13 ms·

First, there are plenty of jobs, but not enough people that have decided to develop themselves enough to have the skills to do them. For example (a real life on

First, there are plenty of jobs, but not enough people that have decided to develop themselves enough to have the skills to do them. For example (a real life one, unfortunately for me): I need a biopsy of a mass near my heart, but the current waiting time for this procedure here in Seattle (at both major hospitals) is two months. What we do have is plenty of regulations that constrain the supply of physicians, services, medical supplies, insurance, and everything else needed to perform operations. It is one of the most un-free markets in America, with predictably disastrous results. Sure, those laws prevent a few people from being duped by charlatans, but they also prevent people like me - who are willing to sit on the phone for hours and days, and willing to do research for weeks on end - the possibility of a longer life. -- There are also plenty of regulations that are limiting career mobility, both in medicine and in other fields. An example of this is that anything that makes it hard for employers to fire people also makes it more costly for them to hire different people (because that new person is an unknown, and therefore risky, as the employer has to hold onto them longer, even if they aren't willing/able to produce.) -- EDIT: I'd like to add that the idea that some people are destined to be doctors (and some aren't) is completely wrong. I was a premed in college (molecular biology degree, worked in a research lab on campus full-time for two years after graduating), and I gave up on the MD track after talking to a few younger doctors. They all told me to quit while I could because they were all in 200k+ in debt, and couldn't switch out of their careers because of it, and they were miserable (tons of useless paperwork, not a lot of progress either in research or with patients). So I went into software, where you don't have to convince a committee to give you permission to make a new app.

