The Problem of Doctors' Salaries - <AUTHOR> https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557 <comment><USER2> Doctors are part of a guild. They artificially limit the number of doctors available by capping the number of medical schools, which also allows the existing schools to crank costs to astronomical levels ("don't worry, you'll make enough to pay it back").

One thing that would help is letting non-MD's, such as nurses or physicians assistants, do more "doctor" things. Dentists, a similar profession, is going apeshit that states are trying to let specially licensed assistants (but non- DMDs) do slightly more advanced work like fill cavities.[0]

The entire health system from top to bottom would benefit immensely from free market forces.

[0] [http://www.mercurynews.com/2017/07/01/dental-lobby-bares- tee...](http://www.mercurynews.com/2017/07/01/dental-lobby-bares-teeth-on- care-laws-2/)

<comment><USER3> > Doctors are part of a guild. They artificially limit the number of doctors > available by capping the number of medical schools

They do not. You may be confusing the AMA (which less than 25% of doctors even belong to) with the AAMC. The latter does cap the number of medical school positions nationwide, but they've also made a concerted effort over the last ten years to increase that number steadily.

But even if they eliminated that cap entirely, it wouldn't matter, because the number of medical school slots isn't a bottleneck for the number of practicing physicians. The number of _residency_ slots is, and the funding gap for that comes from Medicare, which is responsible for funding them.

Unless more residency programs are funded, increasing the number of medical school positions would simply increase the number of people who have medical school debt and aren't licensed or trained to practice medicine, which would be even worse,

> which also allows the existing schools to crank costs to astronomical levels > ("don't worry, you'll make enough to pay it back").

Hardly - in fact, there's already been significant downward pressure on these, because the debt level is already at the tipping point. Today, the typical person who enters medical school can expect to pay off their medical school debt in their 40s. That level of debt load is already having a negative impact on qualifications for medical school applicants (who wants to be past child- bearing age by the time they've paid off their debt, when they can just go into another better-paying field without any of that)?

<comment><USER4> Is this part of the article incorrect?

> In recent years, the number of medical residents has become so restricted > that even the American Medical Association is pushing to have the number of > slots increased. The major obstacle at this point is funding. It costs a > teaching hospital roughly $150,000 a year for a residency slot. Most of the > money comes from Medicare, with a lesser amount from Medicaid and other > government sources. The number of slots supported by Medicare has been > frozen for two decades after Congress lowered it in 1997 at the request of > the American Medical Association and other doctors' organizations.

<comment><USER5> Or you know, hospitals with residency programs could just use of the massive insurance money they make to fund residency positions. It's not like the residents aren't employees or something.. Even the medicaid/medicare procedures are reimbursable.

<comment><USER3> > Even the medicaid/medicare procedures are reimbursable.

Medicare reimburses rates below-cost. About 7% below COGS, which means they lose money _per-patient_ , even before they have to pay doctors, nurses, janitorial staff, etc.

> Or you know, hospitals with residency programs could just use of the massive > insurance money they make to fund residency positions.

The "massive insurance money" is used to subsidize the losses that hospitals make on Medicare patients.

> It's not like the residents aren't employees or something

Great point. And that's why companies generally don't hire employees unless they work they do is profitable for the company. As it turns out, residents are _not_ profitable for hospitals, which is why hospitals don't "just hire more of them".

<comment><USER6> > As it turns out, residents are not profitable for hospitals, which is why > hospitals don't "just hire more of them".

This isn't quite in line with reality. If you familiarize yourself with specific hospital system figures, you find gems like this: Of Beaumont Hospital's 395 residents, 91 are not covered by Medicare and so are paid for by Beaumont. The $57 million for GME represents 4.73% of Beaumont's net patient revenue in 2013, or about $189,368 per resident. [0]

The 91 residents that are trained within the hospital system without medicaid funding speaks to the fact that residents are in fact employees. [0] [http://www.modernhealthcare.com/article/20150719/news/307199...](http://www.modernhealthcare.com/article/20150719/news/307199999)

<comment><USER3> > The 91 residents that are trained within the hospital system without > medicaid funding speaks to the fact that residents are in fact employees

...nobody ever said that residents weren't employees? The point is that they _are_ and hospitals aren't going to go out and hire more unless it's profitable for them to do so. (Which it isn't, or else they would have done so, and that article even says as much).

</comment></comment></comment></comment></comment></comment></comment><comment><USER7> All of my close friends are doctors and the toll that school and residency does on the body and mind is honestly shocking. I'd want to open up the residency and med school programs for nothing else but to not force our young doctors into 24 hour shifts. They're treating these young doctors like it's Hell Week in a fraternity, and the main excuse you'll get from the AMA is because that's what they (the older doctors) did so all of this fanfare is a right of passage towards full membership (attending physician) which unlocks all of these riches to justify sacrificing your youth for.

To me, that's a much better narrative to support increasing the number of doctors than "they get paid too much." Instead, this article reads like a con artist who is using slight-of-hand to distract you from the watch he's taking from your pocket. The trick is the doctor's salaries, but the real stealing is happening from the health insurance companies.

The article mentions how many billions of dollars this "problem" impacts the Federal budget. "Billions" \- it's a large number in absolute terms, but relative to the problems with our inflated military budget ($850B), it's a pittance.

What I'm trying to get at is this feels like the kind of thing a propaganda outlet would do to give you a false enemy to hate. Even if the premise is grounded in truth (that US doctors are paid twice as much as everywhere else), it just feels like the wrong villain.

<comment><USER8> The 24 hour shifts are there because it results in a higher standard of care for patients with life threatening and time sensitive treatment schedules. If they worked in 8 hour shifts, there would be a handoff and loss of information at each shift change that resulted in worse outcomes. It's a fairly well studied phenomenon. My SO is in med school right now and they just changed the regs from 16 hour shifts back to 24 hour shifts.

<comment><USER9> But there would still be a loss of information after 24 hours. Improving quality means upping the shift to 96 hours. We should encourage doctors to not sleep as sleeping means loss of information.

This totally makes sense.

<comment><USER10> So it's not reasonable for a person to work 96 hours. But apparently it is reasonable for 24 hours. The goal is to minimize information loss while maximizing performance. There's a tradeoff. Apparently 24 hours is a local max in this tradeoff.

</comment></comment></comment></comment><comment><USER11> [https://www.cdc.gov/nchs/fastats/health- expenditures.htm](https://www.cdc.gov/nchs/fastats/health-expenditures.htm)

The US spent 3.2 trillion on health care in 2015. 100 billion is 3.12%. It doesn't seem like that big of a problem. This article is just capital scapegoating labour as the source of the inefficiency and insane costs that is particular to the American Healthcare system. If you want an honest discussion, look to the heart of the issue, which is the fundamental incompatibility with effective healthcare and America's fetishism of libertarian market dynamics. I mean even in the Swiss healthcare system which maintains private insurance participation, family doctors on average earn CHF 198,000/USD 201,732.

This is just a hit piece by big Pharma trying to squeeze dollars out of labour and we in tech who went through 4 years of schooling to collect comfy salaries for a few hours a day of productive work, we in tech who love to bash H1B's and foreign grads for increasing our competition, and we in tech who seldom reckon with real human suffering, fear, and death in our line of work, are absolutely eating it up. I absolutely look forward to the time when the squeeze comes and companies pivot to blaming us as the reason for the high costs of goods or as the limiting factor stopping execs from achieving the revenue gains they promised investors.

<comment><USER12> If we spend $3.2TR on medicine and roughly 50% of that is 'overspending', as the article suggests. Then we have roughly $1.6TR in systematic inefficiencies. If the misapplication of occupational licensing for doctors are $100BN of that or 1/16th. What, specifically, is the other 15/16?

I think that author makes a good effort to itemize at least one of the components, now we should be asking what the rest are.

<comment><USER13> Could be wrong but I have a feeling that most of the other costs are related to either mitigating or fighting malpractice lawsuits. Do any other countries have a lot of medical malpractice lawsuits besides the US?

<comment><USER12> Unlikely. Some quick googling gives an annual cost of $55BN for malpractice. Still, including the above, we're now at 1 / 10 of the overage.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/)

</comment></comment></comment></comment><comment><USER14> Software practitioners could learn a lot career-wise from our counterparts over in medicine. Here's a profession with salaries more consistently high and more commensurate with the value they provide, where they're not as worried about global competition, and where ageism is not a factor. They have strong professional organizations who not only set competence standards and control labor supply. They lobby the government to mitigate competition and legislate who-can-do-what, with results very friendly to M.Ds. This is in stark contrast to the free-for-all race-to-the-bottom that characterizes tech labor.

I'm not sure what an "AMA for software developers" would look like or do, but I'm pretty convinced a strong organization would be overall beneficial.

<comment><USER15> This will never happen as long as we continue to have a broad distrust of academics and fetishize the hacker with no formal training. We don't value ourselves as a profession and so we reflexively reject the idea of forming a professional organization. There's also the fact that a significant portion of software developers have no or sub-par formal training and are insecure about their ability to pass any rigorous standardized testing, and so there's some measure of self-preservation involved in rejecting a formal licensing body.

<comment><USER16> I've been repeatedly denied by gatekeepers disinclined to let me inside

They say stay at the perimeter. Keep to the outer limits. They're the ultimate limiters. Competitors can't get in it.

If we can't even begin, they keep taking the win. We stay thin like we've been. They keep raking it in.

Good luck plucking a chicken or an egg from nothing. Success flows to success, and so far I hear no clucking.

I've jumped through enough hoops in my lifetime. More exclusion? No thank you. If we take cues from anyone, let it be tradespeople, e.g. apprenticeships.

