Will the real Paul Krugman please stand up?

Originally posted by telerion
You're right that both parties are interested in their own power. That's the way a representive democracy works. I was writing about the particular strategy of the Republican party in regards to the healthcare proposals. I think it is pretty much unarguable that the Republican party has chosen to oppose nearly any possible healthcare bill. You see it in ings. Basically the Republicans have left that task the conservative and moderate Democrats.

That's unfortunate because in discussions with economists, doctors, and various citizens, I been persuaded that healthcare must be reformed. It would be great if more Republican (rather than just a handful of moderates) became vested in hammering out a consensus legislation. Something that gave Americans better healthcare than the status quo but which also came with more concrete cost savings. Basically the Republicans have left that task the conservative and moderate Democrats.

No matter what the Dems propose, the GOP strategy has been and will be arguing (or implying) that undescribable horrors will ensue. But if the Dems pass something - anything - that pertains to healthcare reform, even if doesn't work the way it was supposed to work, it will be much much less awful than the GOP's alarmist scenarios. And many many people will be left wondering what all the fuss was about.

The GOP can't just keep taking "alarmist" positions on everything without becoming the "Republicans Who Cried Wolf". If that happens, the party will likely be reduced to fringe status.

A lot of people want contradictory reform but they want the reform they want.
Doctors want tort reform, more freedom to practice medicine and the compensation they feel they deserve.
Some citizens want an expanded bill of rights (the exapnsion of tort reform), more affordable health care (doctors get paid less), shorter waits (don't let some homeless guy get coverage while I wait).
Some people want coverage, but can't get a job that pays for it.
Drug companies don't want to be restricted so they can (1) make money (2) produce new drugs. Some people want to restrict their monopolies so that things are cheaper and feel drug companies make enough/ too much money.
Other people are worried about whether the government should pay for abortion and possible other immoral things.
The answer really depends on what you believe
(1) I believe doctors and drug companies deserve to be compensated well and think you save money by paying for abortion
(2) you might believe everyone has a right to be free healthcare even if they can't get a job and that abortion is murder.
There is no compromise because people want contrary things and nothing is cheaper when the government gets involved.
If you think the government is competent at anything read the report that just came out about the SEC and Madoff.

Originally posted by quackquack
A lot of people want contradictory reform but they want the reform they want.
Doctors want tort reform, more freedom to practice medicine and the compensation they feel they deserve.
Some citizens want an expanded bill of rights (the exapnsion of tort reform), more affordable health care (doctors get paid less), shorter waits (don't let some homeless gu ...[text shortened]... rnment is competent at anything read the report that just came out about the SEC and Madoff.

You're definitely right about the abundance of conflicting an complicating demands in the healthcare debate. A bit off track, but I'd like to ask, "Why is it that medical doctors get paid so much?" Certainly they go through a lot of schooling, most earn fairly low wages until after residency/fellowships. On the otherhand there are plenty of PhD's in the humanities that go to school just as long that will make only a quarter of what a doctor makes. It can't be because they are the best and the brightest. While most are no slouches, the sharpest ones are uually in medical research rather than practice.

We all know that it has to come back to supply and demand. Demand is obviously high, but I'd like to take a look at studies of the supply of doctors. High wages should cause students to flow into medicine. Again I don't think that the intellectual requirements for practice are prohibitvely high for a moderately motivated student. It seems like the biggest barriers are medical schools, which keep admission low and charge high tuition thereby driving up the wage demanded by doctors, and stringent medical licensing which makes it difficult for many foreign MD's to practice in the US. I could be way off so I'm curios about what others think on this.


Oh, and I'm glad the SEC is finally getting heat over things. Seems like they've been the one agency getting off light so far in this recession.

Originally posted by telerion
You're definitely right about the abundance of conflicting an complicating demands in the healthcare debate. A bit off track, but I'd like to ask, "Why is it that medical doctors get paid so much?" Certainly they go through a lot of schooling, most earn fairly low wages until after residency/fellowships. On the otherhand there are plenty of PhD's in the ...[text shortened]... Seems like they've been the one agency getting off light so far in this recession.

If you want to go down that route, doctors are probably the most deserving ones of most high earners and they're not even close to the top incomes (in absolute income, not relative position).

Originally posted by telerion
You're definitely right about the abundance of conflicting an complicating demands in the healthcare debate. A bit off track, but I'd like to ask, "Why is it that medical doctors get paid so much?" Certainly they go through a lot of schooling, most earn fairly low wages until after residency/fellowships. On the otherhand there are plenty of PhD's in the ...[text shortened]... Seems like they've been the one agency getting off light so far in this recession.

