Transforming American Medicine


Robert Frank is relatively optimistic that American medicine can be transformed away for our current fee-for-service model into something more like the Mayo Clinic:

Another factor militating against quick expansion of the Mayo model is that many current doctors chose their profession hoping to earn lucrative pay, which they might not be able to do in a nonprofit clinic. But across the economy, we see talented professionals whose career choices are driven by concerns far broader than pay. Many top graduates from elite law schools, for example, turn down lucrative positions in corporate law to work for public-interest groups paying a third as much.

Doctors who choose to work in nonprofit clinics seem to view their professions more as a calling than as a job. There is evidence that when medicine was less adversarial than it is now, American doctors were both happier and more respected, even though their incomes were much lower. Doctors elsewhere also remain satisfied and respected, though they are paid less than their American counterparts.

In time, medical schools will be able to attract plenty of talented people willing to accept positions under the Mayo model, where they would spend more time healing patients and less time fighting insurers. Any of the current health reform bills would help start this transition.

Maybe yes maybe no. But one salient fact about both other countries and the United States of the past is that there was much less inequality in general. A doctor in 1963 had a much lower income than a doctor in 2009, but he was closer to the top of the income distribution. Frank’s excellent Falling Behind is largely about the interplay of rising inequality and status competition, so he doesn’t need me to point this out, but I bet that relative income point is important. Which I think is less a reason to be pessimistic about health reform than it is yet another reason to think that higher taxes on the very rich are a good idea (a component of the House bill, I note).