david927 10y ago
That's like saying there's plenty of room for musicians if you're Mozart. The amount of investment required to develop yourself for a target field has grown astronomically, but that's been coupled with a push down in wages. I know lawyers who spent a fortune for their degree, passed the Bar, and make barely more than minimum wage. Regulation isn't causing this; automation is causing this.
- maxharris 10y ago
  There is no robot that can knock me out (safely so that I wake up when everything is done), snake a thing down my windpipe, poke through the exact right spot in my bronchial tube and into my mediastinum (a name for the bag that my heart), and retrieve a chunk of whatever surrounds my aorta. But here I wait, while people capable of doing this (or at least capable of learning how to do it - and that's a lot of people) also wait. That's regulation.
  - david927 10y ago
    My view is that the times when Capitalism has been a long leash it ends up being wildly destructive. I love fire for cooking, forest fires not so much. I certainly don't think that the reason we don't have more jobs in America is that businesses are so hard pressed with labor laws. I just don't see that. What I have seen, over and over again, are that employers are realizing that they're now in the cat seat and become nothing less than abusive, deeply abusive, to their employees as a result. Once they see how many people apply for new openings and realize how unlikely it is that current employees will quit in this environment, they become mini-dictators. It's an interesting phenomenon. All that aside, I do wish you good health and hope that you can get the treatment you need soon.
    - kamaal 10y ago
      Capitalism creates a winner-take-all market as time progresses. As it becomes harder to enter the market for new comers(See Tesla, also try starting a company to build airplanes) you will see powerful monopolies emerging. That doesn't end well on the longer run. Also Free Market economy seems to play along with popular choice, so pokemon go and cure for baldness is likely to get prioritized above space budget.
    - maxharris 10y ago
      All that aside, I do wish you good health and hope that you can get the treatment you need soon. Thank you (and I mean that quite sincerely). Practically speaking, though, how will I get treatment? Intervention from the government is the only reason I'm waiting for care right now. (See my comments in other posts on this thread - I establish this in great detail if you consider my posts together.)
lastyearman 10y ago
Labor laws are just moving the risk from the employee to the employer. In an ideal world the employee would be compensated more for higher risk so nothing would change. But in the real world most employees won't realize that so we (supposedly) decided to implement labor laws. There are plenty of jobs for sure. Look at how much better we could make the developing world if someone was willing (are you?) to work those jobs.
clifanatic 10y ago
> you don't have to convince a committee to give you permission to make a new app. You do if you want to get paid to make it...
- maxharris 10y ago
  But this is an equivocation. In medicine, the present state is that we have the equivalent of censorship in speech.
  - infinite8s 10y ago
    That's a false equivalence. How could you be sure that your 'doctor' has any idea that they know what they are doing. Market mechanisms don't work with this kind of information asymmetry.
- dredmorbius 10y ago
  More to the point, with the phenomenal centralisation of control of global capital (~45 firms, per a Swiss national science foundation report a few years back), that increasingly affects all new business capitalisation. https://www.newscientist.com/article/mg21228354-500-revealed-the-capitalist-network-that-runs-the-world/ https://www.newscientist.com/article/mg21228354-500-revealed...
pfranz 10y ago
I've had this suspicion that I've been meaning to look into to find out if the numbers match up. The biggest growing industries to me seem to be the service industry and entertainment. Both of these are really superfluous. If is true, I see this as a symptom that we have fewer useful jobs and are pushing people into these superfluous jobs--kind of a sign that soon we'll have more people than jobs. More to your case, the more specialized jobs get, the more difficult it is to transition in and out of. Liquidity of skills comes up a lot in history. I've heard the U.S. specifically makes it really difficult for doctors trained in other countries able to practice here. Usually, if there's an under-supply of a skill someone steps in to remedy it. So why if there's demand for certain jobs, why there aren't more programs to train more of them. It seems like many businesses aren't willing to take on people unless they have the exact skillset where years ago they'd be willing to train people at the business' expense (another feeling I haven't looked into if it's true).
- maxharris 10y ago
  So why if there's demand for certain jobs, why there aren't more programs to train more of them. Medicare (i.e., the federal government, congress) sets de facto limits on the number of new residents that are trained each year. "The Balanced Budget Refinement Act of 1999 (BBRA) increased the limit for rural teaching hospitals to equal 130% of each rural teaching hospital's 1996 resident count (BBRA Section 407)." https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html Debates on these matters constantly criticize the few elements of freedom in our existing system. Rarely do people acknowledge any of the controls and regulations that have been in place for decades, and have brought us to our current crisis...
  - pfranz 10y ago
    I do wish that was brought up. However, government provided healthcare or not (and Medicare or not), I think healthcare should be closely regulated (maybe by professional organizations if not the government). I can't find the citation, but I was reading that as doctor density increases, the number of procedures increase even though the outcomes are the same. It's also pretty obvious that as Baby Boomers start retiring, we're going to need more medical professionals. The demand for those services probably won't show up until it's too late to train them so it'd be good to incentivise people now (although, it might be too late already).
clamprecht 10y ago
> What we do have is plenty of regulations that constrain the supply of physicians, services, medical supplies, insurance, and everything else needed to perform operations. It is one of the most un-free markets in America, with predictably disastrous results. Sure, those laws prevent a few people from being duped by charlatans, but they also prevent people like me - who are willing to sit on the phone for hours and days, and willing to do research for weeks on end - the possibility of a longer life. Sounds like a pitch for medical tourism (traveling to another country for certain kinds of medical procedures at a fraction of the cost of the US)
fweespeech 10y ago
> There are also plenty of regulations that are limiting career mobility, both in medicine and in other fields. An example of this is that anything that makes it hard for employers to fire people also makes it more costly for them to hire different people (because that new person is an unknown, and therefore risky, as the employer has to hold onto them longer, even if they aren't willing/able to produce.) In all 50 states, you can fire people easily unless: 1) You are blatantly discriminatory AND the people who are discriminating against can deploy legal muscle to their benefit. 2) The employer voluntarily entered into a contract with employee(s) that restrict the employer's rights. There are no "regulations" involved beyond #1 in firing people. Its why almost everyone is fired for the generic "performance" reason. Its pretty much immune to criticism unless you are blatantly discriminating.
- WalterBright 10y ago
  It's a bit more complex than that: https://www.rocketlawyer.com/article/what-states-are-at-will-employment-states-ps.rl https://www.rocketlawyer.com/article/what-states-are-at-will...
  - fweespeech 10y ago
    In statute, yes. However, in reality, all of it can be covered by a boilerplate employee contract that makes you effectively at-will and provides negligible protection.
    - otterley 10y ago
      Provisions in contracts that require one of the parties to waive statutory protections are usually deemed void in courts as contrary to public policy.
Gatsky 10y ago
I feel for you - this kind of thing just shouldn't happen. I think that medicine is a bad example of the point you are trying to make though... It has a lot of embedded costs and roadblocks that aren't really related to regulation. For example - the procedure you describe is highly specialised, and can only be learnt in certain places. Say there are 4 people that can do this procedure at a hospital. Attracting a doctor who can do the procedure is often a complicated task. In a highly specialised field thay may need to be incentivised, which also costs money. It is very difficult to control where doctors work - they invariably want to work in large established centres, which are already saturated (and so they don't work full time, they end up taking small bits of work here and there). This problem isn't necessarily solved by training an order of magnitude more - increasing the true training capacity of the health system is actually very hard, and takes a long time. Pumping up the inflow of trainees at one end just means that competition increases, doctors spend more time optimising for selection onto programs and working in certain places rather than doing their training. They also develop a sense of entitlement due to the high debt and difficult and competitive training ie they feel like they should be able to work wherever they want to work, not where they are forced to go. There is limited space in the endoscopy suites usually - increasing capacity means building a new suite, buying all the equipment, paying the nurses, rostering another anaesthetist. The added cost is easily more than a million dollars just to get started, without the doctor even doing any procedures. There could also be other bottlenecks like sufficient recovery areas and clerical staff. This high threshold means that an overloaded service will languish for long periods before capacity is increased.
- maxharris 10y ago
  It is true that medicine is expensive, but so is setting up the technology for a major cloud provider (on the scale of Amazon), or a car coordination platform/system like Uber. The difference is that the tech examples I've provided have not had the ability to progress (and the financial reward for doing so) regulated out of them. The wait time for this is not something that just happened yesterday, and what I'm saying is there's a systematic reason for it that goes deeper than just the nature and cost of the people/equipment/training. An example of this from another field: In a 10-year span during the 1880-1890s, J. J. Hill coordinated and financed the construction of a transcontinental railroad, without any government aid. This was done without the benefit of bulldozers, tunnel-boring-machines, automated track-laying equipment, etc. Today, Seattle's transportation authority says that it'll take 25 years for it to put down six miles of rail between Ballard and downtown. I'd be dead for sure in 1890 (no CT scanners, etc.), but the rate of progress has definitely been restricted. And the difference is just in our ideas, not things, or any inherent rule in nature.

