Long story short, if you are in private practice, you have to pay for overhead, which includes rent, equipment, staff, and the electronic records system (<–this is VERY expensive, is outdated every 5 years, and needs to be completely replaced.). so you have to work a lot more than 40 hours to keep your practice afloat or else you close up shop. Plus, many docs will have to be on call at the local hospital in order to get the privilege to admit your patient in case something goes wrong. So the hours can balloon anywhere from 60-90 hours per week depending on specialty (could be 120 hours if you are a neurosurgeon). Sure you can just work 40 hours a week strictly, but that is considered part time and your pay check will be slashed by up to 50%, depending on your contract. This is not possible if you own your own practice because you will go under.

If you work in a hospital, then you will have to be on call a lot more (typically). I know surgeons who had to wake up at 1am because they were on call, perform surgery for 4 hours and not get paid for those 4 hours. After their 4 hour surgery, they immediately have to start their normal 6am-6pm day. If you want to work strictly 40 hours, they might fire you or again cut your salary significantly. They can hire someone else who will work those 60-80 hour work week without complaining.

The exception is Emergency Medicine. You work around 32-36 hours a week (more if you want). But you have to do day and night shifts. This causes a lot of problems because you mess with your circadian rhythms and the ER is so busy that you often burn out, which causes problems with your lover back home. And you have to work on major holidays (think Christmas, New Years, July 4th, Thanksgiving, ect).

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The reason I omit the government sector from my analysis is that the US government spends almost exactly the same on healthcare (as a % of GDP) as any other developed Western nation. It spends slightly more than the UK (about 8.3% compared to 7.8%) but slightly less than France (9.0%), Germany (8.6%) and Denmark (9.6%), all four of which could fairly lay claim to having ‘the best healthcare system in the world’. If government intervention was the sole cause of a dysfunctional healthcare system then France, Germany and Denmark would be just as dysfunctional as the US. Source. Alternatively we could look at per cap spending to try and control for the fact that some countries are richer than others (since healthcare is a normal good) and we find that the US has an unexplained gap of about $2000 / person which is not explained by their relative wealth per capita. Source In fact my impression (speaking just from memory and without data for a moment) is that the government-run bits of the US healthcare system (Medicare and Medicaid) are respectably run as far as these things go, and the US dysfunction lies in the market system which sits on top of that.

Your comments about obesity are interesting. Perhaps as much as $25bn of the $650bn US spending ‘excess’ can be accounted for by US obesity, so not exactly small change but hardly the be all and end all. You also need to contextualise that by pointing out the US smokes a lot less and is generally younger than most of Western Europe (not to mention it doesn’t have anything like the mental health issues which afflict the Scandanavian countries). The UK is approximately as obese as the US (c.60% to c.65%) and doesn’t have the same level of catastrophic overspend as the US, which limits obesity as an explaination in my mind. Source

It doesn’t really seem fair to snipe at healthcare economists for being a “dysfunctional field” when you could do a first-order check for your claims in five minutes and see that either the arguments are much more subtle than you are claiming or that people who study this really *do* know what they’re talking about when they don’t list obesity as an important cause of US overspending.

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It looks like you followed the instructions you were given, but unfortunately the quotes in the instructions got converted to smart quotes. With any luck you’ll be able to cut and paste this: <a href="url">title</a>

Thanks for a great comment. So frustrating that what needs to be done is political suicide

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* Specifically, people who are skinny because they eat little, as opposed to people who are skinny because e.g. their bodies pass lots of calories unabsorbed.

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