5 ms·

Oh, so there is free movement of foreign medical staff to the US, so that medical professionals have to compete on the same basis as a working class manufacturi

Oh, so there is free movement of foreign medical staff to the US, so that medical professionals have to compete on the same basis as a working class manufacturing employees?

carbocation 10y ago
They have to get re-licensed according to US regulatory standards, which are burdensome for everyone (whether from the US or not), but sure, they can (and do) come practice here regularly. And, regardless, if physician pay went to 0, US healthcare costs would drop by only 10%.
- maxerickson 10y ago
  Isn't it pretty highly likely that we need to do 20 or 25 different things that average dropping the price by 2%? If we consider them in isolation, shrug and say the cut won't fix the problem, we won't fix the problem.
  - carbocation 10y ago
    This is true. I'm biased, of course, but to me the administrative costs are what's breaking the back of medicine. The roles of physicians and nurses are essential (I'm not saying that they can't eventually be automated, just that they have to be done). Those of administrators generally are not. But the growth in administration has been astounding: http://image.slidesharecdn.com/pnhplongsetweisbartversion-121221105916-phpapp01/95/pnhp-long-setweisbartversion-52-638.jpg?cb=1356087906 http://image.slidesharecdn.com/pnhplongsetweisbartversion-12... So, sure, we can cut physician salaries and nursing salaries (nursing pay collectively is about the same as physician pay). But I don't see a downside to trying to reduce the administrative burden as a means of cost reduction.
    - maxerickson 10y ago
      FWIW, when I think about cutting physician pay, I think about incentivizing new supply, as it is likely the most effective way to do it and also probably the fairest. I definitely have lots of concerns about the mega institutions that are swallowing hospitals. It's hard to believe that they really do much to improve outcomes for patients (and it's pretty observable that they haven't done any good for prices).
      - carbocation 10y ago
        > FWIW, when I think about cutting physician pay, I think about incentivizing new supply Sorry for potentially being probably completely obtuse here due to being deep within the structure of medicine, but new supply of what?
        maxerickson 10y ago
        Doctors. Grants, loan forgiveness programs, stuff like that should incentivize people to go into medicine. Have to fix the limits on residencies and such too.
        carbocation 10y ago
        You don't even need those things. Without them, medical schools still accept less than half of those who apply. Let's say they increase capacity so that everyone who applies gets in somewhere. The bottleneck would still be, as you point out, the number of residency slots that Medicare is willing to fund.

Oh, so there is free movement of foreign medical staff to the US, so that medical professionals have to compete on the same basis as a working class manufacturing employees?

carbocation 10y ago

They have to get re-licensed according to US regulatory standards, which are burdensome for everyone (whether from the US or not), but sure, they can (and do) come practice here regularly. And, regardless, if physician pay went to 0, US healthcare costs would drop by only 10%.

maxerickson 10y ago
Isn't it pretty highly likely that we need to do 20 or 25 different things that average dropping the price by 2%? If we consider them in isolation, shrug and say the cut won't fix the problem, we won't fix the problem.
- carbocation 10y ago
  This is true. I'm biased, of course, but to me the administrative costs are what's breaking the back of medicine. The roles of physicians and nurses are essential (I'm not saying that they can't eventually be automated, just that they have to be done). Those of administrators generally are not. But the growth in administration has been astounding: http://image.slidesharecdn.com/pnhplongsetweisbartversion-121221105916-phpapp01/95/pnhp-long-setweisbartversion-52-638.jpg?cb=1356087906 http://image.slidesharecdn.com/pnhplongsetweisbartversion-12... So, sure, we can cut physician salaries and nursing salaries (nursing pay collectively is about the same as physician pay). But I don't see a downside to trying to reduce the administrative burden as a means of cost reduction.
  - maxerickson 10y ago
    FWIW, when I think about cutting physician pay, I think about incentivizing new supply, as it is likely the most effective way to do it and also probably the fairest. I definitely have lots of concerns about the mega institutions that are swallowing hospitals. It's hard to believe that they really do much to improve outcomes for patients (and it's pretty observable that they haven't done any good for prices).
    - carbocation 10y ago
      > FWIW, when I think about cutting physician pay, I think about incentivizing new supply Sorry for potentially being probably completely obtuse here due to being deep within the structure of medicine, but new supply of what?
      - maxerickson 10y ago
        Doctors. Grants, loan forgiveness programs, stuff like that should incentivize people to go into medicine. Have to fix the limits on residencies and such too.
        carbocation 10y ago
        You don't even need those things. Without them, medical schools still accept less than half of those who apply. Let's say they increase capacity so that everyone who applies gets in somewhere. The bottleneck would still be, as you point out, the number of residency slots that Medicare is willing to fund.