Massachusetts Makes Health Insurance Mandatory 779
Iron Condor writes "Massachusetts is the first state to require its residents to secure health insurance, a plan designed to get as close as practically possible to statewide universal health care. Presidential hopeful and former Massachusetts governor Mitt Romney originally introduced the idea in 2004. Effective July 1, 2007, the law, which uses federal and state tax dollars, is aimed at making health insurance affordable to all residents of the state, including low-income populations. Those who fall below the federal poverty line may be eligible for health care at no cost."
Great. (Score:2, Interesting)
Wow, that's progress.
sycko (Score:2, Interesting)
after watching this i am shocked, USA is in a bigger mess than i taught!
as a European i am happy i don't have to make tough choices when it comes to my health, if i need treatment i would get treatment with little hassle
i highly recommend for any Americans with Irish roots to come back here (u wont get hassle getting citizenship!) the economy in last 10 years has grown so much the country is unrecognizable, and u get quality health care (its not perfect but compared to the US...)
Is No One Denied Insurance in Mass? (Score:4, Interesting)
Will there even be an application process if accepting me is compulsory? Will this give insurance companies less loopholes to try to out of paying for my expensive procedure. For example, as pointed out in "Sicko", insurance companies routinely deny expensive insurance procedures by finding things on the insurance application to invalidate their contract with the patient. If one can argue to a judge that the insurance company had to approve them no matter what, I'd assume that this makes Massachusetts a much safer place to be able to depend on the health care and insurance that you are paying for than anywhere else in the country.
I think these are pretty important questions, but I can't seem to find the answer anywhere.
we need universal health (Score:2, Interesting)
Re:Socialised Healthcare is the future for the US (Score:2, Interesting)
Re:Socialised Healthcare is the future for the US (Score:2, Interesting)
Back in 2000, a Brit friend of mine's father needed heart surgery. He was told by national health that he was too old. He went to North Carolina and had the surgery done there. If he had stayed in the UK he would be dead now.
From an outside perspective (Score:5, Interesting)
I would watch American movies and TV shows, and wouldn't understand when you guys talk about, getting a job with 'health benefits'. Here in Australia, the only thing I worry about getting a job is if it pays right.
If I go to the GP (family doctor in the US), or need to go to the hospital, paying the bills is the last thing on my mind. It's all taken care of. Medicines are also subsidised by the government. You collect virtually any prescription for $3.
Honestly, I was surprised you guys let it get that bad. Then again, I wasn't surprised the reason it went the way it did: through greed and politics.
Pre-Existing Conditions, IAALIA (Score:5, Interesting)
Those middle class people in Massachusetts who have pre-existing conditions, will be driven into homelessness. For absolutely certain. No questions asked. Out the door and to the loaves and fishes NOW.
These people will pay $1000 premiums per month - I work with these insurance companies and I see it happening daily in California - and in many cases their contractually agreed upon coverage will get denied.
The raw numbers cannot be denied, and cannot be resisted. The numbers - the the number of people with pre-existing conditions, their income, and their health insurance premiums - all clearly say that a large number of lower and middle-middle class will start paying fines, or going homeless, or leaving Massachusetts.
This is all out war on the middle class, and many will leave, and when they do, the rich will be paying more to support the health care-driven tax increases to support the poor and then the rich will start leaving and badebadebadethatsallfolks!
I hope this law is rigorously enforced. Tie it into SSN's and whichever SSN isn't insured, fine 'em. That'll bring quite a swift end to this law.
Re:Socialised Healthcare is the future for the US (Score:5, Interesting)
It's worth noting here that when I worked for a Lloyds of London medical malpractice underwriter, they refused to cover anyone in the US, partly because of the ridiculous culture of litigation, but also because they had determined that the majority of US medical care just wasn't up to the standards they expected in their other markets. The excessive litigation they could have coped with through increased premiums for Americans, but they found that the excessive incompetence made it more profitable to concentrate on selling cover in India and South Africa instead.
