Somewhere on the tranquil plains between the dream of “an affordable existence for everyone” and the fear of “inadvertent communism through excessive social welfare programs” lie the realities of human nature and disincentivization.
Proponents of the true meritocracy argue that those who have excelled and have accordingly reaped a superior level of reward should not be forced to forfeit the riches they’ve earned. Those with stronger humanitarian views argue that it is senseless to permit the rich to bask in ridiculous opulence while their less fortunate fellow citizens hopelessly toil in failing effort to survive.
It’s an ideological battle that is certain to be at the forefront of next year’s United States Presidential election, and one that’s currently center stage in the Democratic Party primary debates leading up to that election. Specifically situated on the dockett are the questions of a universal health care system and debtless government funding of higher education.
“The United Kingdom’s public health care system is facing a catastrophic crisis of occupational disinterest.”
Amid the dust kicked up during the frothy-mouthed accusations of wanton laziness and cold-hearted greed, though, a few realities of the interaction between economics and human nature are being ignored. It makes this perhaps more unforgiveable that there are clear current and historical examples we’re choosing to ignore rather than treating them as predictors.
Regardless of the strength of our desire to believe that an adequate number of people will be willing to sacrifice an incredible amount of their own time and effort to shoulder the crushing burden of supporting and advancing society, it cannot be denied that disincentivization of crucial career fields is a clear and present danger that we cannot afford to ignore.
To see it, let’s take a step back, set aside the vague and flowery language, and settle on some concrete ideas and evidence. Reducing or eliminating costs to private citizens and eliminating market competition in fields like medicine and higher education will standardize earnings for professionals and generally reduce incomes in those fields.
No one really disagrees with that. It has been true in every other instance of such a transition globally (we’ll take a look at some examples), and it’s an inescapable part of every proposed American plan to move toward singular government funding. Sure, there may be low-level healthcare professionals whose incomes would not be negatively affected (although international examples suggest they’ll still be negatively affected in other ways) by a single-payer system, but no healthcare professionals would be expected to make more, and the highest level would be expected to see decreased incomes.
Even universal health care’s most passionate professional supporters, including the president of Physicians for a National Health Program, Dr. Carol Paris, publicly admits that “highly-paid specialists” are expected to make less.
So we’re all agreed, the champions and the dissenters, that standardization of incomes under one central government system at the very least decreases incomes for the highest paid professionals in intellectually elite and highly demanding fields like medicine and higher education. So what, right? They’ve got plenty, and they’ll still get plenty. Who cares if they don’t make as much?
They do. Medical professionals and high-level educators do. More concerning, potential medical professionals and high-level educators do. While there are admittedly some to whom it does not make a mind-changing difference, it (combined with some other consequences of transitioning to a single-payer system) does make that difference to a catastrophic number of those professionals. Whether or not it is appealing to our more idealistic hearts to acknowledge that, real world examples prove it to be true.
The critical medical doctor shortage in China has been a known and public issue for decades. A lengthy discussion could be had in an attempt to identify all of the factors contributing to this, but the general truth is that in an economic and governmental system in which earnings were controlled, standardized, and limited by the State, too few of China’s best and brightest were inspired to undertake the educational and professional demands of becoming medical doctors. However, China’s national population is massive, and, taken as a whole, China’s level of nationwide modernization and infrastructure can be argued to be incomparably inferior to a nation like the United States.
The popular trend among supporters of a free universal healthcare system/single-payer system/Medicare-for-All system in the United States is to instead point to and praise vaguely familiar European government health care systems that exist in very different national atmospheres. Often, these comparisons are under-substantiated, antiquated, and/or disproportionate. So, for the purposes of this discussion, as a reasonable example, let’s take a look at the current effects of disincentivization on the United Kingdom’s National Health Service (NHS).
The United Kingdom’s public health care system is facing a catastrophic crisis of occupational disinterest. According to the country’s leading medical professionals, the NHS required twice the number of medical students that it had in training in 2018 in order to avoid future collapse. In response, they announced an increase to the number of training locations by 25%, yet the crisis rages on in late 2019 as the mass exodus from and slow trickle into the medical field continued.
In early 2019, panicked and frustrated by a nation-wide demonstration of a lack of interest, the U.K.’s General Medical Council emphasized the need to identify and address the reasons the healthcare field was so miserably failing to retain and attract medical professionals. Some of the problematic elements they noted were doctors’ salaries, work hours, work schedules, and a lack of institutional support, all of which result from attempting to effectively fund a single central public healthcare system.
In a 2019 Medscape poll on U.K. doctor occupational satisfaction, it was found that U.K. doctor real-terms salaries (pay increase compared against inflation increase) fell between 2016 and 2018. Only 1/3 of General Practitioners and 41% of Specialists felt their pay was “fair” compared to their duties, with even fewer younger doctors reporting satisfaction. In fact, the majority of the more than 1,000 U.K. doctors polled reported dissatisfaction with every identified problematic aspect, and a greater percentage of younger doctors reported dissatisfaction in every case.
The age element is significant as an indicator that disincentivization is not improving with time. Significantly less than half of the doctors polled indicated that they would recommend medical professions to their children. A popular answer when asked to explain demonstrated that current U.K. medical professionals feel that their career field is “not rewarding.”
General Practitioner and Specialist doctors, who we may stereotypically consider overly privileged, are not the only disincentivized professionals in the U.K.’s NHS. The Royal College of Nursing also reports that the number of nursing students is decreasing while the number of nurses abandoning the profession due to factors like pay and workload is increasing. Efforts to increase training availability and reduce education costs, they report, do nothing to stem the flow of working nurses out of the medical field.
The U.K. and China are not the only countries facing problems related to critical career field disincentivization. Norway’s oft-touted public healthcare system is reported in 2019 as experiencing a widespread lack of interest from working nurses regarding advancing to management or career positions. Australian PhD students are reportedly flocking away from careers in academia. A study on the mobility of Italian PhDs indicates that wage return is playing an instrumental part in the country’s regional distribution of highly-educated individuals.
The goal of a discussion such as this is not to directly promote or criticize any one political campaign platform or candidate, but rather to emphasize the need to consider more than our own idealistic inclinations on “how things should be”. It is comforting and reassuring to pretend to ourselves that a sufficient number of selfless individuals will set their own individual gain aside in order to dedicate their lives to providing everyone else with advanced education and optimal healthcare. Unfortunately, real-world examples simply do not support this level of optimism.
When weighing our options for how to navigate the waters between obscene wealth for the privileged and equally distributed resources and services for all, we must be very careful not to ignore, or even to underestimate, the effects of “incentive” and the perils of disincentivization. We must be acutely aware that too strictly limiting the appeal of certain critical occupations, which already require an individual to sacrifice a great deal of their own time and effort, may cause a widespread disinterest in pursuing those occupations at all.