It is simply untrue that doctors pay is based on supply and demand. In fact, outsiders continually interfere will supply and demand and any new reform would only increase interference.
(1) doctors are regulated and are mandated to perform certain procedure in hospitals instead of somewhere where it would cheaper
but you want the government to further
(2) a new health care system would restrict what doctors can receive, which procedures will be covered.
Doctors are among the brightest and the expectation are crazy. They have crazy amounts of schooling; they go throw residency where they work like slaves; they are often on call interfering with their lives; they have 100K+/ yr malpractice; they literally save lives regularly. I know of no profession that does that I would be against any system that does not treat doctors well.

Originally posted by Palynka
If you want to go down that route, doctors are probably the most deserving ones of most high earners and they're not even close to the top incomes (in absolute income, not relative position).

Not to be too "economisty" about it, but maybe a doctor does not contribute the moat society. It's a difficult and dangerous subject because we're getting into placing monetary value on human life, but I don't think it's cut and dry to say that the value of their service should give them the highest pay.

I know you won't do this, Pal, but for anyone who might, please do not misconstrue my words to say that I think doctors shouldn't get paid well. I'm just opening a can of worms about why they get so high relative to most professions.

Originally posted by telerion
You're definitely right about the abundance of conflicting an complicating demands in the healthcare debate. A bit off track, but I'd like to ask, "Why is it that medical doctors get paid so much?" Certainly they go through a lot of schooling, most earn fairly low wages until after residency/fellowships. On the otherhand there are plenty of PhD's in the ...[text shortened]... Seems like they've been the one agency getting off light so far in this recession.

You hit on a major issue here.

If we want everyone to have access to all the quality healthcare that they need - at a time when an aging (and ever less fit) population is putting an ever-rising strain on the system - we will need to find ways to greatly increase the supply of quality health providers.

This would definitely include expanding or building more medical schools, allowing more foreigners to practice, and eliminating excessive licensing restrictions. Of course, always making sure that all providers meet legitimate quality standards.

I'm sure there are a lot of ideas that could be looked into. A major problem in the current debate is that these supply issues are NEVER discussed. But unless we want to have a lot of ugly struggles over grandma's "plug", supply issues must become a priority.

Originally posted by telerion
Not to be too "economisty" about it, but maybe a doctor does not contribute the moat society. It's a difficult and dangerous subject because we're getting into placing monetary value on human life, but I don't think it's cut and dry to say that the value of their service should give them the highest pay.

I know you won't do this, Pal, but for anyone who ...[text shortened]... 'm just opening a can of worms about why they get so high relative to most professions.

What I'm saying is that, although it is relatively high, it's far from the highest. And when I look at those earning above them, I find that there are much more glaring cases of "undeserving" (be it measured in unique skills or more abstract notions of social contributions) high pay.

Originally posted by Palynka
What I'm saying is that, although it is relatively high, it's far from the highest. And when I look at those earning above them, I find that there are much more glaring cases of "undeserving" (be it measured in unique skills or more abstract notions of social contributions) high pay.

I 100% agree that doctors are not comensated as well as certain other occupations. It seems health care reform is much more concerned with people having insurance and decreasing costs then making sure doctors get paid. Doctors will not work (nor should they work) extra hours if they are paid below the going rate nor will they be available for emergencies. It is not a better system when there are no doctors to see.

Originally posted by quackquack
It is simply untrue that doctors pay is based on supply and demand. In fact, outsiders continually interfere will supply and demand and any new reform would only increase interference.

I don't understand you here. Are you saying that supply and demand does not determine their wage at all, or that their are factors outside of patients and doctors that alter the demand side?

(1) doctors are regulated and are mandated to perform certain procedure in hospitals instead of somewhere where it would cheaper.
Ok so there's a supply side issue there. The costs of practicing these procedures outside of hospitals is very high (due to regulation).

but you want the government to further

You're trying to put words in my mouth. I have said that I want more government interference at all. Ironically, you point to a regulation which increases the cost of care, but then claim that any reform will increase interfernce and cost. According to your logic, wouldn't a reform that removed that rule decrease the costs of care?

(2) a new health care system would restrict what doctors can receive, which procedures will be covered.

Any reform to healthcare will do this? Or just the ones currently being kicked around? It seems to me from what you're saying that the status quo already puts restrictions on doctors. If so, how doe the existence of restrictions in the proposals automatically make these proposals inferior to the status quo?

Doctors are among the brightest and the expectation are crazy. They have crazy amounts of schooling; they go throw residency where they work like slaves; they are often on call interfering with their lives; they have 100K+/ yr malpractice; they literally save lives regularly. I know of no profession that does that I would be against any system that does not treat doctors well.