Your argument about food is also bogus. Food *is* elastic. If the price of potatoes is too high, I can buy pasta or rice or parsnips or I can grow my own instead. But if I was in the third world and had to buy medical treatment, I would have no choice in the matter. I can't shop around for some other cure when what ails me is brain cancer, nor can I fix it myself. If you really want a food and drink analogy, then you need to compare with water. Water is the one essential (and even then I'm sure there are some crazies who fuck themselves up by only drinking orange juice, or beer). You can pick and choose everything else, but you need water. Additionally, because of the infrastructure (pipes, pumping stations etc) required to deliver water, it is a natural monopoly just like electricity, local phone service, and so on. It is therefore no surprise that the price of water is regulated. If it wasn't, people would have no choice but to pay silly prices just like you poor sods do with medicine.
Factually dubious (Score:4, Interesting)
Hm, nominal spending is more than that. Now I don't know much about the NHS (other than that it doesn't work) but I do know a bit about government contracts in the UK, and I would be very surprised indeed if more than about 50-60% of that went on anything of even peripheral value to healthcare.
Here, the Times (rapidly becoming a tabloid but never mind) has something on it:
Annoyingly chatty but probably basically correct article. [timesonline.co.uk]
To put it another way, the UK NHS is like the US DoD; they're both ways to funnel money from the taxpayer to those who position themselves to recieve it. The NHS, however, which is regarded almost with veneration by most British people and which doesn't have to fight actual wars, is far more corrupt; buildings built, bought, sold and knocked down within the space of a few years, and so on. But the NHS long ago passed the point where it's powerful enough to keep going forever -- it's quite a political power broker in fact, which is why you *do* get reasonable free healthcare from it in much of Wales and Scotland.
Meanwhile, in England, health care does cost money -- you pay over the counter for even a basic dental checkup. You don't want to? Then take out some private health insurance. It's a fast growing sector in the UK. Good!
I imagine that there are people who find it hard to afford, though, what with all the taxes they're paying. And that's bad. But what can you do?
How to fix the US healthcare system (Score:3, Interesting)
1.Completely ban health insurance companies from specifying which treatment options a patient must take if they are to be covered (e.g. "you must use our preferred hospital" or "we wont cover you for that really expensive test even though the doctor says you should have it") or from charging differently based on what options are picked. This change doesn't mean they have to provide coverage for stuff like baldness cures (ala that one Simpsons episode) or whatever other non-life-threatening treatments they don't currently cover
2.Do whatever is necessary to increase choice of provider. If there are more options for people to pick from then we will see insurance companies competing for business (here in Australia, health funds spend big money trying to convince you to switch to their policy)
Those 2 provisions would be a good start in fixing the system. Feedback from those who know more about the system would be nice
Re:At least according to Michael Moore (Score:3, Interesting)
Also, I think the government should offer at cost liability car insurance.
Re:Socialised Healthcare is the future for the US (Score:4, Interesting)
In other words, the free market handles it just fine.
Not quite. There is tremendous variety in the ways people get food - anyone can even grow it themselves. Even without home-growing there are lots of ways to get basic nutrition really cheap (huge bags of rice and beans are pretty cheap).
The medical field, on the other hand, is highly regulated by the government causing a scarcity in the number of people who can practice medicine. Even if I have a lot of money I can't just go open a hospital because I'd have to staff that hospital with qualified doctors, nurses, physicians assistants, surgeons, specialists, and medical assistants. There are only so many people who are already qualified and the schools can only pump them out so fast.
So you have a situation where the supply is not very elastic and most of the elasticity in demand is to simply choose to get care or not. And often the choice to not get care early on means the overall costs, and demands on the system, will be much much higher when situation gets worse.
A friend of mine, for example, got a deep cut on his finger. Instead of going to the doc-in-a-box and get stitches, he decided to take care of it himself. A couple days later he woke up with a high fever and he was unable to move his entire arm. He ended up spending 3 days in intensive care and another 3 days under observation. The cut had gotten infected and the infection went systemic on him. Thankfully for him he had insurance.