</comment></comment></comment><comment><USER17> Going against the popular opinion.

Sure, but when the salaries are too low like they are in Southeastern Europe doctors don't want to schedule surgeries($500+), do a proper look-up ($50-100) or even bother to check on you or when an inadequate doctor/nurse/practitioner checks on you or does a procedure and screws up what happens? Nothing. Tough luck pal. Healthcare is public, you're required to pay for it and it's deducted from your salary. What do you get in return?

Two nights ago I brought my girlfriend's sister to the ER, her appendix was inflamed, she couldn't walk, talk or move due to pain and was left waiting for an hour. They did blood work and gave her an IV and sent her home, told her "we cured you" after another blood work was completed and her leukocytes dropped a bit. No ultrasound, ct or anything advanced, they haven't even properly checked her stomach. Her leukocytes were >19000.

I was later told by a friend that I need to give a 50 to the nurse to push her through the line and another 100 to the doctor. Great world we live in.

Don't get me wrong, but I think you should not fix something that is not completely broken. Your doctors still do their work and don't expect money, expensive gifts, bottles of whiskey and roasted pigs like they do in my home country.

In my country number of doctors you're allowed to have in a Clinic/ER/Urgent Care is proportional to the number of people living in the region. There is 1.3 gynecologist on a region of 10,000 people. Is that normal? My grandmother has to schedule a month and a half in advance to get her prescription medication and check ups are every two-three months. Not sure how it is in the States now, but in my 10 year tenure there and 10 times I was in the hospital, I never waited for more than 10-15 minutes after my scheduled time.

<comment><USER18> > Going against the popular opinion.

> Sure, but when the salaries are too low like they are in Southeastern Europe > doctors don't want to schedule surgeries

Nobody is saying to pay doctors according to undeveloped country standards. We're talking about developed countries with similar if not better health outcomes.

<comment><USER17> You're not getting my point.

Salaries for doctors are too low for the Southeastern Europe standard. The whole point I was making is that you should not lower it as per your standards. It's good as it is.

<comment><USER19> The point the article is making is that the US is getting significantly lower value out of their doctors than other comparable countries. They pay doctors more and get worse outcomes, which points to the conclusion that the doctors are overpaid for the value they provide.

<comment><USER17> The point I am making is that you can pay less and get the value I mentioned in my original comment.

</comment></comment></comment></comment></comment><comment><USER20> It's too bad this is the case. My experience with the medical professionals in my area isn't particularly positive. Many of them just look up symptoms on some kind of medical Google and regurgitate what the screen says.

I had RSI in my wrists for years. I had several different diagnoses, and none of the treatments worked. Finally I found Dr. Sarno's book and my RSI has been gone since then.

I guess my point is - we pay these people a lot, and they aren't even particularly competent at what they do. I'm sure the Mayo Clinic specialists are, but those folks are making more like 500k a year. To be competent.

<comment><USER21> I understand that feeling of incompetence when you watch them look up symptoms in front of you. But think of it like a programmer digging into a language's documentation or a structural engineer looking up calcs in a load table. You can't be expected to remember every single detail. And it requires tons of experience to trust the result you've chosen. In other words, would you rather have a practitioner that works purely from memory, or one that checks their assumptions against the corpus before making a diagnosis?

<comment><USER20> If I hire a web application developer who says they are proficient in JavaScript, I expect them to be able to get moving without checking documentation constantly. Certainly they should check it to confirm a hypothesis or to jog their memory on individual API calls, but any decent senior programmer need not check the docs for simple things, or at least they will start with an idea of what they are looking for "I know there's an API that does this..."

The doctors I encounter are the equivalent of a junior developer right out of code school, checking the docs for everything. That might be OK, if we were paying them commensurately with their value add.

<comment><USER22> To be fair, the web developer's work probably doesn't lead to someone else's health decline or death if they misremember something.

<comment> xkcd-sucks Yeah, if my bugfix was scheduled three months out and had to be figured out, implemented and merged during a half hour appointment without making things worse-- I would read the docs for literally everything, and probably copy- paste from them to avoid typos

</comment></comment></comment></comment></comment><comment><USER23> The article failed to mention the high cost of medical school, high interest rates for loans, and being phased out of interest deductions from earnings (which are capped quite low IMO to being with). My wife attended a Big 10 university medical school, costing around 50K/year, graduating with around 200K of debt, added to her 50K of undergrad debt, deferred through most of training, making 50-60K as a resident and fellow, looking at a 2000+/month expense for P&I on those loans. We've re-financed it, but the rates are still quite high relative to car loans, home mortgage etc., so of course this reality of essentially carrying a second mortgage of debt, was a factor in her choosing to go into a specialty, with additional training (fellowship), and moving to a lower cost, higher demand (higher wage) area. We pay 15K+ INTEREST annually on those loans and we are phased out from deducting any of that. If undergrad was less expensive, or free as it is in other countries, if med school was less expensive, doctors could enjoy the same quality of life with less salary.

<comment><USER24> Isn't the important statistic when break even with someone who makes less but started saving earlier with less debt (say only college debt). I haven't run the numbers but 250k in debt doesn't seem so bad if you make 300k after you finish at 32, compared to making $100-150k with 50k debt starting at 22.

You could also compare the opposite, if you have 250k at 19 is it a good investment to go to medical school or take a less lucrative job and just invest the 250k in index funds, I'm guessing medical school still comes out on top, maybe after 20 years.

<comment><USER25> I agree with your point. I never understood why making >150K starting at the age of 32 with a debt of about ~300K is an insurmountable burden. I have a close friend who fits the above profile. She actually makes about ~200K/year (after tax and everything, she nets about 100K); her work hours are nothing unusual--~9-10hours. With this rate, she can comfortably pay off her debt in ~10 years top.

<comment><USER26> 1\. Because they might burn out or change career to homemaker before they make that money.

2\. Because when they make $300k/yr they feel entitled to spend $250/yr or more

<comment><USER24> Changing careers is definitely an issue when you end up with 200k+ in debt. Although, even without the debt 10 years has a large opportunity cost. However, not saving because you make money is up to you, if you want to live lavishly to make up for the 2 decades living like a student who is to say thats wrong. You'll obviously end up with less savings but if your a doctor I think you can figure that you.

</comment></comment></comment></comment></comment><comment><USER27> "The number of slots supported by Medicare has been frozen for two decades after Congress lowered it in 1997 at the request of the American Medical Association and other doctors' organizations."

Wow, just wow..

<comment><USER28> More students are accepted to medical school than there are residency spots available.

See "Figure 1" [http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match- Re...](http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and- Data-2017.pdf)

<comment><USER29> That's by design, and not in some secretive, nefarious way. People will drop out of med school.

There is also a lot of residency spots that go unfilled. I know infectious disease is struggling to get bodies into spaces.

<comment><USER30> The drop out rate for med school is under 5%. Infectious disease is a 3 year fellowship that's done after completing a 3 year internal medicine residency. Oddly, the average salary for infectious disease specialists is lower than that of internal medicine physicians. Economically, it doesn't make sense for internal medicine physicians to spend 3 years doing a fellowship only to make less money on the other end. On top of that, these physicians are missing out on an attending's salary during those 3 years of fellowship.

</comment></comment></comment></comment><comment><USER31> 1) Physician salaries have been decreasing relative to inflation for the last 30 years. Decrease it further, and opportunity cost will drive smart talented people away from healthcare.

2) Physician education and training are fundamentally different from nursing education. Not just in duration, but also in mindset. Doctors think through medical problems through a physician mindset, and nurses think through nursing problems through a nursing mindset. Simply letting nurses make medical decisions without the proper frame of thinking has been proven to have higher rates of complications and misdiagnosis and physician consultations.

3) The main driver of healthcare costs is not physician salary. More attention needs to be paid to equipment, capital infrastructure, nursing staff, administrators.

</comment><comment><USER32> One problem not covered by this story: it takes too many years to acquire a medical degree. In India, you can go to medical college right after graduating from high school. It only takes 5 years in the medical school to become a doctor. By age 22 you are a doctor. Compare that to the US: you have to get degree from a 4-year college before going to medical school. This is wasteful, unnecessary, and increases the cost of medical education, which in turn increases cost of medical care.

<comment><USER33> You don't always have to have an undergrad. A good friend's Dad earned an MD/PhD from the University of Chicago without an undergrad. This was in the 1960s though and he entered after doing a stint in the Peace Corps.

<comment><USER5> This is less likely now since competition is so high so undergrad courses/GPA is a filter, but it does speak about how an undergrad degree is strictly orthogonal to the job. You could probably get away with it today based on the MCAT as proof of pre-qualification maybe...

</comment></comment></comment><comment><USER34> I'm aware that that many of doctors' high salaries are due to the government creating artficial shortages and I support less government regulation in order to make helathcare better and more affordable.

That having said, I don't think high doctors' salaries are the most important societal problem in healthcare. Years and years of studying, long working hours, great responsibilities, saving lives and healing patients: doctors are welcome to their high salaries.

<comment><USER35> I read once that doctor salaries account for 30% of the cost of healthcare. Its significant.

<comment><USER36> Nope. 8%.

Source: [https://www.jacksonhealthcare.com/media-room/news/md- salarie...](https://www.jacksonhealthcare.com/media-room/news/md-salaries-as- percent-of-costs/)

<comment><USER35> Thanks! Had that wrong, or remembered it incorrectly. NYT says 10% in another article.

Its still considerable. Have to take into account that a 5% reduction in price can lead to a much higher increase of consumption than 5%, particularly on things like healthcare in the us that have clear excess demand.

<comment><USER26> How is it possible for 5% decrease in price to cause ore than 100/95 consumption, if medical care is already a top priority for spending?