david927 10y ago

That's like saying there's plenty of room for musicians if you're Mozart. The amount of investment required to develop yourself for a target field has grown astronomically, but that's been coupled with a push down in wages. I know lawyers who spent a fortune for their degree, passed the Bar, and make barely more than minimum wage. Regulation isn't causing this; automation is causing this.

maxharris 10y ago
There is no robot that can knock me out (safely so that I wake up when everything is done), snake a thing down my windpipe, poke through the exact right spot in my bronchial tube and into my mediastinum (a name for the bag that my heart), and retrieve a chunk of whatever surrounds my aorta. But here I wait, while people capable of doing this (or at least capable of learning how to do it - and that's a lot of people) also wait. That's regulation.
- david927 10y ago
  My view is that the times when Capitalism has been a long leash it ends up being wildly destructive. I love fire for cooking, forest fires not so much. I certainly don't think that the reason we don't have more jobs in America is that businesses are so hard pressed with labor laws. I just don't see that. What I have seen, over and over again, are that employers are realizing that they're now in the cat seat and become nothing less than abusive, deeply abusive, to their employees as a result. Once they see how many people apply for new openings and realize how unlikely it is that current employees will quit in this environment, they become mini-dictators. It's an interesting phenomenon. All that aside, I do wish you good health and hope that you can get the treatment you need soon.
  - kamaal 10y ago
    Capitalism creates a winner-take-all market as time progresses. As it becomes harder to enter the market for new comers(See Tesla, also try starting a company to build airplanes) you will see powerful monopolies emerging. That doesn't end well on the longer run. Also Free Market economy seems to play along with popular choice, so pokemon go and cure for baldness is likely to get prioritized above space budget.
  - maxharris 10y ago
    All that aside, I do wish you good health and hope that you can get the treatment you need soon. Thank you (and I mean that quite sincerely). Practically speaking, though, how will I get treatment? Intervention from the government is the only reason I'm waiting for care right now. (See my comments in other posts on this thread - I establish this in great detail if you consider my posts together.)

