Noam Scheiber and Megan McArdle on Bloggingheads, in a segment entitled “Megan: Obamacare will cause doctors to quit medicine”
Scheiber at TNR with the follow-up post:
(Short version: Megan thinks our brave new health reformed world will cause lots of people to pass on being doctors in favor of becoming lawyers and middle managers. I think doctors will enjoy enough social prestige that we won’t have trouble filling hospitals even if we pay them slightly less. We ended up in a bit of a stalemate over the empirical question of how much declining doctor pay has, in the past, affected people’s desire to go to med-school. I’m going to try to dig up some evidence to shed light on the question. Anyone with a study to point me to should feel free to point away in comments.)
In Scheiber’s next post, he links to a Matt Yglesias post. Here’s Yglesias:
An interesting fact about Sweden is that an extremely high proportion of its population is foreign born. It’s not the highest in the world—Canada and Australia take the crown—but the foreign-born are a larger proportion of the population than in the United States
A large number of those immigrants are from other European countries, but apparently Sweden has one of the world’s largest Assyrian populations.
Why is this relevent? Scheiber:
I argued in response that the ability to bathe doctors in social prestige isn’t exactly a fixed feature of one’s national character–it’s not that Americans are genetically incapable of it, or that Europeans naturally excel at it. If doctors made slightly less money, but the system were seen as better for patients overall, the social prestige of doctoring might rise a bit and compensate them for the loss of income.
At this point, Megan came back with:
“We don’t have a unified culture. There’s no–Sweden can talk about having a Swedish culture, and to some extent a Swedish status hierarchy and Swedish values. That’s just not true of America. Everyone’s participating in about 97 different subcultures. So you can invent your own status hierarchy, but you can’t get everyone to buy into the idea that we should pay our doctors $60,000 a year and then all love them a lot because they’re doctors.”
I guess Megan’s point is that Sweden has a more discernible status hierarchy because it’s a much more homogeneous country. And it sorta sounds plausible (though I still think most people are inclined to respect doctors regardless of whether or not they belong to the same subculture–all the more so if they’re satisfied with their health care).
Matthew Yglesias enters the fray:
But you don’t need to look to Sweden to look for an example of a group of people who are esteemed out of proportion to the financial rewards they receive—just look at the officer corps of the American military. There’s a reason why the perception that Obama is at odds with General McChrystal could be politically damaging, there’s a reason why General Petraeus’ famous congressional testimony was a big deal politically, and there’s a reason why the White House was eager to release the photo above after having gotten hit for Obama not being directly engaged with McChrystal. The American military has a lot of prestige in the United States and so do military officers, all without being lavishly paid.
And McArdle responds to all:
I could be wrong–I’m certainly no expert on Sweden–but my understanding is that Sweden has a very high immigration rate because of its extraordinarily generous asylum policy. However, these immigrants are not particularly well assimilated, and are not really the people who become doctors in Sweden. Indeed, the non-Western immigrants to whom Matt refers seem to have a horrifically high unemployment rate. Second generation immigrants, particularly those who are not from Northern Europe, appear to have severe lagging income gaps with ethnic Swedes.
My impression is that the ethnic Nordics who have a higher probability of finding jobs as skilled professionals do in fact think of themselves as participating in a common Swedish culture in a way that is just not comprehensible in the United States. They talk about being Swedish in the way that an individual American might talk about being Jewish, or a Harvard grad.
In America, it’s not just that we have a high percentage of immigrants right now; it’s that all the previous generations of immigrants also created their own subcultures, as did the regional divides between north/south/west, the endlessly multiplying religious divides, and so forth. It’s generally harder to substitute status for income outside of relatively closed and homogenous cultures, which is why small towns rely on volunteer firemen, and cities don’t.
Matt Yglesias, who totally mangled what I said to interpret it as saying that income confers status on a profession–possibly true, but not what I argued–offers the Officer’s Corps as an example of skilled profession that isn’t particularly highly paid.
I’m not sure that it’s an accident that the career military is so heavily drawn from hereditary military families, and white southerners, both of which place extraordinarily high status on joining the military. It’s also true that officers have quite a lot of financial opportunities after they leave the military, but of course a lot of them are in it for honor rather than money. The thing is, being a high-ranking officer is so weird in so many ways that I’m not sure you can generalize it to any other profession–at least not unless you’re willing to give successful doctors a few aides de camp, subsidized housing, and maybe a private plane.
McArdle quotes this Michael C. Moynihan Reason piece:
First, Geier, debunker of myths about Sweden and Swedish socialism, surely knows that the plurality of the foreign-born in Sweden are Finns and Finlandsvensk-Swedish-speaking Finns-who are very much a part of the Nordic welfare tradition. This will soon change, with the influx of asylum-seekers from the Middle East, and we’ll soon see how much stress this puts on the “Swedish model.” That said, and as Geier seems to concede but not comprehend, the remaining 87 percent are native-born Swedes with, for the most part, a common cultural, religious/irreligious, social, and political heritage. This is, obviously, not the case with native-born Americans, a patchwork of ethnicities and religious affiliations. (Incidentally, I am an American-born permanent resident of Sweden.)