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If I’m an American citizen (only) and want to become a diplomat or a military submarine captain or a central banker, I pretty much have to work for the government. Making it so that if you want to be a doctor, you (mostly) have to work for the government is no different.
The politicians in single payer systems often stand up against paying doctors more because they know that if they do they have to pay all public sector workers more, and that means their own fiscal priorities often become unaffordable. The incentives aren’t perfect but they’re better than the current system where responsibility is diffused.
There are ways around it. The big drug makers have forced the UK to pay more by threatening to move well-paid pharma jobs offshore for example. Governments fund tens of billions of dollars in medical research, private universities do too. I’m unconvinced there will some collapse in new drug development if single payer happens, the global system might just become more fair instead of the American taxpayer paying for a disproportionate share of medical innovation.
Yes, if you want to become a diplomat (in a non-shithole country, anyway) it's good to have contributed a lot to the party in power. Like I said, corruption. Not sure how that's responsive to my issue, which is that your "negotiation" will consist of politicians negotiating doctor's reps with other people's money.
They actually don't have to pay all public sector workers more. But if they did... eh, it's not their money.
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The AMA would probably fight against most versions of single payer, and pretty heavily. If the proposal was "single payer and doctors are now going to be subject to the standard federal pay schedule", I don't think anything could prepare you for the fury that would be unleashed to prevent it from passing. Mayyyybe they could accept "...and we'll make a new, separate, special pay schedule (which can be changed separately from the standard schedule) for doctors, who are special," but there's just absolutely no way that the US government will actually have the political will to bulk force doctors to take a 3-8x pay cut.
Thousands of physicians are already public servants. They work for the public health service, the veterans administration or they're members of the armed forces. Other agencies employ them too (e.g. State dept, Indian Health Service). They receive special rates and do pretty well for themselves. They certainly make less than if they ran a successful practice, but not everyone is interested in those sorts of headaches and risk. And there are other tangible (loan forgiveness) and intangible (training, travel, work-life balance) benefits to working for the government beside the pay.
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That’s nothing new. The BMA (British Medical Association) was the most aggressive and chief lobbyist against the formation of the NHS in the 1940s. Doctors hate single payer because it drives down physician pay. That is precisely a reason to do it.
I mean teachers pay is politically radioactive in the US and doctors are roughly as sympathetic.
No, it’s different. Public school teachers are paid relatively averagely given years in the workforce and levels of education; a few make $130k but that’s a small minority in the highest paying districts in the country. They are paid toward the bottom of the most common ‘public service professions’ pay scale (cops, nurses, local government workers), especially in red states. In blue states, particularly rich ones in big cities with very high private sector salaries where the ‘we support underpaid teachers’ sentiment is most common they are paid slightly better, but so are the NYPD and nurses who work in Manhattan.
Meanwhile, while Americans have a lot of respect for doctors, I’ve never heard the sentiment that they’re underpaid except from doctors. They might say underpaid ‘compared to’ dislikes groups like CEOs and bankers, but that is more about the latter than the former. “No, I believe my anaesthesiologist should make $900k a year instead of $600k - hell why not a million?” just isn’t really the kind of thing people are saying or thinking.
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