Is it ethical to contract for a service you know in advance you'll be unable to pay for simply because you really need it?
It may seem like a simple question with an easy answer, but it's not.
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I too am pleasantly surprised by the figure for teachers.
If you read my post carefully you will see that I stated we pay doctors more because of their education not that their pay is necessarily justified. In my opinion the figure for neurosurgeons you have quoted is not justified.
It reminds me of a similar situation in soccer in England (obviously this is a more trivial example as it does not involve people's health). In England's top league (Premiership) soccer players are paid ludicrous sums of money (top players can make £60,000 a week) compared with the next league down. One cannot sensibly argue that they are that much better at playing soccer.
A lot of people get upset about these inflated salaries because they push the ticket prices up for the average punter. And yet people keep going and paying. It actually makes less sense in this case because, as you point out, you pay the neurosurgeon literally on pain of death. People could just stop going to watch soccer until the prices came down. Weird.
I didn't mean for the gun to the head analogy to become a justification for large fees. Charging someone a lot because they must pay it or die isn't ethically supportable. It's like looting, only it's looting someone's finances rather than a liquor store.
A lot of people get upset about these inflated salaries because they push the ticket prices up for the average punter. And yet people keep going and paying.
To take that analogy and run with it, insurance companies are part of the problem at both ends. On the one hand, they maximize thir profits by excluding people based on their probability of actually needing insurance in the first place. At the other end, while they do often limit payouts through negotiations, they still do go ahead and pay many of these extravagant fees, which just encourages doctors to ask for huge rewards.
BTW, emergency room doctors also save lives and often in really dire situations, yet how many ER specialists make anything close to a typical average neurosurgeon?