lastyearman 10y ago

Labor laws are just moving the risk from the employee to the employer. In an ideal world the employee would be compensated more for higher risk so nothing would change. But in the real world most employees won't realize that so we (supposedly) decided to implement labor laws. There are plenty of jobs for sure. Look at how much better we could make the developing world if someone was willing (are you?) to work those jobs.

clifanatic 10y ago

> you don't have to convince a committee to give you permission to make a new app. You do if you want to get paid to make it...

maxharris 10y ago
But this is an equivocation. In medicine, the present state is that we have the equivalent of censorship in speech.
- infinite8s 10y ago
  That's a false equivalence. How could you be sure that your 'doctor' has any idea that they know what they are doing. Market mechanisms don't work with this kind of information asymmetry.
dredmorbius 10y ago
More to the point, with the phenomenal centralisation of control of global capital (~45 firms, per a Swiss national science foundation report a few years back), that increasingly affects all new business capitalisation. https://www.newscientist.com/article/mg21228354-500-revealed-the-capitalist-network-that-runs-the-world/ https://www.newscientist.com/article/mg21228354-500-revealed...

pfranz 10y ago

I've had this suspicion that I've been meaning to look into to find out if the numbers match up. The biggest growing industries to me seem to be the service industry and entertainment. Both of these are really superfluous. If is true, I see this as a symptom that we have fewer useful jobs and are pushing people into these superfluous jobs--kind of a sign that soon we'll have more people than jobs. More to your case, the more specialized jobs get, the more difficult it is to transition in and out of. Liquidity of skills comes up a lot in history. I've heard the U.S. specifically makes it really difficult for doctors trained in other countries able to practice here. Usually, if there's an under-supply of a skill someone steps in to remedy it. So why if there's demand for certain jobs, why there aren't more programs to train more of them. It seems like many businesses aren't willing to take on people unless they have the exact skillset where years ago they'd be willing to train people at the business' expense (another feeling I haven't looked into if it's true).

maxharris 10y ago
So why if there's demand for certain jobs, why there aren't more programs to train more of them. Medicare (i.e., the federal government, congress) sets de facto limits on the number of new residents that are trained each year. "The Balanced Budget Refinement Act of 1999 (BBRA) increased the limit for rural teaching hospitals to equal 130% of each rural teaching hospital's 1996 resident count (BBRA Section 407)." https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html Debates on these matters constantly criticize the few elements of freedom in our existing system. Rarely do people acknowledge any of the controls and regulations that have been in place for decades, and have brought us to our current crisis...
- pfranz 10y ago
  I do wish that was brought up. However, government provided healthcare or not (and Medicare or not), I think healthcare should be closely regulated (maybe by professional organizations if not the government). I can't find the citation, but I was reading that as doctor density increases, the number of procedures increase even though the outcomes are the same. It's also pretty obvious that as Baby Boomers start retiring, we're going to need more medical professionals. The demand for those services probably won't show up until it's too late to train them so it'd be good to incentivise people now (although, it might be too late already).

