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Why Are American Doctors Paid So Damn Much?

Mother Jones

Conservatives have picked up today on a Kaiser Health News piece reporting on doctor complaints that insurers plan to pay them less for Obamacare patients than for other patients:

Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors. But many primary care doctors say they barely have time to take care of the patients they have now.

Matt Yglesias is unsympathetic. He says American doctors are very well paid and should quit griping: “If we ever reach the point where American doctors have been squeezed so badly that they start fleeing north of the border to get higher pay in Canada, then we’ve squeezed too hard. Until that happens, forget about it.”

That’s pretty cold. But if you really want to know what’s going on, take a gander at the chart below. It’s from the OECD, so it includes all of the world’s relatively rich countries:

That’s damn peculiar, isn’t it? If Econ 101 is to be believed, higher pay should produce more doctors. And yet, even though the United States pays doctors far more than any other country on the globe, we’re in the bottom third. We have more doctors per capita than poorish countries like Mexico and Poland, but far fewer than Belgium and Britain and Germany—all of which pay doctors considerably less than we do here. So what’s going on?

As Matt says, the basic answer is that U.S. doctors operate as a cartel. They artificially limit their own ranks, which drives up their compensation:

What we really ought to be doing is working to further pressure the incomes of doctors through supply-side reforms. That means letting nurse-practitioners treat patients without kicking a slice upstairs to an M.D., letting more doctors immigrate to the United States, and it means opening more medical schools. Common sense says that since the population both grows and ages over time, there should be more people admitted to medical school today than were thirty years ago. But that’s not the case. Instead we produce roughly the same number of new doctors, admissions standards have gotten tougher, and doctors have become scarcer.

This is yet another reason not to shed too many tears for doctors. They’ve basically brought this on themselves. If the market were allowed to produce as many doctors as there’s demand for, they’d already be getting paid less. Right now they’re enjoying the substantial rents that come from squeezing their own supply, and they’ve fought like lemmings for decades to keep it that way. You can hardly blame them for that, but there’s no reason the rest of us should put up with it. It’s time to fight back.

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Why Are American Doctors Paid So Damn Much?

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6 Things You Might Not Know About Bill de Blasio, New York’s Mayor-in-Waiting

Mother Jones

Come Tuesday night, Bill de Blasio will likely be the first Democratic mayor-elect of New York City in two decades. De Blasio is expected to crush his Republican rival Joe Lhota. Most national attention has focused on the implications of de Blasio’s win for the future of big-city liberalism, contrasting the humble Park Slope public advocate with Wall Street-friendly billionaire Michael Bloomberg. The city’s rich denizens are supposedly quivering with fear that the new Democratic mayor will hit them with a small tax increase to fund universal pre-K, though Gov. Andrew Cuomo is poised to squash any tax hikes from NYC.

Here are several fun facts about de Blasio that you might have missed amid the class warfare.

He was born Warren Wilhelm, Jr.:

De Blasio has a fraught relationship with his deceased father. A navy vet who lost his left leg in World War II, Warren Wilhelm fell prey to McCarthyism in the 1950s. His career as an economist at the Commerce Department derailed when he and his wife were questioned about their views on communism. Wilhelm Sr. later became an alcoholic and de Blasio’s parents divorced. “The pain he caused people, even if he didn’t mean to, just so many people were badly affected,” de Blasio said in an interview with The New York Times. “I think I really was angered by that.” By the end of high school the he had ditched his given name and opted for his childhood nickname Bill and his mother’s maiden name.

He worked on Hillary Clinton’s 2000 Senate campaign:

De Blasio managed Hillary Clinton’s first run for office, but it ended poorly as the Clintons came to view him as weak and indecisive. Longtime Clinton pal Patti Solis Doyle was brought in from Washington to spearhead the final months of the campaign. Per The New York Times:

Despite having the title, Mr. de Blasio hardly fit the profile of a traditional campaign manager.

While he had a say on all sorts of matters, including finance and personnel, he did not have signoff power on many key issues, and did not enjoy the same access to Mrs. Clinton as other advisers, according to more than two dozen people involved in the race. Then still the first lady, she often relied on a team of White House aides she had known for years.