<comment><USER35> Because there are people that do not get healthcare today because it is above their affordability.

If net income for a large amount of people is 100 U$S, and healthcare service costs 101U$S, the jump from 101 to 96 would surge in demand.

Medical services have low elasticity but there are millions of people in america not getting medical service.

</comment></comment></comment></comment></comment></comment><comment><USER37> My wife is in medical school and we often talk about these types of issues.

I think this article is a bit misleading in suggesting that the limitation of spots in residency programs are intentionally and disingenuously imposed.

The reality is training doctors is very, very hard and there simply enough resources to do it properly. This is not an issue with medicine alone.

We're seeing similar trends in the tech industry where developer salaries are sky-rocketing because there is a lack of highly qualified talent. Even with a slew of "bootcamps", "code universities", and a general influx to the industry the tech industry still doesn't have enough highly qualified individuals.

The medical industry is facing a similar issue, but everything has even higher standards because medicine involves human life. The medical industry is trying to keep up (my state has opened 3 new medical schools in the past 5 or so years), but it takes a very, very long time for organizations to find the proper resources and build a proper program. I believe my wife's school was in works for 10 to 15 years before opening its doors 4 years ago.

Opening more spots requires finding qualified doctors who not only understand the subject well, but can actually teach it. This severely limits the sample size. On top of that, these programs also require doctors who are willing to put up with medical students and residents on a daily basis.

Could you imagine if you were paired with the new development intern every day of your working life? You'd go crazy.

\----

I do think something needs to be changed, but I don't think medical schools and residencies are really the place to make an impactful change. I see a lot of value in doctors becoming "supervisors" and managing a team of nurse practitioners or physician assistants. Then again, we're seeing similar training issues in both of those fields.

<comment><USER26> Programmers are making a fortune because they are critical to generating massively superlinear business profits, and the market is winner-take-all competitive

My doctorcan't generate superlinear profits for curing me better than your doctor cures you.

<comment><USER37> I'm a programmer so I see both sides.

The reality is both programmers and doctors have a highly technical skill. A high school can build an "app", but they likely don't have the depth of knowledge to build it properly and reliably.

The same goes with medicine. A nurse, WebMD, or other resource might get you the correct answer, but that's not really the name of the game. Medicine is about both getting things right and not getting things wrong. It's easy to teach the first, it's very hard to get the second.

</comment></comment></comment><comment><USER3> A big point people often forget when comparing doctors' s salaries to other fields: physicians are expected to cover a large number of their own work- related costs, like continuing education, insurance, or even medical equipment and (sometimes) overhead like office space. Because physicians almost always pay AMT, these work-related expenses are _not_ tax-deductible.

$250,000 sounds like a lot, but it's really not once you take into account how much of that goes towards insurance, licensing fees, equipment, supplies, and all your normal business expenses. (The article linked says that this is "even after malpractice insurance and other expenses", but that's clearly _not_ what the underlying source data represents.)

<comment><USER38> Their gross pay is way higher then $250,000. Actually $250,000 is the net salary after all expenses, and that's about right for not particularly enterprising doctors (ie. internal medicine, no surgery).

<comment><USER3> > Actually $250,000 is the net salary after all expenses

It's _not_. The article says that, but it's flat out wrong - even the source that the article links contradicts this claim.

> For employed physicians, patient-care compensation includes salary, bonus, > and profit-sharing contributions. For partners, this includes earnings after > taxes and deductible business expenses but before income tax.

The author of the article clearly doesn't know that "deductible business expenses" covers only a tiny fraction of the business expenses that physicians are expected to pay - most are _not_ deductible.

<comment><USER38> What business expenses are not deductible?

<comment><USER37> deductible != credit

A 100k expenses does not translate to 100k of tax savings.

</comment></comment></comment></comment></comment><comment><USER39> I don't think it is fair to compare physician salaries from countries where education is heavily subsidized by the government. Are new doctors in the UK or the rest of the EU starting their careers $200k+ in debt?

<comment><USER40> So American taxpayers should fund the absurd cost of medical school instead? Genius

<comment><USER39> Either that or you will have even fewer doctors with much higher salaries. How would a doctor be able to afford any sort of life working 80hours a week to barely pay back loans accumulated over a decade of education. Supply/Demand

<comment><USER40> I have doctors in my family. They would be sad to know the truth, just like you. There's nothing special about American doctors... the education, the quality. It's just another classic example of the fat needing to get cut. And there's a juicy chunk of fat to cut here

</comment></comment></comment></comment><comment><USER41> Personally I believe that the good doctors are underpaid for the skill and training they have.

<comment><USER42> Are they really that super skilled?

If medical school was free and had unlimited places, do you think we would have the same number of doctors that pass the bar?

<comment><USER43> Honestly, while cost is a real factor, I don't think the number of doctors that pass the bar would increase by as much as you think. The amount of knowledge, skills, experience in that practicing physicians possess dwarves what people in many other specialized professions have. I doubt most people would have the grit and patience that it takes to cross that bar. (Disclosure/source: my partner is a physician, I am a software engineer).

That said, (only) one of the reasons for compensating physicians more is the time and money they put into their education. At least 2x - 3x more than other professions. Reduce this time / money commitment, you will be able to reduce the salaries.

</comment></comment></comment><comment><USER44> most of the health care cost is NOT due to doctors salaries. the reason health care costs are so high in America is due to the way Providers (Hospitals, small clinics, and large Systems) charge insurance companies. Several decades ago when insurance really started getting big, they realized they had huge groups of people they could send to "in network" hospitals. they choose which Providers are in their network. therefore they have leverage over the Providers, and use it to negotiate the price they pay for all claims (the bill the provider sends the insurance company). They negotiate huge discounts on the "listed" price for a claim. Therefore, every year for decades, hospitals have been jacking up their prices in order to actually be able to stay in business (given that the large majority of costs are paid for by insurance companies, who are getting a huge discount). So 2 tylenol go from $3 to $10 to $100 to $500 over time, as the insurance companies negotiate bigger and bigger discounts. This is why the "cost of healthcare" is so high, even those it's not really the true cost. Unless you're not insured, in which case you have to pay the "actual" rate (ie $500 for 2 tylenol).

Here's an article that explains further [http://www.npr.org/sections/health- shots/2014/11/15/36406408...](http://www.npr.org/sections/health- shots/2014/11/15/364064088/they-paid-how-much-how-negotiated-deals-hide- health-cares-cost)

<comment><USER45> Salaries make for a great distraction though, like hosepipe bans in California when 80% of the water use is agricultural.

<comment><USER46> $500 Tylenol anecdotes make for an even better distraction. The likely problem is a little of both.

<comment><USER47> Do you mean to suggest that physicians' incomes should be several orders of magnitude less than what they are currently? If not, I'll continue to be "distracted" by the Tylenol.

<comment><USER48> No, it means to suggest that the number of people who have actually paid anywhere near $500 for a couple Tylenol pills is so small as to be an irrelevant rounding error in the grand scheme of things.

Note I said _paid_ , not _billed_.

</comment></comment></comment></comment></comment><comment><USER49> It blows my mind that people can't see this is as one of the glaring issues with out healthcare system. In addition to the outrageous costs of higher education and the litageous nature of our judicial system, it's pretty obvious why healthcare costs so much. We can talk about insurance and Medicare until we are blue in the face, but those are just symptoms of a system that was broken from the start.

</comment><comment><USER50> There should definitely be more med school slots and more residency slots in the US. The idea of nurses prescribing pills is very bad though.

The shortage of doctors is a problem, but we should not kid ourselves -- the biggest problem in America's health care is out of control drug costs. Even with the shortage there has not been a massive inflation of doctors' salaries. In fact all of my doctor friends are constantly complaining about how they are paid less than the previous generation.

But there has been a massive inflation of drug costs.

<comment><USER42> Why are nurses unable to prescribe? Nurse practitioners (mid-senior nurses) have been able to prescribe a limited set of drugs in the UK for quite some time now, quite successfully.

<comment><USER51> Nurse practitioners can prescribe in the US as well.

<comment><USER38> This right. In fact CVS MinuteClinics are usually manned by nurse practitioners. They can do many things typically associated with internal/family medicine.

</comment></comment></comment></comment><comment><USER52> I feel like doctors should at least be paid as well as programmers. My wife is a physician with $500k in debt and she completes residency next summer. That took 4 years of undergrad, 1 year to burnish her credentials, 4 years of medical school, and 6 years of residency. Her job offers are all under $200k for pediatric neurology. With that enormous amount of training, debt, and responsibility, I feel like she should be making a lot more than your average AI programmer.

In other countries the education process is much shorter. For example, in Columbia, I'm told, you skip undergrad altogether to be a physician. Some other nations make training free, which encourages more general practitioners.

Can anyone explain why Medicare subsidizes residency slots? Moreover, why do they need to be subsidized? Residents earn about $40-60k per year and work 80 hour weeks.... If you think PhD students are slave labor, talk to residents.

<comment><USER53> I don't understand the reasoning that because one opts for expensive training that incurs debt then a high salary is necessary. What other forms of debt behave that way, where the more you take on the more compensated you should be?

I did a physics PhD, which took roughly 8 years of graduate training. My stipend was ~$12k per year for 80 hour weeks, and from that I still had to pay student fees. It's possible to graduate debt free in that situation (I did not), but does that imply that my working salary should be less? Or, because I did take on debt, I should get paid more?

</comment></comment><comment><USER54> I sorta figure if you spend around about a DECADE of your life training in a profession then that profession should give you that sort of salary. The amount of education doctors have to do compared to the other routes to getting $200k p.a. makes me much more sympathetic to this outcome than say investment banking.

