Reducing the Cost of Doctor’s Appointments at No Taxpayer Expense
As the national conversation around healthcare continues, there are few proposed solutions from the perspective of those of us who would like to see less government spending overall and less government involvement in our health care in particular. As Americans struggle to find ways to cope with the cost of health care, medical students struggle with rising costs of higher education: about 80% of medical students take out loans to pay for their education, with the average student accumulating $251,600 worth of debt.
Medical student loan debt and health care costs are part of the same problem. One way to lower the cost of doctor’s appointments is to reduce the amount of medical school debt that doctors have by creating a two-part, tax-advantaged system of debt-free medical school programs and a network of affordable, excellent doctors at no taxpayer expense.
This approach is a departure from a “one size fits all” solution to health care costs. Instead, entrepreneurs can identify each costly area of healthcare and develop strategies to reduce the cost. And a logical place to start is the cost of doctor’s appointments.
Just this year, I spent $440 on an initial consultation with an endocrinologist and $373 for a 15-minute follow-up appointment with a hematologist after receiving treatment. These numbers are not unusual; the average cost for a routine adult physical is $200-$240, while an appointment for sickness ranges from $130-$180. These numbers rise to an average of $365 for specialists. These prices are not only out-of-reach for people without health insurance, but even people with insurance struggle to make these payments as deductibles climb.
Despite these high costs, not all doctors are without their own financial worries. Instead, they are known as HENRYs—High Earners, Not Rich Yet. Though their income is high, their expenses are also high, and it isn’t uncommon for doctors to end up living paycheck to paycheck.
For example, one of my cousins is a doctor and is married to a doctor. Though both are employed as doctors, they could only afford a rat-infested apartment in Brooklyn. After several years, he took a job as a doctor in Louisiana, and she moved back in with her mom in New York. They are still married, but live in different states, because they could not afford to live in the same place.
When our doctors are living with this kind of student loan debt, we cannot expect them to charge less for their expertise.
One solution is debt-free medical school programs offered at universities across the country. These programs would then feed into a network of top, affordable doctors. This could solve the problem of medical school student loan debt and provide affordable doctor’s appointments at no expense to the taxpayer.
For the first component, I propose creating debt-free medical school programs as a subset of existing programs at medical schools. For example, the University of Michigan could continue their traditional medical school program, and then create an additional, smaller debt-free medical program that requires students to complete five years in an affordable doctor’s network upon graduation (more on that in a moment). The debt-free program would be similar to how many graduate programs in the sciences and the humanities throughout the country fully fund a percentage of their graduate students, while the remainder of the graduate students pay the regular tuition and fees. The only difference would be that there is a work requirement upon graduation (more on that in a moment).
For example, a student applying to the University of Michigan would apply for consideration in the debt-free program, but could still be accepted as a paying student. Universities can offset the lost tuition by setting up the debt-free medical school program as a nonprofit subsidiary and leveraging tax advantages. With some creativity, they might even capitalize on it.
For the second component, graduates of the debt-free medical school program would be required to work for five years as part of a non-government, nationwide network of affordable doctors. The requirement for graduates to work in this program would be held by the university, not the government, thus avoiding a lot of the bureaucratic hiccups that have plagued the federal student loan forgiveness program. Graduates would be obligated to pay back part or all of their tuition, depending on the college, if they worked for fewer than five years expected of them.
Because these doctors would be graduating from highly desirable and competitive programs, they would be not only affordable, but excellent doctors. This network should have an attractive name, like “Gold Coat Doctors,” though the branding can be determined later.
These Gold Coat Doctors would work at existing healthcare facilities—hospitals, urgent care facilities, or private practices. When a patient looks for a doctor in their area, the Gold Coat Doctor would show up along with all the other doctors at the facility, distinguished perhaps with a small gold coat icon next to their name. If necessary, appointments with these doctors could be limited to those without health insurance or to those who have not yet met their deductible for the year. As you can see, there is plenty of wiggle room for creativity.
Because the Gold Coat Doctor would have no medical school student loan debt, their appointments could be offered at a much lower cost than traditional appointments without negatively impacting the doctor’s standard of living. The cost of appointments could be further reduced if the Gold Coat Doctor Network purchased group malpractice insurance in which their doctors participated. A Gold Coat Doctor might make $115,000 a year instead of the mean physician salary of $313,000 per year. After five years, the doctor would be free to go on to work anywhere they wanted, or set up their own practice, and charge whatever amount they choose.
Overall, this would be a much more advantageous position for doctors. Not to mention, universities would have the opportunity to distinguish themselves as forward-thinking and philanthropic, which could lead to other streams of revenue. The rotating nature of the program would ensure that affordable and excellent doctors were always available to patients. And all this would happen within the private sector.
The proposed Gold Coat Doctor Network and debt-free medical school programs could be implemented within our existing healthcare and education systems relatively quickly and at minimal cost. And while it wouldn’t reduce the cost of drugs, pharmaceuticals, or tests; get rid of student loan debt for all doctors; or reduce doctor’s bills for all people; it would still benefit tens of thousands of patients and doctors.
Such a program could prevent thousands of doctors from living paycheck to paycheck trapped by medical school student loan debt. And it could provide low-cost, high quality doctor’s appointments to tens of thousands of people who otherwise would not go to the doctor at all.
Though this certainly wouldn’t be the answer to all of our health care and high tuition woes, it could work as a starting point for a long-term, sustainable solution.