Having insurance he should have gotten it treated right away. But so many Americans lack insurance that they couldn't afford the $300 bill to get the finger treated when it would have been simple. Such a person would also be unable to pay the several thousands of dollars the 6 days in the hospital would have cost. "The system" currently buries this cost in overhead.
In Oregon (where I live now), our former governor, who was an E-room doc, has been advocating for universal coverage here in Oregon. The models used by his team demonstrate that the overall cost to the system would be less by helping ensure people get small things taken care of before they become really big.
Mass. probably is hoping they can save on those overhead costs by making sure everyone has the incentive and financial capability to get insured.
furthermore, putting more citizens on the governments teet, eliminating the need for them to take care of themselves, to take resposbility for their actions, will hurt a country in the long run.
That's all fine for those who actually have the resources to divert directly to healthcare. But many don't - and because we as a society have decided that everyone can get emergency care, those people wait until small things become emergencies.
There are really only 3 choices: pay excessive costs for emergency treatment, pay moderate costs for preventive care, or simply turn away the uninsured and let them die in the streets (and have higher secondary costs such as higher threats of epidemics, higher crime, and lost potential as people end up living lives crippled and damaged when they could have been treated).
Other woes of the US system; (Score:4, Interesting)
Essentially, once you're diagnosed with a disease or condition, it's impossible to change to another provider because they won't cover pre-existing conditions. This means that if you leave a job (or are fired), you have to personally keep paying very high rates to your old company's provider in order to keep insurance. Your new employer (if any) will usually not take on those costs, because they have their own provider and plan - which you don't qualify for due to the pre-existing condition. It's a vicious circle.
However, I lived in Massachusetts as well, and I did like some aspects of the co-pay system there. In Canada, anyone can go to the doctor whenever they like, and it's free. So, you get mothers dragging their kids to the doctor every time they sneeze, and all kinds of other useless visits to hospitals and so forth. Having even a token co-pay (exempted for those below poverty) reduces needless visits. I think most visits on my plan in the USA were $10 or something, which is enough.
So - my ideal world would be the Canadian system, plus a small co-pay. Unfortunately most of Canada's best doctors move to the USA so they can get rich instead.
MadCow.
Re:Socialised Healthcare is the future for the US (Score:3, Interesting)
Not exactly my field of expertise, but the issue is clearly not so simple.
I live in Oregon and our former governor Kitzhaber (who was previously an ER Doc) made exactly that argument. We, as a society, by ensuring everyone can get emergency care, are incurring a certain cost. He argues, with more facts than I have readily available, that if more money were spent on basic healthcare the ER costs reduce by more than the money spent - resulting in a net savings.
He's involved in two major projects two that aim:
http://archimedesmovement.org/ [archimedesmovement.org]
http://wecandobetter.org/ [wecandobetter.org]
We basically have 3 choices:
1. keep spending more for ER treatment with only so-so outcome
2. spend more on basic/preventative health care and probably save more in the long run with better outcomes
3. stop treating people in the ER who can't pay for it, which may save money in the short term but will probably result in higher societal costs across the board (higher crime, more job insecurity, lost potential)
Socialized and Quality can coexist. (Score:3, Interesting)
Socialized healthcare works. I'm glad we use it up here and will never vote for a politician that even dares to dream dismantling it. That being said, Canada's system has some drawbacks which you should study and try to avoid. It's a tad off topic, so I won't go into too much depth. However, one of the biggest problems with socialized healthcare is drawing the line between necessary procedures/drugs that everyone is entitled to and procedures which they have to pay for themselves, while at the same time not making it inordinantly difficult to pay for those procedures.
If you want perfect teeth in Canada, you pay for it. Braces are not deemed a medical necessity. However, private dentist clinics are everywhere so this is not a problem. Lots of companies offer dental plans, and you can also buy private insurance very similar to medical insurance in the U.S.. Finding a place that will do esoteric cosmetic surgery that has no non-frivolous applications can be difficult. Facial reconstruction? No problem. Labia sculpting? Good luck. Also, good luck finding a company plan that includes boob-jobs. (To be totally honest, there is one bar in town that has gained notoriety for it's policy of funding breast augmentations for employees. Let's consider them an exception to the rule.)
