My father did his training in:

Iceland
Germany
England
Canada
United States

He, then, settled and practiced in the US.

He made the observation that the US was the only place that during training the cost of patient care is never an issue in the curriculum.

I believe Milton Friedman came to the conclusing that the MD in the US is essentially a membership to a trade guild.

Mark McCormack in "The Terrible Truth About Lawyers" simply summed it up by quoting Plato in saying that "The professions are a conspiracy against the lay people."


If that is valid it certainly explains some of what we see.

In any case, doctor's incomes are a very small part of the total medical care expense.

Historically to speak of being cost effective and to talk health care in the same sentence has been blasphemy.

A major part of the problem here in America is that we continue to think that health care is a "private good"

It is also to a large extent a "public good"