Many years ago Dave Sackett was involved in several studies that demonstrated a decline in the knowledge of the best treatment of hypertension that was associated with the year the physician graduated from medical school. A strong argument for evidence-based medicine, as it’s the lack of reading the current literature that is primarily responsible for this deterioration.

At our institution the tuition in vet school is less than med school, and most vets begin their practice immediately after graduating; med students have a minimum of 3 and a maximum of 8 years of residency before starting their practice. Residents’ salaries will not make much of a dent in a large debt. Don’t get me wrong, I’m not arguing that doctors are underpaid; they’re not, but the distribution of the payment is what’s wrong with salaries. Why should an ophthalmologist make $5000 for a 20 minute cataract extraction and an internist who spends an hour and half trying to diagnose a complex problem get reimbursed $60?

If you look at the figures regarding rising medical costs, there was one time (the early ’90s) that the rise leveled off and in fact even decreased (http://hspm.sph.sc.edu/Courses/Econ/Classes/nhe00/). The reason? Significantly managed care. That was the time of the aggressive HMO, when all procedures were questioned, and there were significant limitations in provider choice. What happened? The public would not accept those kind of restrictions. If you saw “As Good As It Gets”, remember Helen Hunt’s rant about HMO’s? So health plans changed. Less than 1% of requests are denied, some plans don’t even ask for approval now, and the selection of providers is much broader with more options. And with that relaxation, costs immediately began rising again. Thing will get worse. The population is aging, and there’s new and expensive technology developed every day. I agree with the comment about the political will being the driving force. It’s one thing to have lower middle class workers lose their health insurance; when this starts happening to a broader section of the population, who wield more political power, there will be a national health plan of some kind.

Indeed. There are well established industries, like water companies and agriculture – they are characterised by low profits, large amounts of consumers who pay little, stable business models and a declining proportion of GDP. New industries behave differently – high profits, high innovation, little stability, relatively high prices for consumers, and a rising share of GDP.

Healthcare is an established industry that behaves much more like a new industry. Also patients have the propensity to want a “life and quality of life”-saving treatment, if it exists, at whatever the cost. This means that medical innovations push up costs more than in most industries.

So if we really want to reduce medical spending while maintaining acceptable standards of care, the most rational thing to do is to reduce the pace of medical innovation. Removing patent protections from medical drugs would be the easiest way to do this, and would bring down medical costs in the short term as well.

But if we want to maintain fast medical innovations, we’re probably addicted to rising healthcare costs (not that we can’t try and slow that rise through other means – but slow is all we can do).

How can you be sure? Someone dying on a hospital bed would presumably pay any amount of money he could afford to survive (with a good quality and length of life afterwards).

If we let the market decide (either the monetary or the political market) I don’t see any reason why medical expenditure wouldn’t reach 80-90% of GDP.

There are people on this blog (myself included) who have ambitions of becoming immortal. How much of your income would you be willing to pay out to achieve that goal? Because that’s the market upper bound on the percentage of GDP devoted to healthcare.

On the overconfidence of doctors: 1316 patients who had no regular source of care and kept their initial primary care appointment were enrolled and randomized with either a nurse practitioner (n = 806) or physician (n = 510). … No