Another, somewhat chilling aspect of socialized medicine is that the state has to do cost/benefit analysis when deciding what procedures to perform. If an ninety-year-old in the U.S. can pay for hip replacement surgery he or she will get it if it kills them. In Canada, the cost of the operation, the risk to the patient, and the low benefit (a ninety-year-old is statistically unlikely to get much use out of a new hip) may mean that the patient won't get anything other than a wheelchair. This is not a system in which the patient is always right.
Bludgers vs Battlers (Score:5, Interesting)
Unobtainium is worthless. Next up, a rant....(not aimed at "you" personally).
The Australian system is similar to the UK's NHS, so much so that we look after each others tourists for "free". I was an asthmatic teenager when the "establishment" told us universal health care was a communist plot that was crippling the UK and would bankrupt the country. 30+yrs later and we are far from bankrupt, we have "world class" prevention, care, teaching and research. I belive "the system" saved my son's life and it definitely kept me out of bankruptcy.
As for footing the bill for "non-taxpayers" (depending on political expediency the Australian term for non-taxpayers is either "bludgers" or "battlers").
I spent all of my 20's at the "trailer trash" end of the socio-economic scale. Happily, I am now in the "high income" bracket where I am supposed to "top up" with private cover for stuff such as dentistry and silcone tits - personally I prefer the extra $500 "fine" at tax time and pay for my own dentistry...anyway...When you do the math it turns out I am paying to cover 5-6 non-taxpayers, yet I have only two (grown) kids and I'm no longer married (to the lazy bitch...sorry...that just slipped out, see the "political expediency" comment earlier).
The reason I am not only glad but proud to pay the levy is that I hope the system works for those 5-6 people as well as it did for me in the past. The reason I don't buy "mandatory top up" insurance is because it is medicinal "fluff" that I can afford. Most of all I don't want a return to the partisan politics where one side refuses to acknowledge the inherent "social evil" in a system that can routinely take eveything the patient's family has, and then promptly hang the patient with red tape.
How do my costs compare to the cost of similar cover in the US?
From comparing notes with one or two US slashdotters in the past I belive my 1.5% levy on taxable income is considerably less than HALF of what similar cover (and care) would cost in the US, the exact ratio varies from state to state. Not very scientific I know, but I also know that the death rate from asthma in the US has now overtaken that of Australia, this is despite Australia having one of the highest incidence rates in the world. Make what you will of the facts and figures and competing "-isims", I know first hand it's not me and my five "battlers" who are getting "ripped off" [google.com.au].
Re:Socialised Healthcare is the future for the US (Score:3, Interesting)
Re:Yes its broken (Score:1, Interesting)
Now that's fantastic! Question is, which would you prefer?
Re:Socialised Healthcare is the future for the US (Score:2, Interesting)
Insurance in principal involves sharing risk. Recommend it for health all you want. Claiming it's a matter of trivial responsibility on par with personal hygene, clean clothing, and shelter is absolutely bogus. There's a reason the "white badge of honor" is a status symbol. Only the wealthy can afford skiing accidents.
My fun story (Score:2, Interesting)
Re:Nope. It's 105 billion pounds. (Score:3, Interesting)
I'm a little tired of this excuse.
Let's be honest here. If you are well-off enough to have your own health insurance in the US (and your procedure is covered, and they okay whatever procedure you need done, which are not always givens), then you don't generally have the huge waiting lists for elective surgeries like hip replacements because we have an insane number of specialists here. (Things depending on donations... well, good luck.) That's because there's a HUGE disparity in the amount specialists make versus the amount general practitioners make, so something like 70% of our MDs specialize, whereas in other countries the numbers are flipped or much closer to equal.