clamprecht 10y ago

> What we do have is plenty of regulations that constrain the supply of physicians, services, medical supplies, insurance, and everything else needed to perform operations. It is one of the most un-free markets in America, with predictably disastrous results. Sure, those laws prevent a few people from being duped by charlatans, but they also prevent people like me - who are willing to sit on the phone for hours and days, and willing to do research for weeks on end - the possibility of a longer life. Sounds like a pitch for medical tourism (traveling to another country for certain kinds of medical procedures at a fraction of the cost of the US)

fweespeech 10y ago

> There are also plenty of regulations that are limiting career mobility, both in medicine and in other fields. An example of this is that anything that makes it hard for employers to fire people also makes it more costly for them to hire different people (because that new person is an unknown, and therefore risky, as the employer has to hold onto them longer, even if they aren't willing/able to produce.) In all 50 states, you can fire people easily unless: 1) You are blatantly discriminatory AND the people who are discriminating against can deploy legal muscle to their benefit. 2) The employer voluntarily entered into a contract with employee(s) that restrict the employer's rights. There are no "regulations" involved beyond #1 in firing people. Its why almost everyone is fired for the generic "performance" reason. Its pretty much immune to criticism unless you are blatantly discriminating.

WalterBright 10y ago
It's a bit more complex than that: https://www.rocketlawyer.com/article/what-states-are-at-will-employment-states-ps.rl https://www.rocketlawyer.com/article/what-states-are-at-will...
- fweespeech 10y ago
  In statute, yes. However, in reality, all of it can be covered by a boilerplate employee contract that makes you effectively at-will and provides negligible protection.
  - otterley 10y ago
    Provisions in contracts that require one of the parties to waive statutory protections are usually deemed void in courts as contrary to public policy.

Gatsky 10y ago

I feel for you - this kind of thing just shouldn't happen. I think that medicine is a bad example of the point you are trying to make though... It has a lot of embedded costs and roadblocks that aren't really related to regulation. For example - the procedure you describe is highly specialised, and can only be learnt in certain places. Say there are 4 people that can do this procedure at a hospital. Attracting a doctor who can do the procedure is often a complicated task. In a highly specialised field thay may need to be incentivised, which also costs money. It is very difficult to control where doctors work - they invariably want to work in large established centres, which are already saturated (and so they don't work full time, they end up taking small bits of work here and there). This problem isn't necessarily solved by training an order of magnitude more - increasing the true training capacity of the health system is actually very hard, and takes a long time. Pumping up the inflow of trainees at one end just means that competition increases, doctors spend more time optimising for selection onto programs and working in certain places rather than doing their training. They also develop a sense of entitlement due to the high debt and difficult and competitive training ie they feel like they should be able to work wherever they want to work, not where they are forced to go. There is limited space in the endoscopy suites usually - increasing capacity means building a new suite, buying all the equipment, paying the nurses, rostering another anaesthetist. The added cost is easily more than a million dollars just to get started, without the doctor even doing any procedures. There could also be other bottlenecks like sufficient recovery areas and clerical staff. This high threshold means that an overloaded service will languish for long periods before capacity is increased.

maxharris 10y ago
It is true that medicine is expensive, but so is setting up the technology for a major cloud provider (on the scale of Amazon), or a car coordination platform/system like Uber. The difference is that the tech examples I've provided have not had the ability to progress (and the financial reward for doing so) regulated out of them. The wait time for this is not something that just happened yesterday, and what I'm saying is there's a systematic reason for it that goes deeper than just the nature and cost of the people/equipment/training. An example of this from another field: In a 10-year span during the 1880-1890s, J. J. Hill coordinated and financed the construction of a transcontinental railroad, without any government aid. This was done without the benefit of bulldozers, tunnel-boring-machines, automated track-laying equipment, etc. Today, Seattle's transportation authority says that it'll take 25 years for it to put down six miles of rail between Ballard and downtown. I'd be dead for sure in 1890 (no CT scanners, etc.), but the rate of progress has definitely been restricted. And the difference is just in our ideas, not things, or any inherent rule in nature.