<comment><USER35> Thankfully, it is not up to the individuals to gauge what the value of other peoples labor is.

Any decision that strays from what people want to pay is going to be either more expensive than it should, or lead to supply shortage. In this case, both are happening.

</comment></comment><comment><USER55> For those interested in the broader picture, I recommend Aaron Carroll's series "What makes the US health care system so expensive":

[https://theincidentaleconomist.com/wordpress/what-makes- the-...](https://theincidentaleconomist.com/wordpress/what-makes-the-us- health-care-system-so-expensive-introduction/)

Physician salaries are a part of the problem, but by his numbers they are a pretty small part (as shown in his pie chart at the bottom): [https://theincidentaleconomist.com/wordpress/what-makes- the-...](https://theincidentaleconomist.com/wordpress/what-makes-the-us- health-care-system-so-expensive-conclusion/)

<comment><USER56> > _Much of what we choose to spend money on is stuff that we as Americans seem > to value. Much of that value, unfortunately, isn't all it's cracked up to > be._

This speaks volumes, far beyond just the healthcare system too.

</comment></comment><comment><USER57> Most other wealthy countries subsidize the cost of medical education to some extent. This article didn't touch on the possibility that the extra $100 billion the US spends on doctor salaries is just being spent on education subsidies in other countries.

Many professions in the US are paid more than their counterparts elsewhere. Software development is a good example, where the salaries I see in the US are often _twice_ as high as what I see in Europe. But Americans have basically no rights as employees, very little time off, no access to universal healthcare, no access to high quality public transportation, etc.

</comment><comment><USER58> So lets just say the savings as described in the article by not paying doctors as much would be $100billion (cut doctors salaries by half). Spending on US Healthcare was in 2015-16 was $3.2 trillion. Assuming there are no side effects in the market (such as number of students entering medical school would decrease etc) the $100 billion in savings is 3.1% which is a very small figure.

</comment><comment><USER59> Medical education in Europe is free. In the US, it costs hundreds of thousands of dollars, on top of 4+(1-9) additional years of training with grueling hours during the prime of your life. 80% of doctors are burned out. The emotional toll of watching innocent people die, telling their families, and doing your best with variable levels of success is indescribable. Doctors in the US are not overpaid - the pay is the only thing keeping them in the profession. The real money is going to hospital administration (non-profit hospitals with executives paid more than 6 million per year), malpractice insurance which can go up to 30% of a doctor's salary (a single malpractice case can cost $1M to defend, whether you are guilty or not), and most importantly, tests that have to be done, not out of necessity, but because there is a 0,1 chance of a rare condition that can get caught by it, and the doctor can be sued if they miss it.

</comment><comment><USER60> And now let's look at the size of US drug market and it's 4.6x the size of estimated salaries from the article. Almost looks like article was sponsored by Big Pharma

</comment><comment><USER61> [https://www.cdc.gov/nchs/fastats/health- expenditures.htm](https://www.cdc.gov/nchs/fastats/health-expenditures.htm)

The US spent 3.2 trillion on health care in 2015. 100 billion is 3.12%. It doesn't seem like that big of a problem.

</comment><comment><USER62> Before making a judgement on whether doctors are overpaid or not, I'd kinda like to see an analysis on the value doctors provide. For instance, how much does an average doctor's treatment affect the economic productivity of all her patients in aggregate? If patients would produce substantially less without treatment, and she sees many patients, a high salary is much more justifiable. If you're not keen on analyzing things strictly in terms of GDP, how much does an individual doctor influence quality of life, happiness, lifespan, etc? Again, an outsized effect warrants an outsized compensation. Of course, value is quite difficult to assess - especially added value versus alternatives (I.e. online self-diagnosis) - but it'd be interesting to see.

<comment><USER63> But the main argument is that US health outcomes, with their much higher costs, are not better than the outcomes in other developed countries with much cheaper costs, and there are lots of studies to back that up.

Seems like you can skip all the analysis you are asking for, at least as long as salaries in the US are much higher than elsewhere without commensurate improvement in health outcomes.

<comment><USER62> I think comparing salaries across the world isn't really a good way to measure whether a provider is "overpaid" or not. If you're just looking at contribution to well-being and human happiness, that way of looking at things might be valid, but even if well-being/happiness outcomes in different healthcare markets are equal, productivity outcomes might be quite different. Americans work longer hours than in the countries outlined in the article, resulting in significantly higher annual productivity per capita compared to other countries. From a labor economics perspective, doctors in the US therefore might (again, depending on real metrics that I'd like to see) contribute more in absolute terms to GDP than doctors in other countries.

Additionally, it might be the case that, relative to their productivity, doctors in other countries might be significantly underpaid. This sort of distortion happens in many other industries. Software, for instance, is notorious for this. Internationally, people might look at US software engineering salaries and balk at how high they are compared to the rest of the world, and might make the judgment that US software engineers are underpaid. But if you look at the profit per employee at leading tech companies, that figure dwarfs engineer salaries (e.g. Facebook's profit per employee is north of $400,000/year, Google's is similar). So, relative to value delivered, many software engineers in the US are actually underpaid. This implies that software engineers abroad are significantly underpaid, as they often work for the same multinationals doing the same sort of work.

At the end of the day, salaries are determined by all kinds of factors, including competition, regulation, value generated, etc. I think that real value added is the only way to determine if a position is overpaid, and comparing to other systems doesn't really help us evaluate that.

</comment></comment></comment><comment><USER64> This featured pretty promenantly in the most renecent episode of the Freakonomics podcast:

[http://freakonomics.com/podcast/nurses-to-the- rescue/](http://freakonomics.com/podcast/nurses-to-the-rescue/)

</comment><comment><USER65> I do think that there might be too much regulation in medicine. It seems strange that someone should study for 20 years to learn how to perform the same operation on a specific human organ...

Most doctors tend to specialize anyway so why should a heart surgeon spend so much time learning about other organs which they're never going to sink their scalpels into?

Doctors are extremely well rounded these days, maybe they don't need to be. There are plenty of very good software engineers who never went to university, could it be the same for doctors; if we allowed it?

<comment><USER66> I don't think "less" and "more" should ever be used when discussing rules, regulations, and laws. Only "better" and "worse".

As for "specializing" in a type of medicine, this is naive. The human body is not separated into discrete modules; every part is extremely interconnected to many others. Doctors must understand general medicine because treatment can effect all body systems.

<comment><USER65> Maybe you do need at least one person who understands everything to oversee treatment but does the person who actually does the 12 hours of precision meat-cutting need to be that person? I don't know, it's just a thought.

Master jewelers can do very fine work and handle lots of variation in the materials they work with but they don't need to know anything about the chemistry of gold in order to actually make the jewelry... They just need to know the right techniques and potential issues that can arise.

</comment></comment></comment><comment><USER67> The problem are not doctors salaries, it is everybody elses. Double the salary of everybody else, to where it would have been if they hadn't been fooled into dropping unions.

<comment><USER35> Oh my. That's not how it works. Thats not how any of it works.

There are less people getting health services than there would be if it weren't a constraint field. Also, the total amount of money paid to doctors would be much higher if more doctors would join: it just would be a lower average.

The doctor community makes less money by contraining supply the same way a bagel shop makes less money if it doesnt satisfy its demand. This is absolutely basic microeconomics.

</comment></comment><comment><USER68> The next great thing tech can do is to automate and streamline as many procedures that currently require a physical doctor. We will need to lobby Congress to change regulations and possibly even torte reform for automated, computer based health care.

I believe it's the best way we can scale health care. We need machines that can do the majority or tests and diagnosis to at least flag things as suspicious and then send the person onto a human doctor for further analysis.

</comment><comment><USER69> The article fails to mention the debt-load that doctors acquire through their lengthy schooling. I agree that it seems ludicrous to pay (some) doctors the outrageous salaries that they are paid, but most professions don't require a couple thousand dollars of _post-college_ debt to practice. That may be fine for a specialist surgeon pulling in 600k annually, but it's quite different for academic primary care docs making more like 120k$ in major metropolitan areas.

Disclosure: doctor

</comment><comment><USER60> OK considering the time it takes for someone to start making that amount of $ in medical field to be honest we in IT should really be the last to complain.

</comment><comment><USER70> I'm a big fan of the NHS in the UK and I live in Sweden now which also has national healthcare services that are heavily subsidised. There are some things that allow the system to be cheaper- for sure. As one hospital buying cotton balls might be more expensive per cotton ball than if you decide as a country to produce or procure millions of them at a time.

But RE salaries; Is it the USA who pays too much? or is it those other countries which pay too little?

The NHS in the UK and the Vardcentralen in Sweden are both having intense crisis' at the moment due to funding and are overstretched to say the least. In Sweden in particular Doctors are more keen to be contractors and hire themselves out to hospitals and offices, mostly due to the fact that Vardcentralen has limits for how much it will pay permanent staff Doctors. And since that's so ubiquitous the Vardcentralen cannot avoid paying these contracting rates, else it would not have Doctors for people.

So, are they greedy? or are they just getting what they should really get? Eitherway we end up paying the Doctors the full amount out of tax money-

<comment><USER71> >In Sweden in particular Doctors are more keen to be contractors and hire themselves out to hospitals and offices, mostly due to the fact that Vardcentralen has limits for how much it will pay permanent staff Doctors.

This is much the same in the UK. Hospitals struggle to fill rota gaps, so offer locum shifts at sometimes 2-3x the normal rate to fill gaps at short notice.

However staffing is so tight now, one can sustain a workweek solely on locum shifts.