On the other hand, if you DON'T have your own health insurance, you either get to fight the Medicare red tape (which is new to me, now that my parents have retired, and it is truly impressive) or you don't get it at all.
Add on to that all the uninsured and underinsured people who are raising health care costs for everyone in the United States by being unable to pay for basic preventative check ups or procedures and letting medical situations go until they reach crisis stage, and really? We're not doing ourselves any favors.
I was married to an Australian. My Australian in-laws have both government and private health insurance, and it's not exactly breaking the bank for them. On the other hand, back here in the good ol' US of A, if I'd wanted to add my husband to my health insurance provided by my workplace because it was better than his, it would have cost us $300 per month. We were both in our twenties at the time. I can't even imagine what adding kids to that plan must cost. (Adding me to his plan was cheaper, but his plan was worse.)
I'd also like to comment that I spent several months in Australia about 5 years ago. Inevitably, I picked up a few illnesses while I was there, so I saw a doctor. Not being a citizen, I had no insurance coverage. Cost for an office visit? $20 Australian. At the time, that was like $13 American--which is about what I'd expect to pay as a copay with my private insurance in the US. Right out of college, I was uninsured, and I can tell you that the uninsured office visit price for my local doctors was between $60 and $80 per visit.
So we can keep our system where we're all currently paying out of our noses for a health care system that ranks something like 37th in the world with costs that are spiraling out of control because there are no real limits on what doctors and hospitals and drug companies and insurance companies can charge, or we can institute something that gives every person some basic level of coverage, eliminating some of the really expensive medical procedures that come about from lack of medical care (for example, the amputation of a leg of a diabetic who should have been having regular medical check ups), which MIGHT end up with slightly longer waits for some people to see specialists for elective surgeries.
Of course, since we currently have more specialists than you can shake a stick at, and many of those people who would have to wait are the same people who wouldn't even have a chance in hell at even getting basic health care right now, I'm not really seeing the big downside here.
Re:Bludgers vs Battlers (Score:1, Interesting)
Re:Bludgers vs Battlers (Score:3, Interesting)
The rich and the poor have no problems. the guy just barely making by and not below the poverty line get's screwed hard as now he has to come up with $100-$300 a month to buy the mandatory health insurance.
It's a "law" designed to screw people into buying an overpaid and under delivering service.
They want it fair, then they can raise the taxes in that state and give the insurance FREE to everyone. make the "healthcare tax" a percentage of gross income and call it done.
That will never happen as the jerks that passed this law are the same rich jerks that evade 90% of their taxes and are against a flat tax of any kind.
"Freedom", the magic word (Score:2, Interesting)
you guys have it tough! The problem to me seems to be that Americans are wedded to 'freedom'. I'm quoting the word on purpose. In many ways I am more free in the Netherlands (can smoke dope, can afford healthcare, will have at least 25 days of vacation a year etc...). But... I pay more taxes, on pretty much everything. The state decides; if I don't pay, I go to jail. I have no choice not to insure my health; i'm not free!
You in America are more free in that respect. Unfortunately, you are also f***ed over by pretty much every large company that's out there, be it Wallmart, Microsoft, big Pharma, you name it. But you are 'free' not to be their customer. Yeah right! You have to eat, you have to have healthcare etc....
The word freedom is the red flag for the American bull. Any time anyone (typically Democrat) suggests anything that might actually improve the living of the Americans (healthcare, labor laws), all any Republican has to do is spout some crap about loosing "freedom", and everyone backs off; oh dear, don't want to lose my "freedom".
A more rational approach would help the U.S. people a lot. It used to be that the U.S. was the shining example for the world, but that definitely has passed.
Good luck
Bart
Re:Bludgers vs Battlers (Score:3, Interesting)
P.S: Politicians may be sleezy but at least Massachusetts DOES have a flat tax. http://en.wikipedia.org/wiki/Massachusetts#Econom
Quite a bit higher than in the US... (Score:2, Interesting)
You can get affordable health insurance - with the ability to go to ANY doctor - if you look for it. Too many in society just expect it to handed to them, or refuse to actually do some basic research. In my case, it meant calling an insurance broker out of the Yellow Pages, and talking for 5 minutes.
