuses on the headline number. "Hedge fund manager makes $100 million." Gets the average American's blood boiling.

    What is NOT news is the other 10,000 hedge fund managers who make $0 every year. While the mean income for doctors is easily in the 6 figures, I would bet the mean income for hedge fund managers is something like $10,000 a year.

  2. The problem is so multifaceted. I think the costs of healthcare have to do with a. Physician salaries b. Drug costs c. Device costs d. Unreasonable expectations and an inability to accept death as a natural part of life (and how everyone plays on the fear of dying to sell more shit) e. Hospital mark-ups,9171,2136864,00.html f. Defensive medicine g. Red tape preventing technological advancements to be transitioned to increased efficiency in hcare provisions. h. Monopolies The discussions of who makes too much would go around in circles in a capitalistic set-up without any constructive ending. Maybe "socialized" medicine isnt just the answer.... but maybe a "socialized" society is? Maybe a degree of socialism is a good thing? I never liked the terms "capitalism" ..."socialism"....they are as generic as "republican" and "democrat" . There is definitely room for a think tank of free thinkers to change our country towards a better tomorrow in the healthcare arena amongst other arenas. I wish there was a safety net for everyone, including my parents. I am a doctor. My job is challenging and I like it. I'd be a hypocrit to say I didnt like money. I like "poppin bottles." hehe. I also like the science. I've cried with patients. I've been up many nights worrying about patients or if I did or didnt do something right. I do think I might be overpaid. I think "social entrepreneurs" can cure some of the ailments of the system, but we might need a hcare Gandhi to do more. The areas of inefficency are quite obvious but I dont know how easy it is to change them. I think money motivates most people, including doctors, in fact I think it is one of the primary motivating factors for most my collegues (i know i will get attacked for this but just being honest). There are good docs and bad docs. There are docs who do un-needed procedures to make money ( I know...scary). Being a doc doesnt make you a good person. Whenever I tell people how I am interested in entrepreneurship, its funny how many jump to the money bit. I love how people think "business" is a dirty term...everything in life is a "business" because by definition this is an exchange of good/services. Lets be honest though, who doesnt like money? But if you can create value, money will come and so will good things for people. the system in our country is definitely in need of some repair though. The question is which of big players would even let that happen?

  3. Love your take Ram. Thanks for sharing. Are you familiar with physician pay in the UK? Its much less glamorous from a monetary perspective (so i am told) and therefore attracts more of the folks who do it for pure passion.

    I like how in the UK you could choose between the socialized system or the private system. I went to an NHS doctor for flu-like symptoms when i lived in London and they basically told me to go home, rest, drink water...toughen up. I was surprised they didnt prescribe anything at all, some Z-pac or any antibiotic that moves like candy in the US. Cost me nothing for their advice.

    Another time, I went to a private doctor and I sat in his fancy office (it looked like an antique library), never removed an article of clothing, and walked out with a few different prescriptions and a bill for 300 quid (about $600 at the time). Its a "pay for play" model.

  4. The UK has a pretty good system...i like it too. I would like to learn more about the systems of the 36 countries ahead of us on the WHO list.

  5. Well said my friend. I work in "healthcare" and we struggle to get reimbursement from insurance companies for treatments that cost in the $100 range. It's frustrating as I feel the speech therapy I provide my patients is vitally important in making them productive citizens of the world. However the earning potential is just not there. Does that make my work less important or significant?

    1. Em, I think we have to be the ones who define whether or not our work is important. The goal is to find something we love doing, with purpose, and that can sustain a decent standard of living. You are doing something significant that solves a problem. I bet some of your reimbursement dollars are being sucked out by unethical people in the system.