incomes begin to fall more into as you noted ‘upper middle class’ — along with more sane cost controls — cannot this work?
You can have your cake and eat it too, though. The solution is the integrated medical home.
A thriving internist practice probably takes in nearly a million dollars a year per internist. Now, subtract out the office administration, the employed nurses, the required insurances, and all the other shit that has nothing to do with MEDICINE, per se, but has to do with the BUSINESS practice of medicine.
When you’re all done, the average urban internist (in a typical city, not NYC or LA) W2’s 200–250K. And they had to put up with all the bullshit of running their own small business.
So, the medical home comes along, and says “shit, I’ll just HIRE you for 200K, and I’ll take care of all the adminstration, medical records, IT, yada yada yada.”
And the cost of health care drops a bunch as those administrative costs get spread out over the medical home.
So, no, I don’t want to drop those guys down to 125K or 150K. I want to keep paying them 250K, and I’ll pocket the savings from lowering the adinistrative costs of practicing medicine.