Affordable health insurance is available if you just look for it. Given that - worst case, after maximum deductibles - I'm responsible for $3500/year. About half the UK average. And I don't have to wait to see a doctor, don't have to deal with queues, get to choose - and stick with - my doctor, and have a very affordable copay.
My last contract gig offered health insurance; I was shocked how many of my fellow contractors took it! By turning down the insurance, I was able to negotiate for an extra $4/hour, which means that AFTER I paid for my own health insurance, I'm still up $550/month in income...
Re:Socialised Healthcare is the future for the US (Score:3, Interesting)
Riddle me this, how is a lifestyle responsible for someone getting leukemia? It sounds to me like you think they have a choice in the matter. Does someone have a choice in the expression of a genetic disorder?
Also, if you pay taxes you would be paying for the effects of your lifestyle, and everyone else's. But everyone else would be paying for the effects of your own. It's this socialist idea of sharing the cost amongst everyone.
Details unclear (Score:3, Interesting)
Re:Socialised Healthcare is the future for the US (Score:5, Interesting)
How does one do that again? My wife worked from the age of 13 and continued for 40 years. During that last year she started becoming fatigued and feeling pain. Her attendence at her place of work suffered and so did mine because I would stay to take care of her when she hurt too badly to get out of bed. This was gradual, first it was what seemed an isolated incedent, then it became every other week. She was seeing a doctor and her diagnosis at that point was lupis.
Finally she had an incident where her leg suddenly lost feeling and she dropped on the stairs at work. She suffered no direct injuries. Wendy was already on final notice for attendance and in too much pain to return. After six months Sony stopped paying her disability benefits and claimed there was nothing wrong with her. She applied for social security disability.
Because there was now one income in the home and not two we couldn't afford to keep the house and lost it. We moved to small town IL with my family. I got a job but Wendy could not. While there I paid cash (her old insurance policy was tied to her employer and no new policy would cover her condition) for her doctors and medications. Her diagnosis became MS and then finally settled on Fibromyalgia.
Predictably the only insurance she had left, Social Security, denied her claim. They had sent her to their doctor, who agreed with her fibromyalgia diagnosis but they denied anyway. She appealed and they denied it on review. She went to a hearing, the judge decided she just had arthritis, which while disabilitating is not one of the conditions approved for disability. Oh yes, the judge also decided she smoked and therefore must be evil.
We appealed on the grounds that the judge was reaching her own medical opinions and not ruling based upon the medical opinions of those actually qualified to reach them. Social security denied the appeal upon review (our lawyer told this that they always do before we even filed it). We filed an appeal to the federal level. Wendy quit smoking. She and I moved back to Florida but kept an address in Illinois to avoid the several month delay that a change of jurisdiction would introduce in the process. She began seeing a specialist, this time the specialist actual wrote the exams the specialists take on Fibromyalgia. This doctor evaluated her independently and also diagnosed her with Fibromyalgia. The federal court has a staff that screens cases, the ruling of the Judge exhibited extreme biased and she played doctor so the federal court summarily sent the case back for retrial without seeing Wendy.
We went back to Illinois again. The judge upheld the previous judges ruling and failed to consider her new doctor, despite him being 'imminently qualified' because he hadn't been seeing her long enough (3 months). Naturally we appealed again, social security denied again, we appealed back to the federal courts, and once again the ruling was deemed bad enough that they simply sent it back for retrial. This time social security sent it back to the same judge who ran the first trial.
That saga is coming soon and we expect another cycle of rinse and repeat. We have appealed to a senator in IL and if the federal court doesn't overturn the ruling this time we will move the jurisdiction to Florida in an attempt to get a fair hearing. It is obvious that social security is biased toward rejecting claims and their judges are also biased toward rejecting them.