Most doctors at junior level have taken notice, and many (more then half afaik) defer entering specialty training after their first two years to spend a year (or three!) solely filling these shifts.

At the cost of job progression and workplace continuity, you're getting paid way more for the same work, but with way more shift flexibility and less CPD paperwork.

Sounds pretty good to me!

Are docs greedy? Hard to say. If locum wages are what fills rota gaps, is that the market dictating the true price of medical labour?

The feeling among a lot of my friends is that if regular and locum wages met in the middle, it might help things. Can't really account for that flexibility of what is essentially taskrabbit for doctors though.

</comment></comment><comment><USER72> If you want to reduce doctor salaries, then you need to reduce the exclusivity of their skillset. You need to reduce their working hours, their student loans, and you need to automate the detection of issues/mistakes.

Their hours need to be limited to sane levels. Medical schools need to get cheaper. Robots, IoT health and fitness devices, and nurses need to take over more functions that Doctors perform.

</comment><comment><USER73> Yup. As unionjack22 says, this is just a hit piece. For instance, hospital bureaucrats can make way more than doctors. This from a 2014 NY Times article: "The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors' salaries, according to an analysis performed for The New York Times by Compdata Surveys: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor." \-- [https://www.nytimes.com/2014/05/18/sunday-review/doctors- sal...](https://www.nytimes.com/2014/05/18/sunday-review/doctors-salaries-are- not-the-big-cost.html)

</comment><comment><USER74> The first step is to actually start spending more money, specifically on grants for med students. One of the reasons we have to pay doctors so much is because they have so many loans to repay. I've been told that between med school and the low pay during residency, a doctor's break even point can be around age 40. If we paid them less, they might not get out of the hole with time left to save for retirement. But if we can keep them from going so far into debt to become a doctor, it'll be more reasonable to pay them less. Other countries have programs to help or even fully subsidize their training...we should have something similar. Because the way it is now, they get bitten by interest twice, on their loans and on their inability to save for retirement during their 20s and 30s.

</comment><comment><USER75> Totally agree with this article. All excellent points. I think these sorts of improvements to a free market medical system need to be fully explored before we turn to socialized medicine. I'm not opposed to socialized medicine if it's necessary, but I think all else equal, market-based systems are better. If we truly can't make a market based system work, then i'm all for it. But I think there are a lot of ways to improve competition and drive down costs without making that leap.

Just to pile on a few other things:

\- In order to open a new hospital in the US, you need to demonstrate 'need' for it. Who certifies that there is a need? A panel of the other hospitals in the area. [https://en.wikipedia.org/wiki/Certificate_of_need](https://en.wikipedia.org/wiki/Certificate_of_need)

\- A large percentage of the things people go to the doctor for right now could be handled by a nurse, or someone substantially less qualified. You don't need to see an MD to get diagnosed with a cold. Making it easier for people with lower tiers of qualifications to provide basic types of care, and even write prescriptions for simple issues would dramatically increase access and reduce costs. There has been some movement in this direction, but not nearly enough.

\- Breaking the doctor-pharma company relationship. This is a tricky one, and i'm not sure how to go about doing it in a way that doesn't overly trample either entity's rights. However, there is an enormous problem in the US of drugs being prescribed to patients without regard for cost. Often there are many nearly equivalent pharmaceuticals to address a given problem, but doctors will prescribe the latest and greatest one, because they are incentivized to do so by the pharmaceutical companies. Since that drug is still under patent, it costs substantially more than many 'nearly as good' alternatives. Patients don't have the information or education to know this usually, and so they just follow their doctor's recommendation.

</comment><comment><USER76> 1\. Someone's paying for those mansions Doctors live in. 2\. Someone's paying the people selling drugs to doctors, advertising on tv etc 3\. Someone's paying to run the insurance business

According to my uk taxes I'm paying £800/year for the NHS

<comment><USER5> And that's cheap! With employer health insurance I pay $4k in premiums.

<comment><USER48> How much coverage do you have? My coverage is only for myself, but I would pay a bit less than $4k in premiums if I paid for 100% of my insurance.

</comment></comment></comment><comment><USER77> My wife is applying for family medicine residency right now.

There are 20 slots for the entire Bay Area. 6 at UCSF, 6 at Kaiser San Jose, and 8 at Stanford.

Family medicine isn't neurosurgery or radiology but the artificial limitations on residencies still lead to hyper competition, long hours, and an insane "match day". When graduating med school it doesn't look _that_ much harder to push a bit more for a specialty and get paid twice as much.

And now we have too many specialists in the United States. It seems like we could solve this pretty easily by simply increasing the number of residency slots for GPs.

</comment><comment><USER78> One thing not mentioned is the cost of medical school (both in time and money) in the US vs. other countries. I'd imagine that a decrease in doctors' salaries in the US could cause a significant drop in the number of people willing to spend the amount of time and money necessary to become a doctor. If we want to decrease the pay to match other countries, I think we'll also need to decrease the investment required to become a doctor in order to maintain a reasonable level of supply.

</comment><comment><USER79> This is a big reason why the NHS is a lot more affordable, average wage for a GP is still something like £90k, but it's not in the hundreds of thousands. Staff costs are just a really big part of the total cost of providing care. The rest of the benefit is making clear cost:benefit decisions on buying drugs, reducing bureaucracy from the insurance system, the ability to centralize and scale care without so much replication, etc. But doctors salaries are still a big part of it.

</comment><comment><USER80> The issue here is we don't directly pay for the services. It is handle by 3rd parties, AKA health insurance companies. Health insurance company is not true insurer. They pay for everything. I meant, do you call your car insurer to pay for oil change?

Since health insurance companies merely handle the payment and get a cut for this services, they have the incentive for the cost to go up. High cost equals to higher profits.

Insurance company should be insure on highly unlikely illness, such as cancers.

<comment><USER81> > Insurance company should be insure on highly unlikely illness, such as > cancers.

I get what you are trying to say, but I think it's worth looking a little bit deeper. It's possible that it could be more cost effective to also cover some preventative care.

</comment></comment><comment><USER82> As an engineer my salary is frozen in 1998, technical salaries have been effectively frozen so long that my salary thinks Biggie and Tupac are still the big thing. It doesn't matter how rare the technical skills there's a hard ceiling on income coupled with high cost of living and you work 100 hours a week but still have to go hungry on some days. Salaries are frozen in time for the benefit of the thin layer of people who own other people for a living.

</comment><comment><USER83> I'm a surgical intern right now, it's not fun. I'll be doing radiology next year, and very much looking forward to it.

I'm biased, but I don't agree with the premise of the article; Doctors _should_ be among the highest earners in any country, it's the price you pay to ensure the brightest students are attracted to medicine despite the long training. I do agree with the following:

 _A second route would be to end the requirement that foreign doctors complete a U.S. residency program in order to practice medicine in the United States. This means setting up arrangements through which qualified foreign doctors could be licensed to practice in the United States after completing an equivalent residency program in another country. The admission of many more doctors would put downward pressure on the pay of doctors in the United States, as insurers would have a new pool of physicians to add to their networks who will accept somewhat lower compensation._

I've met many foreign-graduates who have already completed residency. In makes ZERO sense to have these individuals repeat a residency in the U.S. They have already undergone 12+ years of training, actively treat patients in their home countries, and there's a need for physicians in the U.S. This is very much cartel-esque of the AMA. I know it would result in lower salaries, but this would (hopefully) translate into lower-cost medical school in the U.S.

This is a situation that may benefit from tech solution. There are already certain states allowing foreign medical graduates to practice in the U.S. If you're looking for a "startup pain point", let me present you with the two sided market:

1\. There were ~7,500 international medical graduates who applied to residency in the U.S. ([http://www.nrmp.org/wp-content/uploads/2016/09/Charting- Outc...](http://www.nrmp.org/wp-content/uploads/2016/09/Charting-Outcomes- IMGs-2016.pdf)) Presumably, these are individuals who want to practice in the U.S., but must undergo a U.S. residency. I don't know how many of them have already completed a residency in their home country, but let's conservatively say 25% or ~1,800.

2\. The AAMC is estimating a physician shortage of 30,000 by 2030 ([https://news.aamc.org/medical-education/article/new-aamc- res...](https://news.aamc.org/medical-education/article/new-aamc-research- reaffirms-looming-physician-shor/)).

Even if _all_ of the foreign train medical graduates were allowed to practice in the U.S. w/o residency, it still wouldn't be enough. Maybe there's a startup opportunity that matches foreign MDs to positions in the U.S. As I mentioned, states like Missouri have already allowed some non-residency- trained physicians to practice ([https://www.statnews.com/2017/05/15/missouri- doctor-dearth/](https://www.statnews.com/2017/05/15/missouri-doctor-dearth/)). My preference would be to have a foreign doctor who has undergone residency in his or her home country rather than a U.S. grad with no residency.

</comment><comment><USER84> I remember in one clinic...7-8 nurses at one docs office. 4-5 minutes time with the doctor and probably a $150 bill.

A lot of money also goes for people to process insurance claims

</comment><comment><USER85> This article is founded on bad research. Research that considers only what it costs to have a consult with a doctor. The same research does not consider what it costs that doctor to _become_ and _remain_ a doctor. Those costs are borne much more directly by the physician in the US, whilst in the other countries discussed it is far more diffused into the public tax burden.

In other words, the entire article is built on sand.

</comment><comment><USER86> You have a similar number of doctors per capita as other comparable countries so it seems unlikely that the mere supply of doctors is the problem, Patients per doctor Norway: 320, US: 390, UK: 440. ([http://bigthink.com/strange- maps/185-the-patients-per-doctor...](http://bigthink.com/strange-maps/185-the- patients-per-doctor-map-of-the-world)).

