I’m not too concerned that some talented people will choose other professions if doctors no longer make quite so much money (and you’re right that doctors will make less if there’s a single-payer system — or a totally private, non-insurance-driven-system — because we won’t be overpaying them quite as much). Even under a reformed system, doctors will still be making more than many other professions (an upper-middle class wage, as you say). And that’s fine. I’m not overly impressed with the quality of most doctors I’ve currently seen in the U.S., and that’s because all their incentives are screwed up by the system. They’re motivated to authorize unnecessary procedures and over-prescribe medications, even as we have these pharmaceutical companies controlling medical regulatory bodies and getting them to issue ridiculous and medically unsound recommendations that do things like recommend that pretty much everyone over 60 be on statins or whatever, which then creates many more medical problems than it solves (through the horrific side effects of such drugs) and drives people right back into the healthcare system. I’d rather have people drawn into the medical profession because they actually want to be there and not because they’re so motivated by the vast amount of money they can earn, and I think the more important thing is getting rid of the screwed-up incentive structure we currently have. That’ll do much more for the quality of the medical system than any increase or decrease in salaries ever could.

You also wrote: “Right now, private insurance premiums get jacked up because doctors cost-shift their medicare/aid losses to the patients with private insurance. If private insurance goes away……no place to shift those costs too. Premiums skyrocket across the board.”

My point is that if private insurance goes away — either as a result of a single-payer system or as the result of a pure out-of-pocket market system — the actual cost of medical care is going to drop precipitously, because what’s keeping it artificially high is adverse selection and the unnecessary drugs and services. These are the main issues, as I see it, and these issues would get addressed in either of the solutions I’m proposing. If we have the whole country paying into one public insurance system through taxation, then we don’t have this issue you identified of doctors being able to shift their losses on medicare/aid to patients with private insurance. Same if we don’t have insurance at all.