I'm beginning to think that you might have another horse in this race. Perhaps you have a relative who's a doctor or aspire to be one yourself. I don't mean to insult anyone so I'll moderate my language on this. I know quite a few friends who are doctors as well as a couple relatives. From what I can tell, on average the really bright ones are in research. The guys and gals who practice aren't stupid by any means but outside of discussions of human anatomy and generl health I haven't found them to be any more gifted than your average professional. It seemed that more important than intellect for success as a physician is self-discipline and hard work. It's not like an OB/GYN has to wrap his mind around some especially difficult problem.

In terms of length of school most science research professors go through a lot more training. You have 4-6 years of doctoral study plus multiple post-docs before they finally get am assistant professorship. When they finally get their position they still don't get paid that well. I don't think doctor's pay is much about intellect or schooling, although the latter does play some part.

Originally posted by quackquack
I 100% agree that doctors are not comensated as well as certain other occupations. It seems health care reform is much more concerned with people having insurance and decreasing costs then making sure doctors get paid. Doctors will not work (nor should they work) extra hours if they are paid below the going rate nor will they be available for emergencies. It is not a better system when there are no doctors to see.

I guess I would ask then, "Why do doctors on other countries work hard despite being paid so much less?"

Originally posted by Melanerpes
Krugman did state that the economy was "depressed" in 2004 - not sure why - but this period was clearly not a major business cycle event such as the downturns of 2000 and 2008+ -- and Krugman's stated point was that the deficit was NOT cyclical (only a "little bit" was due to the so-called depressed economy).

In the 2004 statement, Krugman was taki ...[text shortened]... y has set in, he may well return to his alarmist position in say 2011.[/b]

Krugman will not return to an alarmist position again until Republicans are in power. The only possible exception will be him sounding the alarm that the Republicans are misleading the public into NOT supporting democrats.

I've tried to find consistency in the NY Times Op-Ed writers for years and the closest thing to consistency that I can find is all writers but David Brooks support the democrats and demonize republicans.

I did not mean to put words in your (or anyone's) mouth or to misrepresent what you said and imagine you did not mean to misrepresent me either so I will re-organize my thoughts.

(1) Many claim that we need "insurance reform because the free market has failed." This is untrue as we do not have a free market. We have a regulated system that many believe is failing. I do not think more regulation will make it better. In fact, one of the huge problems is the lak of a free market. Insurance costs far more than it is worth for an individual For example, in NYC a teacher with a family gets 50K in pay but has insurance that costs 30K in the open market. I would imagine that they would want a cheaper policy and keep some of the decreased costs, but that option is not available.

(2) I do not agree that the smartest doctors are in research. People make career choices for all sorts of reasons. Some get more satisfaction working on new developments while others want to directly help people now. Some people such as mothers with families want more flexibility in when they can work and do not want to deal with the business side of medicine. Others want private practice and the advantages of being in a capitalist society.

(3) Any system that is being proposed will have a compensation rate for a procedure. The government markets their system as one that will decrease costs. As such, I imagine the government will try to put downward pressure on the compensation rates. Therefore I expect doctors will make less.

(4) In order for any new insurance (or any insurance) to be effective doctors have to accept it. I am not sure how the government expects this to happen. If rates are like medicaid, then the government will need to use some sort of coersion or it will not be accepted. I also do not think there is enough capacity for universal healthcare. There is no point in believing you have medical coverage but have the inability to see a doctor (due to overbooking or the doctor not wanting the governmental coverage).

(5) I would argue that doctor training is as hard as any profession. With MCATS, tutition, life and death pressure, routinely working 24+ hours and years of training.

I also believe doctors are important and if we subject them to malpractice cases and red tape without compensating them we simply won't have them. I fear that the reforms push us in the wrong direction.

Originally posted by quackquack
I did not mean to put words in your (or anyone's) mouth or to misrepresent what you said and imagine you did not mean to misrepresent me either so I will re-organize my thoughts.

(1) Many claim that we need "insurance reform because the free market has failed." This is untrue as we do not have a free market. We have a regulated system that many belie ...[text shortened]... ing them we simply won't have them. I fear that the reforms push us in the wrong direction.

What makes you think a "real" free market system would work?

Originally posted by KazetNagorra
What makes you think a "real" free market system would work?

We are a capitalistic country and normally the free market works.

In healthcare specifically there would be certain advantages
(1) people could purchase the insurance or the medical services that they want; instead of have over/under insurance based on their job.
(2) medical providers would have a free market system determining price instead of an outside regulator.
(3) there would be less red tape; filling out forms
(4) there would be less moral hazards

Then, if it some did not like how it works (capitalism may not be the cure for everything) we could have a simple system and discuss modifying things. Right now, with medicare, medicaid, Social Security, private insurance, health savings accounts, supplemental insurance, separate optical and dental insurance it is impossible to see whether anyone would be better off with any proposed changes.