</comment><comment><USER87> Some hospitals certainly are making a lot of profit, and quite a few of the most profitable are non-profit hospitals. [https://www.bizjournals.com/denver/news/2017/11/15/denver- ho...](https://www.bizjournals.com/denver/news/2017/11/15/denver-hospitals- increase-profits-with-some.html)

</comment><comment><USER88> I've been expecting this type of discussion for a long time. It's part of the march toward socialism.

We are now starting the price fixing phase of the march. Now that enough of the nation's healthcare bills are being paid by tax payers, it will be popular to blame overpaid doctors.

Forget all the government involvement that got us to this point and just blame the free market. Things like this make me sad for our future.

</comment><comment><USER89> Hmmm, shouldn't you compare doctor salaries not just with doctor salaries in other countries, but also salaries relative to other professions that require similar level of IQ and schooling in the US? 250k doesn't seem that high in that context. A mid level manager in a company can make that much

</comment><comment><USER90> I feel like the most obvious explanation here (one which the article doesn't really cover all that well) is that college tuition is disproportionately high in the US. This means doctors (and other professionals) have to be paid more just to be able to pay off student loans.

<comment><USER5> Doctors that work at qualified non-profits can get loan forgiveness. Also there are special programs to pay off medical school debts.

</comment></comment><comment><USER91> Not-yet-so-famous musicians should be able to hang out at a doctor's office or house for free. I even see room for mutually beneficial symbiosis, as music as something cheerful in and on itself can help enhance medical treatment.

But I digress... :)

</comment><comment><USER92> Isn't politico a fairly conservative news hub now? I don't see paying physicians less as a good thing, do we really want the lost cost physician operating on us?

</comment><comment><USER93> Medical tourism or maybe get an medical intern, they can do it for sweat equity and stocks

</comment><comment><USER94> Paul Starr's The Social Transformation of American Medicine is the standard text on these issues.

</comment><comment><USER95> Correlation is not causation, but this basic principle is sometimes lost on political journalists.

</comment><comment><USER96> > Doctors and other highly paid professionals stand out in this respect. Our > autoworkers and retail clerks do not in general earn more than their > counterparts in other wealthy countries.

You need to compare doctor pay with pay on other skilled careers like software engineers and lawyers. A software engineer earns considerably more in the US than in Europe.

</comment><comment><USER97> So... adopt the UK model then?

</comment><comment><USER98> Disclaimer: I'm not a doctor nor do I work in the US. My prespective is as a software engineer who contacts daily with doctors.

In order to get into med school you must sure that your high school grades are on the top 5%.

You must ensure that the hospital(s) you work in are able to function 24/7\. This means you don't really control your vacations, you must work nightshifts and you will work on special holidays.

You don't get to clock out when your shift ends. You are medicaly responsible for your patitients until someone else takes over. If the patient starts having problems just before the end of your shift, you have to handle it. Its frequent to only actually leave the hospital 2h after.

Your work doesn't end when you come home either. You are supposed to study for exams, to refresh your knowledge over the diseases you are currently working on. You need to build your curriculum by publishing research papers and attending expensive conferences. Your hospital rarelly pays for this. You either lobby with pharmaceuticals in exchange for favours or pay out of your pocket.

In order to get a specialization you have to go through 4-6 years of training/evaluation. That is, if you can get into one in the first place. Due to the limited amount of positions available, doctors have to compete against each other. Only the top 2% will get to the prestigious/high paying positions such as neurology or plastic surgury.

The pressure is huge. People will die or live depending on your decisions. You'll make 10s of those every day.

People will still die everyday regardless of what you do. Its not cost/health effective to try every procedure on all patitents. You will have to come home to your family knowing that you could have saved someone but you decided not to. You will be the one informing their relatives.

They might sue you or the hospital over malpractice. The hospital has insurance for this but its there to cover the hospital, not its workers. You are expetected to have your own insurance if you work in high risk zones (e.g. ER).

Being a doctor is a high risk profession. There are plenty of infectious diseases just lying arround. You never know what the next patient might have. You have to be wary of criminals trying to steal drugs, criminals comming in to finish of someone, patients with mental issues trying to hit you. Not to mention people that have received bad news or have simply been waiting for too long, wanting to take some frustration out on the next person they see.

The 200k _average_ is most likelly misleading. Where I live doctor salaries are very skewed. Most high profile doctors also have management positions and can make 10x than regular doctors.

Sure they get more money at the end of the month, but for what its worth, I wouldn't trade my salary/responsabilities/perks over theirs.

<comment><USER9> Increasing the supply of doctors will not only lower their salaries but it will alleviate a lot of the issues you talk about which is largely caused by the fact that we don't have enough doctors because it's so hard to get into med school.

Paying doctors humane salaries to work humane hours leads to better doctors.

</comment></comment><comment><USER99> This article is total bollocks. Doctors are not overpaid in the US, the ones in Europe are massively underpaid and overworked because they are funded by tax payers.

</comment><comment><USER100> In Russia most of doctors getting very low salary, less than MacDonalds employee. It doesn't work very well, talented people moving to other professions.

</comment><comment><USER101> When you start with the premise that a price is too high (or too low) the resulting reasoning is bound to be sloppy and fraught with bias.

This article is no exception. It is embarrassing to read this article, because it is full of small, emotionally-potent morsels for those who don't like doctor salaries being high. It's as if the article were read as ASMR but the excitement is instead induced by those potent "the price is bad" morsels.

The truth is that not all doctors make even $200K and many struggle for years to pay back their med school loans once they finally are able to earn a salary after years and years of training.

But it's only by a slight of hand that we are even focusing on doctor salaries instead of the broader issue of the cost/benefit offered by the healthcare system as a whole.

Doctors combine a form of scientific authority with both social and moral authority. They have scarce knowledge, they judge whether or not we deserve workers comp, a paid sick day, a sticker to park in a coveted parking spot, permission to take a pill that takes the pain away, etc. They tell us which of our symptoms we are to blame for vs which we can blame on others, and they offer us hope when our loved ones are at death's door.

This makes doctors the closest thing modern, mainstream (secularized) culture has to priests and priestesses. The status held by doctors goes far beyond any financial rewards.

We must ask ourselves the difficult question of why we (as a society) need the absolution and authority offered by doctors. Why can't we just (as the article suggests) make pragmatic decisions that would lower the bar for entry into the profession?

To do this, we must appreciate that there is a uniquely American view of health that differs from the view held in many other places. Health is something we deserve. Health is understood as something that can be restored or improved through science. Disease is understood in a way that is analogous to "evil forces" that can be successfully eradicated from the body. The social and psychological aspect of disease is minimized, and the physicalization of mental health challenges is nearly completely denied.

Death too is treated differently. Death must always have one cause, and the implication is that were it not for that cause life would have gone on much longer.

In such a view, it is only through the perfect knowledge and/or perfect technical performance that we can overcome disease and stave off death, so doctors must be close to perfect. This is why the bar is set so high for entry into the profession. Those who are selected into the profession are typically very highly skilled. Medicine is among the most popular career plan for college freshmen, but only a small percentage manage to be admitted into medical school. The rest wash out either because they don't want to work that hard or because they can't make the grades.

This pressure on perfect outcomes (and all the fallacies the notion entails) results in expensive malpractice insurance and far too many costly interventions that have little chance of significantly benefitting the patient.

A massive amount of lifetime healthcare spending occurs in the last two months of a person's life. The author seemingly blames this on doctor salaries. This is false. The problem is that patients and their families expect the 80 year old with pneumonia to miraculously recover and live to be 100. The fact is, when an 80 year old gets very sick and ends up hospitalized, it's quite likely that a cancer or two might be discovered, as well as all sorts of other impending problems. But the family still thinks of the person as a healthy 80 year old. Most of the cost of our healthcare system comes from this adjustment process during which we flush money on useless tests and interventions, all to help a patient and family adjust to the reality of old age and impending death.

Yes, there are some docs who profit from largely elective and arguably wasteful surgeries, but many of those are also the optional "lifestyle" surgeries that the public demands most (arterial stents, plastic surgeries, many cosmetic derm treatments, etc.).

</comment><comment><USER102> Until I met my MD wife, I would have agreed with most of the points in this article. Doctors in the US are certainly well compensated relative to Doctors in other countries. Also, the story of physician credentialing as a means of restricting labor supply appeals to my economic rationale.

However, there are some weaknesses with this argument. To start with, physician compensation makes up just 8% of total healthcare costs in the US:

[https://www.jacksonhealthcare.com/media-room/news/md- salarie...](https://www.jacksonhealthcare.com/media-room/news/md-salaries-as- percent-of-costs/)

So, if they were somehow cut in half, that would net a savings of just 4%. That assumes there wouldn't be a corresponding drop in quality as a result of loss of physicians from the occupation. Keep in mind that this is an occupation whose supply is so tight that one of the primary ways being discussed to increase supply is by lowering the credentialing requirements for primary care by having Nurse Practitioners and Physician Assistants provide primary care, unsupervised by a Physician.

I think that's really the rub in terms of talk of lowering physician pay. The barriers to entry in the field (in the US) are so high that if physician pay were significantly reduced without a corresponding reduction in the barriers to entry, it would disincentivize our smartest, and hardest working people from becoming physicians. Which would lead to a significant decrease in the quality of healthcare in the US.