Wendy filed her claim six years ago. She worked for 40 years without any interruption of more than 30 days. Her diagnosis has been confirmed by 2 general practicioners and two specialists (including SS doctors). Two social security career experts have said that if the limitations specified by her doctors are correct Wendy would be unable to work any job.
Wendy had a good job, insurance, she had a retirement plan in addition to social security (already burned through paying expenses out of pocket. So you tell me, how was she supp
Re:Socialised Healthcare is the future for the US (Score:3, Interesting)
How can we be an example to the rest of the world if our own country is in such poor condition?
Simple: The US has long ago stopped being an example. As a European I can say that most people here that have actually looked at the US find it backwards and vastly inferiour in quality of living, education, infrastructure and other aspects. Not to want to look down on your country, but I believe one primary reason for this is that most US citizen still believe the US is the "greatest country in the world". It is not. In most respects by a fair margin. In some by a drastically large one. There is a lot of work to be done to bring the US into the 1st world. I hope you make it. And yes, being a member od the 1st world does includes reasonable healthcare for everybody, regardless of wealth.
Lower Doctor pay doesn't show up until years later (Score:3, Interesting)
However, the newer, younger doctors, were unable to start practices as easily in the 80s, as it became difficult to get on the HMO lists, etc. More of them work for the older doctors for lower pay, more work at hospitals, coops, clinics, etc. Doctors make less money.
But, you won't see the effects for decades... you SEE it in Canada and Britain, whose single payer systems are starting to suffer, badly. The best and brightest don't go into medicine, or leave for the US, you're importing your Doctors.
Why don't you see it for decades? Let's look at the status quo...
Imagine you're a 45 year old specialist, making great money, $500k/year. You're living on $400k, putting away $100k, and planning to retire in 5 years at age 50. Now, your income is cut by the HMOs by 20%, you're now making $400k, living on $400k. You now have to wait for your older investments to fund retirement, so you wait until 60. Nobody is going to shed a tear for this guy, but the income cut kept him in practice an extra 10 years, so you see an increase in doctors.
Now, shouldn't less income mean you work less, or find other work, it depends. If you're a 21 year old biology major junior, you might decide that instead of spending 4 years in medical school and 6 years in residency, you'll spend 3 years in law school, expecting to make more money. Sure SOME Doctors make half a million, but lots "get by" at $100k-$200k... sure that's a lot of money, but remember that they have an extra $200k in education, plus 6 years as a resident to specialize in elite specialties. So at age 32 they are making $100k+, but all their friends that went to law school are making $100k+, and have been working for 7 years, own a house, etc.
Another scenario, you're 31, in your 5th year as a resident for your specialty, and the HMOs start chopping pay. Now, if you could go back at 22, you might decide to go to law school and be on your way at 25, but if you switch to law school now, you'll be 34 when you finish, competing with 25 year olds. You do your 6th year and suck it up and bear.
When pay cut, the older doctors stayed on longer, so we saw no shortage. The people in the residency track trucked on, because the "wasted time" is a sunk cost... Those in their 1st year saw the changes, and cut their losses and went into family practice. Others in med school found specialties that didn't take 6 years before you earned a living.
Basically, for a good 10 years after the HMO crack-down, we had a surge in doctors, as retirements got delayed. We also kept all our doctors in the pipeline because their next best alternative sucked. A 4th or 5th year resident was better off spending 2-3 more years to complete their specialty than they were switching to a new option...
However, in another 10 years, we're going to see the consequences of cutting doctor pay... we'll have more intelligent lawyers, and less intelligent doctors. We'll import doctors because American doctors are still better paid than British or Canadian doctors, and they'll import doctors from India who speak fluent English and find the British/Canadian doctors paid better. However, this model isn't sustainable.
If you compare most doctors in their 30s with those in their 50s, really talk to them, the former are NOT as intelligent as the latter. We have a decade or two of doctors that aren't that bright (the brightest got a JD), and we're going to lose our elite older doctors to retirement.
I'm really excited to see if the Massachusetts experiment works. Each state needs to tailor theirs differently, New York with its