It doesn’t seem like there are too many hurt feelings, though. Both Hillary and Bill endorsed de Blasio, but not until he’d already secured the Democratic nomination. Hillary also headlined a million-dollar fundraiser for de Blasio in late October.

His was a lefty activist in his 20s:

De Blasio got his start in progressive politics by supporting the Sandinistas in Nicaragua during the 1980s:

Mr. de Blasio became an ardent supporter of the Nicaraguan revolutionaries. He helped raise funds for the Sandinistas in New York and subscribed to the party’s newspaper, Barricada, or Barricade. When he was asked at a meeting in 1990 about his goals for society, he said he was an advocate of “democratic socialism.”

He worked as a political organizer at the Quixote Center in Maryland for his first job out of grad school, soliciting donations to send to Nicaragua.

He worked out at his local YMCA during the campaign:

Hard to imagine Bloomberg working up a sweat at the local gym. From New York magazine:

If I needed any further indication that the city is on the verge of a radical change in mayoral style from Bloomberg, who seems as if he were born in a pin-striped suit, there’s the 52-year-old De Blasio himself: He’s just back from his daily workout at the 9th Street Y and wearing a frayed, sweat-soaked blue T-shirt and baggy gray sweatpants.

He was evicted from his first New York apartment:

He moved to SoHo in 1983 but couldn’t stay there since the apartment was an illegal sublet. Perhaps that experience will make him more sympathetic to those city residents who lack affordable housing than New York’s current mayor.

He’s not a Yankees fan:

In fact, he roots for the Bronx Bombers’ despised rival, the Boston Red Sox. De Blasio must be feeling confident heading into the election, since he couldn’t help himself from bragging about the Red Sox’s World Series success, even when he campaigned in the Bronx.

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6 Things You Might Not Know About Bill de Blasio, New York’s Mayor-in-Waiting

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Elizabeth Warren: Why is the Government Backing Expensive Private Student Loans?

Mother Jones

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On Monday, Sen. Elizabeth Warren (D-Mass.), demanded that Ed DeMarco, the head of the Federal Housing Finance Agency (FHFA), justify why his government agency is supporting the super-high-interest rate private students loans that are drowning many Americans in debt.

For the past few years, one of the Federal Home Loan Banks that DeMarco’s agency oversees has been funding Sallie Mae, the largest provider of private student loans in the country. Warren wants DeMarco to explain why.

The Federal Home Loan Banks were “intended to bolster the banks’ support for the housing market—not to be a backdoor way to subsidize highly-profitable private student lenders,” Warren wrote in a letter to DeMarco sent Monday. “It is deeply worrisome that the Federal Home Loan Banks may be undermining their mission by extending billions of dollars in cheap credit to private student lenders.”

Sallie Mae has an $8.5 billion credit line from one of the FHL Banks at an interest rate between 0.23 and 0.34 percent. But Sallie Mae charges students taking out loans a rate that is 25 to 40 times higher. Sallie Mae “was able to borrow at less than one-quarter of one percent interest because the government’s sponsorship of the Federal Home Loan Banks allows them extraordinarily cheap access to capital,” and yet took in about $2.5 billion in student loan interest last year, Warren noted.

In the letter, Warren asked for documentation detailing FHL banks’ funding of Sallie Mae and other private student lenders, and any analysis the FHFA has on the impact of student debt on homeownership. (A Consumer Financial Protection Bureau report found that student loan debt is a huge barrier for Americans trying to buy their first homes.)

Total student loan debt in this country currently stands at close to $1 trillion. Most of that is federal student loan debt, not private, which means those loans have lower interest rates. But that may change soon; student loan interest rates are scheduled to increase from 3.4 percent to 6.8 percent on July 1. Members of Congress—including Warren—and the president have come up with a bunch of different schemes to avoid that interest-rate jump; Warren’s year-long fix would give students the same close-to-zero rate that banks pay to the Federal Reserve for short term loans. But no deal is nigh.

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Elizabeth Warren: Why is the Government Backing Expensive Private Student Loans?

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