In response to Government makes health care more expensive and therefore it is unreasonable to withdraw subsidies, a commenter wrote
Is the government responsible for Baumol’s Cost Disease?
Is the government responsible for extreme concentration of wealth?
The bulk of the problem is a lot simpler than you, Vance, and most others in the public square make it out to be.
Baumol’s Cost Disease says that industries with no productivity growth, such as string quartets performing live, have to compete for workers with industries that have high productivity growth and hire workers to write code for sticking ads into Facebook or press the “start” button on a fully automated factory.
“Drivers of health care expenditure: Does Baumol’s cost disease loom large?” is a 2012 paper by economist Carsten Colombier. He concludes that the effect is minor and mostly spending on health care has been “quantity-driven” (i.e., people are getting more tests and procedures, taking more drugs, etc.).
What about an informal analysis? “Obamacare Isn’t Stopping Doctors’ Incomes From Soaring” (Fortune, June 10, 2016) says
Far from flattening, as some Obamacare experts predicted, or even waxing in low-single digits like salaries for contractors, lending officers, beauticians, and most other workers, pay for doctors is surging.
Dermatologists, cardiologists, urologists, among others, are reaping double-digit increases that lift their salaries to the $500,000 a year range, and that’s not including substantial performance and signing bonuses, relocation allowances, and even full payment of their med school loans.
A system that fuels demand with huge subsidies, yet systematically restricts the supply, is a textbook formula for fast-rising costs. No illustration is more vivid than the problem with doctors’ pay, a category that accounts for 22% of all U.S. healthcare spending.
On average, family doctors got a $27,000 raise in the past year, from $198,000 to $225,000, for a 13% increase. Doctors in the two other primary care categories, internal medicine and pediatrics, also had great years. Each garnered 15% bumps to $237,000 and $224,000 respectively.
… general surgeons at $378,000 up 12%; dermatologists at $444,000. also up 12%; urologists at $471,000, up 14%; OB/GYNs at $321,000, up 16%; otolaryngologists at $403,000, up 21%; and non-invasive cardiologists at $493,000, which have seen their pay rise more than 30% above what they have been paid on average over the past three years. Orthopedists and invasive cardiologists also got inflation-beating increases of 4% and 5% respectively. On average, both specialties pay well over $500,000 year in salary alone.
[Note the spread between primary care and specialists. An American who has sex with a specialist earning $500,000 and collects child support should have close to the same after-tax spending power as an American who goes to medical school and works as a primary care doctor (works better in Massachusetts than Minnesota, though!). (The American (or foreign visitor) who has sex with two or three different cardiologists can have the same spending power as a cardiologist, if the state is chosen correctly.)]
If a fresh-out-of-training specialist can earn $500,000 per year by going to an “underserved” area of the country, how can we attribute this to competition with manufacturing employers? Intel gets tremendous productivity per worker out of its fabs, but how many Intel workers get $500,000/year?
If high salaries for people working in health care are primarily due to competition with other industries, why are those salaries going up at a faster rate than what other industries pay?
Nurses at one of our local hospitals are preparing to strike (Boston Globe):
Both sides agree that nurses wages’ at Tufts are below those of other Boston hospitals. Tufts officials say that they want to rectify that by offering a 10.5 percent raise over about four years to nurses at the top of the pay scale.
All other nurses would receive a 5.5 percent pay hike over four years, in addition to 5 percent annual step raises, which are already built into the contract.
The average pay for a full-time nurse at Tufts at the top of the pay scale is $152,000, according to the hospital.
Nurses are able to unionize and strike for higher pay, something that is unusual in the market portion of the U.S. economy. If patients would go to a cheaper non-union hospital rather than pay for these higher union wages, it wouldn’t be possible. So plainly there is some non-market factor in operation that makes consumers indifferent to the prices that this hospital charges and/or unable to go elsewhere.
Finally there is the patient experience. If we’re old we remember the days when seeing a doctor meant actually seeing the doctor and possibly a receptionist or nurse. Now the “doctor’s office” is stuffed with non-doctors embroiled in various paperwork tasks.
Readers: Can we relax and not worry that we spend 4X the percentage of GDP compared to Singapore or 2X compared to Europe on health care?
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