In the case of my wife, she is both smarter and harder working than I am. She spent her 20's and early 30's working 60+ hour weeks doing work that is very taxing mentally and emotionally. She went through four years of undergrad and four years of medical school. She exited medical school at 26 with a significant amount of student debt (though less than many, and at a lower interest rate due to smart decisions on her part) that started capitalizing immediately. She then spent four years in a residency program, making $50,000 a year, and then another four years in two different fellowship programs also making $50,000. When she finally got to a point where she started making a Physician's level of compensation, she was almost 35 years old with $240k in student loan debt and a small amount of savings and retirement built up. She could have dropped or failed out at any time and, if she had, she would have taken on the full cost of the student loan debt without the ability to repay it. This level of debt represents a significant personal risk for physicians that shouldn't be discounted. If you were to compare our financial situations independently, as a software developer, I'm in a better position financially. I've had the opportunity to invest my earnings in my 20's and 30's and haven't had to forfeit so much of my later earnings to debt. As a result of this financial head start, even though she makes more than twice what I make, she doesn't have a chance to catch up with me in terms of wealth accumulation until she's in her 40's, assuming she's financially disciplined and doesn't succumb to physician lifestyle inflation.

If she had instead aimed to become Nurse Practitioner or Physician Assistant, she would have been looking at a low to mid 100k job in her mid-20's with maybe 40k in debt. This would have been a much lower risk in terms of debt, it's much less work to go into one of these fields, and I would argue it may be a better move financially because of the ability to put her money to work earlier from an investment standpoint.

So, if the carrot of higher compensation later down the road is eliminated, I think we will see less quality people entering the field. Physicians are some of the smartest and hardest working people in the US. They'll be able to weigh the cost benefits and will choose alternative fields that have better financial renumeration or lower risk. If the student loan burden were reduced for physicians, you might be able to get away with lower pay without disincentivizing becoming a physician. But I don't see the government providing more assistance to cover the cost of medical school.

If we really wanted to cut down costs for healthcare in the US, the first place to look is administrative costs. We pay more than twice what other countries pay in administrative costs as well. And administrative costs make up a greater percentage of the total money spent on healthcare. Administration costs are mostly waste in that the reason it exists is to keep the gears turning so people can receive healthcare. One of the reasons administrative costs are so much higher is b/c of the complexity of the private insurance system in the US. As others have noted, some of the administrative burden would be simplified by a universal healthcare system.

[http://www.commonwealthfund.org/publications/in-the- literatu...](http://www.commonwealthfund.org/publications/in-the- literature/2014/sep/hospital-administrative-costs)</comment>


Show HN: Theorylog – Notes for Developers - <AUTHOR> https://www.theorylog.com <comment><AUTHOR> Hello everyone,

For a long time I thought there must be a better way to utilize notes in your work. Physical notes are difficult to bring with you and "search" through and ordinary note apps often don't have functionality for math and code snippets.

For this reason I created this website where you can add the following:

Links:

The key thing here is that these links are searchable by the content they point to since they are scraped. This is useful for things that are hard to google and you want to keep for later use.

Markdown documents with additional functionality:

Here you can add:

* code snippets that are made searchable, independently of the markdown document, by adding description and/or tags.

* images

* math (latex)

* PDFs (converted to images)

The text inside the images/PDFs are also extracted and added to improve the search of the markdown document (this doesn't happen instantaneously though but can take a bit of time to propagate). The markdown documents are useful when taking notes since you can combine theory and code snippets while making both searchable.

Still in the early stages, feedback is appreciated!</comment>


Sam Altman "Super Impressed" with Waterloo Region - <AUTHOR> http://news.communitech.ca/news/communitech/y-combinators-sam-altman-super-impressed-after-12-hours-in-waterloo-region/

<comment><USER2> I remember him! He spoke at Hack the North, and brought a YC panel to the event as well!</comment>


Zin Boats reinvents the electric boat in a bid to become the Tesla of the sea - <AUTHOR> https://techcrunch.com/2020/08/11/zin-boats-reinvents-the-electric-speedboat-in-a-bid-to-become-the-tesla-of-the-sea/ <comment><USER2> [https://candelaspeedboat.com/](https://candelaspeedboat.com/)

Candela has an electric boat with foils, using the advantage of electric motors to provide high instantaneous torque to pull the boat out of the water. Once on the foils, the power required is a fraction of a displacement hull at equal speed.

<comment><USER3> Now that makes sense.

The surfboard sized version is very cool.

[https://youtu.be/ieigm2t9apk](https://youtu.be/ieigm2t9apk)

</comment></comment><comment><USER4> Price aside, boats are a fairly compelling electric vehicle. Boats are one of the most efficient means of transporting large amounts of freight : [https://en.wikipedia.org/wiki/Energy_efficiency_in_transport](https://en.wikipedia.org/wiki/Energy_efficiency_in_transport)

In short, doubling the weight on a ship does not double the energy needs required for moving it. The same can't be said for wheeled transportation, let alone air. Batteries are very heavy, but on boats this doesn't have to be a big negative.

However, we're not talking large amounts of freight here, this is more or less a personal watercraft. Also, for personal watercraft most of the energy is spent on accelerating and decelerating, something that boats are not as efficient at.

So, good idea in theory, bad idea in application.

<comment><USER5> > In short, doubling the weight on a ship does not double the energy needs > required for moving it. The same can't be said for wheeled transportation...

I wonder how the physics of freight on a ship vs a train works.

Yes, the static coefficient of friction of train wheels would make it harder to run a longer train, but I see some awfully long freight trains with only one or two diesels at the front!

<comment><USER6> Train wheels are pretty interesting. To keep good performance, wheelsets (axle and 2 wheels) are regularly removed and the wheels are machined on a lathe. This can also be done while the wheels are on the train. Then every couple of years the wheels are popped off the axle and new wheels are pressed on. The axles last like 70 years.

With such care, the rolling resistance is very low, but it takes a bit more power to start moving. Despite that, one strong person can push one rail car, usually starting with use of a pry bar.

A locomotive cannot actually move many rail cars from rest. That's why there is slack between each car, and to start, the locomotive is first reversed to push the rail cars together, then moves forward, pulling a single car until the slack is taken up, which pulls the next one, and so on. That's also why you see one locomotive pulling so many cars. If a train stops on an incline for some reason, it generally needs to reverse all the way down the incline and start again.

The static coefficient comes into play during braking and if the locomotive wheels slip under power. For that, sand is applied to increase friction.

<comment><USER4> I didn't know some of this, thanks! I used to live near an active train yard, and one of the warnings people gave me when I moved there was the sound caused by the trains "stacking" (which is the noise caused by each of the car couplings pulling out of their slack).

I thought it was a drawback at first, but now that I've moved away I kind of miss it.

<comment><USER6> I used to work in the industry, mainly designing the machines that handle wheels and I really miss it and miss being in the railyards.

</comment></comment></comment></comment></comment><comment><USER7> Frauscher is an Austrian boat manufacture that has been making electric boats for over 70 years!

[https://www.frauscheramerica.com/electric- yachts](https://www.frauscheramerica.com/electric-yachts)

Their styling, engineering, and quality of build are all exceptional. This Zin boat looks like a shoddy toy. Another commenters mentioned it would make a great tender for a yacht, its size to seating capacity is too small for most yachts. This company looks like another SV VC pump and dump that is to be hyped up so the naive an uninitiated waste time and money on an inferior product...sigh....

As an aside Frauscher's 1414 Demon is one of the sexiest power boats you will ever see. I highly recommend the youtube review!

[https://www.frauscheramerica.com/1414-demon](https://www.frauscheramerica.com/1414-demon) [https://www.youtube.com/watch?v=bW_siGAYTa0](https://www.youtube.com/watch?v=bW_siGAYTa0)

</comment><comment><USER8> So hard to get excited about toys built for multi-millionaires.

Quarter million is a bit of a reach for a toy. Call me back when they make one for... $50k?

<comment><USER9> Tesla's first car, the Roadster, sold for $120k (~$145k today after inflation): [https://en.wikipedia.org/wiki/Tesla_Roadster_(2008)](https://en.wikipedia.org/wiki/Tesla_Roadster_\(2008\))

Gotta start somewhere.

<comment><USER10> Yeah, that's what Piotr told me (I'm the author). Boats are already very much a luxury good and the first question is not of reaching a large market but proving that the product is superior. Once that's established you can differentiate up and downmarket. In the article I note a cheaper (still $175K) version is already in the works, and of course costs only go down with scale.

I'm not one to get excited about toys for millionaires either but this one is potentially the beginning of a major change to a pretty gross industry.

<comment><USER11> I have no use for a boat. But my parents have one from the early 90s and would love to get an electric replacement. I think $100k is probably the upper limit though...

And I've often thought about how easy (compared to cars) it would be to make a good one. I thought it would make for a good between-jobs hobby project.

<comment><USER12> Cars are extremely complicated; boats are much simpler because the production volumes simply do not support such complexity. That said, an electric boat is subject to a great deal of corrosion and other problems; I personally know of two electric boats which have caught fire and sustained significant damage.

</comment></comment></comment></comment></comment><comment><USER13> Whenever I see the "something of the something" I always think of anchorman movies and eating bats being the "chicken of the cave".

<comment><USER10> Yeah I tend to stay away from them myself but in this case the comparison was too apt. You'll be glad to know I nixed "cyberboat" though.

</comment></comment><comment><USER14> There's a popular sailing channel called Sailing Uma. When they were first getting started, on low budget, they DIY a used a cheap fork lift motor. They recently got rid of it, but it lasted them many years.

[https://www.youtube.com/watch?v=GoD-j9Dy6xQ](https://www.youtube.com/watch?v=GoD-j9Dy6xQ)

<comment><USER15> It's tough. It takes a lot of energy to move a boat. And boats go slow. Sailboats go 6mph or so under motor. And they use about half a gallon of diesel an hour (for a boat ~40ft) to do that. That's a ton of fuel!

Electric motors are probably 2x as efficient (probably more like 1.5x? I guess?) But even then you have to fill your boat with expensive batteries to even get 1/20th of the range of your normal boat with 50gallons of diesel.

<comment><USER16> And not just that, now you have to have a way to put all that energy back into the batteries each day. This is hard to do from solar or wind alone if you need any sort of real-world range (20-30nm/day for instance). It may be Ok for a day sailor that just uses an engine to get in and out of the harbor but if you use your boat to do real travel you can't always rely on wind for sailing or a dock to plug into at night.

For instance, in a typical Pacific Northwest summer even a sailboat ends up motoring a lot in the Inside Passage with few places to recharge from plug-in electricity.

Some hybrid systems that use a diesel generator and lithium batteries almost get there but it's tough to make it all fit in a sailboat in the 35ft range, which is a popular size.

Diesel is a pretty compact energy storage system for boats and it's hard to beat. We recently had to repower our sailboat and we just couldn't make it work without severely limiting our range.

</comment></comment></comment><comment><USER17> That photo showing the LCD screens in the center console that are not angled to face the seat position... I really doubt those will be viewable at all in direct sunlight. In the photo they're already barely legible. This is what happens when you directly implement a concept rendering into real life without taking into account other environmental factors, and real-world human UI requirements.

[https://techcrunch.com/wp- content/uploads/2020/08/ZinBoats_I...](https://techcrunch.com/wp- content/uploads/2020/08/ZinBoats_Interior_front.jpg?resize=1536,920)

How is that _in any way_ a good design? It's like they wanted to slavishly copy a Tesla, but without actually making it usable for the person piloting the boat.

<comment><USER18> A speedboat is pretty simple to operate. A steering wheel and throttle lever really are enough. Since the screen is mostly for entertainment, the driver shouldn't be especially accommodated. The design might be improved by better shading from the sun, but it shouldn't be made less egalitarian.

<comment><USER17> yes, and no, I don't see any gauges for battery percentage remaining, throttle level, anything like that. The equivalent to an instrument cluster on a power boat.

<comment><USER18> I figured that stuff was on the little orange "Torqeedo" display to the right of the steering wheel.

</comment></comment></comment></comment><comment><USER19> OK, I was a bit cynical but this actually does seem like a well-designed boat for what it is (a superyacht tender.) Stable, accelerates fast, appears well made, 10/10 toy for the rich. I imagine it'll be popular in that market if they manage to make them in large enough numbers and don't have any serious problems they'll do very well.

That said, it is still a quarter million dollar toy for the rich... so the environmental impact of one dinghy (electric or not), amongst all the megayachts and private jets, is really nothing.

In case anyone's curious about specs, they're 20'/6m long, draft 18"/0.45m, 1850 lb/840 kg, seat 5-10.

</comment><comment><USER20> Interesting there aren't any solar panels. I guess the weight would undo the charging benefit for most customers? I wonder if folks will add them after market or if it's just not useful for a watercraft like this.

<comment><USER21> I did a high-level study a while ago. It makes no sense for cars, or boats, to consider solar panels. They just don't produce enough energy to justify their presence there.

It _might_ make sense if you incorporate solar panels into large sails, but the engineering required to make it work (main problem: too much weight; not enough elasticity) is essentially unsolved for now.

<comment><USER20> Couldn't it make sense if you only use the boat every day or two, and it's docked in the sun when not in use? I can see that it wouldn't make sense for cars since cars are typically parked (1) out of the sun, in covered/enclosed structures, and (2) near power outlets, which provide an alternate source of energy.

Some people might want to use a boat infrequently, and not near charging stations. But perhaps a speed boat isn't the type of boat someone would choose for this due to lack of sleeping quarters, fridge, etc.?

<comment><USER22> It definitely makes sense for some applications. For example, I believe Uma was running their electric motor purely using solar for charging for a few years: [https://www.sailinguma.com/electro- beke](https://www.sailinguma.com/electro-beke) Not a huge amount of solar either - 480W of panels on a 36-foot ocean-going sailing yacht, shared with all their other electrical needs. It worked for them because they were primarily _sailing_ , with the motor used briefly for maneuvering in tight areas like harbours, so they had plenty of time on passage and at anchor to recharge the batteries between each use. (Their current setup has regen, so they can charge the batteries by sailing - basically a very indirect form of wind power. Some small sailing boats have actual wind generators but those are loud and take up space.)

For speed boats? Probably not. Those things are small and incredibly power hungry - going fast on the water is expensive in terms of power used.

</comment></comment></comment></comment><comment><USER23> Has anyone experimented with DIY electric hydrofoil boats or surfboards? it looks like fun

[https://efoil.builders/](https://efoil.builders/)

<comment><USER24> I've built a few ~10-20 hp equivalent electric boat motors and some smaller brushless pod motors like the ones that efoils use -- It's really satisfying engineering work and you have to master so many disciplines along the way: machining/fabrication, CAD, electronics, software, etc... And as with any project of that complexity, you could spend a lifetime just getting interested in a single part of the project.

<comment><USER23> looks like our chinese friends already have the motors, ESC's and so on ready to buy, and there is open source software - so the project thankfully becomes more an assembly exercise, similar to building drones

</comment></comment></comment><comment><USER23> Another electric boat from Finland - [http://q-yachts.com/](http://q-yachts.com/) \- looks beautiful.

They have been making electric propulsion for boats for ~15 years - [https://en.wikipedia.org/wiki/Oceanvolt](https://en.wikipedia.org/wiki/Oceanvolt)

</comment><comment><USER25> There's also Silent Yachts (solar panels, battery, and diesel range extender): [https://newatlas.com/silent-55-solar-powered-ocean-going- cat...](https://newatlas.com/silent-55-solar-powered-ocean-going- catamaran/60207/)

</comment><comment><USER26> This is too expensive and short range to sell in any significant numbers. That said, batteries are steadily becoming more energy-dense and less expensive. That means the proportion of cases where an electric boat makes sense will be steadily increasing.

</comment><comment><USER27> This is a really good idea! Most recreational boaters do far less than 100 miles per day. I wonder how quickly the price will drop if they make it out of less exotic materials.

</comment><comment><USER28> Doesn't look very seaworthy to me. A bit of chop and i bet that thing will struggle and be a very rough ride. Might work ok on a lake or something though.

</comment><comment><USER3> $250K? $30K-$60K is typical for an open speedboat in that form factor.

<comment><USER29> What new boat can you get for $60k that is not an entry level model? A 23' Chris Craft starts over $100k these days. That is something that I would put as roughly on par with what they are marketing this electric boat to in terms of buyer profile.

$250k is still pricey, possibly double what a similar gas boat can be had for, but you're not going to find something in that class under $100k from most makers today.

</comment></comment><comment><USER30> There's more than one comment here about competition and I'm curious how they compare because the article seems to write them off:

> Like electric cars, they enjoyed a brief vogue in the early 20th century. > And likewise they were never considered viable for "real" boating until > quite recently.

…

> And in fact there are a few competitors, but they tend to be even more niche > or piecemeal jobs, mating an electric engine to an existing hull and saying > it's an electric boat that goes 50 knots. And it does — for five or 10 > minutes. Or there are custom boat builders who will create something quite > nice for a Zin-type customer — head on over to Monte Carlo and buy one at > auction for a couple million bucks.

> Zin sees his boat as the first one to check every box and a few that weren't > there before.

</comment><comment><USER31> Maybe I'm just playing the uneducated fool, but that much electricity, surrounded by water with a boat having wet decks is a little worrisome to me..

</comment><comment><USER32> Personally I avoid any corporation claiming to be the <famous company> of the <different field>, since that implies they are unable to succeed on their own merits.

<comment><USER18> How do you compose an elevator pitch without this idiom?

<comment><USER33> Speak to the merits of the product or find an alternative attention grabber that people don't instinctively tune out. There are some openers that people flag as preceding a BS spiel.</comment></comment></comment>


Show HN: Proof of Position - <AUTHOR> http://proofofposition.com

<comment><USER2> I kinda like the concept, except there is no way to prove you were there in the first place. It just proves you inputted a set of GPS coordinates at a specific time and can prove that.

</comment><comment><USER3> Why? And even if there is a good reason this does not work because you can not prove that you actually were at the location you encoded into the block chain.

<comment><AUTHOR> Why? Wanted a decentralized database of memorable places I've visited.

Proof? The key pair signing the transaction proves it originated from this service. HTML5 geolocation data could be incorrect in the same way a Foursquare check-in doesn't prove one is actually at a given venue.

<comment><USER3> But why put it into the block chain instead of a database?

<comment><USER4> My guess would be the decentralized nature of it. Even if this service goes away (like Foursquare could), your check-ins with service won't (at least until the blockchain dies, which is presumably longer than an individual company).

<comment><USER3> I thought of that, too, but then - with bitcoin still in its infancy and far from sure to survive the next five years - I think that a cloud service is a far safer bet than the block chain. Or just have your own database on the site hosting the website.

</comment></comment></comment></comment></comment><comment><USER5> It's quite unclear to me - how much does it cost to store this data in the blockchain? I'm imagining the quantity must not be nil as otherwise it'd be possible to DOS the blockchain by supplying a large quantity of useless data.

<comment><USER6> Long story short 0 or 0.0001 BTC.

Long story - It depends on the inputs to the transaction you want to make.

</comment></comment><comment><USER7> With all the paranoia over privacy right now, I don't think too many people will buy into it.

</comment><comment><USER8> GPS spoofers are built into most major browsers.</comment>


What makes a book your favorite book? - <AUTHOR> https://stactivist.com/ <comment><USER2> Explosions and shit.</comment>