5 ms·

MDs also have the benefit of an artificial monopoly (vs factory workers) that I imagine will fight hard to keep its members employed. https://www.cato.org/publ

by zdean 10y ago

MDs also have the benefit of an artificial monopoly (vs factory workers) that I imagine will fight hard to keep its members employed. https://www.cato.org/publications/policy-analysis/medical-monopoly-protecting-consumers-or-limiting-competition https://www.cato.org/publications/policy-analysis/medical-mo...

abakker 10y ago
Calling medical education and licensing a monopoly is pretty intellectually dishonest. To borrow the OP's analogy, that is like saying drivers with licenses have a monopoly on driving. Seems like a pretty strange argument. Certainly, the medical industry does not face the same competitive pressure from outside, but that is the nature of industry in general. Rather than calling medicine a monopoly, it is more accurate to accuse heal care providers and practitioners of colluding to ensure prices are high. Monopolies by definition cannot collude since there would be nobody to collude with. In the grand scheme of things, I believe medical costs are accurately priced and it is people's wages that are not adjusting correctly.
- zdean 10y ago
  The AMA controls the requirements for licensing, the schools that can educate for the purpose of licensing, and the number of licenses that can be issued. Exactly what is intellectually dishonest about calling that a monopoly? http://www.economist.com/blogs/freeexchange/2007/09/a_spoonful_of_monopoly_helps_t http://www.economist.com/blogs/freeexchange/2007/09/a_spoonf...
- frisco 10y ago
  > To borrow the OP's analogy, that is like saying drivers with licenses have a monopoly on driving. Not so, as the number of medical residents is de facto set by Congress (due to how the funding system works), thereby limiting the number of doctors in each specialty.
  - sangnoir 10y ago
    If local production capacity is too low, why not import them?
- hanoz 10y ago
  like saying drivers with licenses have a monopoly on driving ...if drivers got to set the test standard and pass rate.
- egocodedinsol 10y ago
  > that is like saying drivers with licenses have a monopoly on driving. The critical difference is that there's no limit on the number of people who can get standard driver's licenses, but there is on medical licenses. It's not just the AMA directly, though. Residencies are funded federally, I believe. I'm pretty sure the numbers per specialty are centrally controlled, but I'm not certain how the process works. And I don't know who limits the medical school slots, but I'm under the impression medical schools can't just increase the number of students at will. All that being said, keeping the supply artificially low probably has some benefits.
- IndianAstronaut 10y ago
  Any system where they control entry not just by a passing threshold but by raw numbers or on a curved exam scale is a monopolistic regime. They aren't just looking for people who can pass the test and meet qualifications but to keep a throttle on numbers.
bluetwo 10y ago
I agree with both sides here. AMA protectionist? Yes. Absolutely. That is their #1 goal even if they don't write that one down. But I'm not sure opening up the gates is exactly what we want either. There are countless examples of charlatans trying to push the line here, and as a consumer, it would be too difficult, especially while fighting a serious disease, to tell who can really help me and who just wants my money. There are better ways to make healthcare more affordable and more effective than to throw away the idea of proper certification. For instance, some states (like the one in which I live) have granted more powers to nurse practitioners. I support this move.
- cmdrfred 10y ago
  How about I can go pick up my asthma medication without a 6 month visit to verify for the 1000th time that I do, still indeed, have asthma? The only purpose for that is so the physician can bill my insurance company. It wastes both my time and money.
  - sedachv 10y ago
    That is the fault of the United States health insurance industry blocking attempts at universal single-payer healthcare and turning Medicare into a privatization scam. Blaming the AMA for that is completely misguided.
    - aianus 10y ago
      We have single player in Canada and it's even worse. I have to book one appt to get referred for a blood test, another to take the blood, and then another appt to get the results! There's even a big sign at the doctors office that says "only one health issue per appointment". Why? So they can scam the system for more cash.
      - sedachv 10y ago
        > We have single player in Canada and it's even worse. Do you have any experience with the US medical system? I lived in Alberta for 7 years and in Quebec for 3 (important to note because it is hard to take you seriously since you did not even mention that healthcare is provincially administered in Canada). > I have to book one appt to get referred for a blood test, another to take the blood, and then another appt to get the results! Here is an alternative explanation to "doctors are incompetent scammers": you need a referral for a specialist so that specialists are not overwhelmed with requests from hypochondriacs who read something on the Internet. Once the test results come back the doctor wants to see you to explain the results and recommend further treatment. That saves everyone time and money and is the opposite of "scam[ming] the system for more cash." The "one health issue per appointment" is not a government policy, it is a policy that some physicians have so that they can see more patients each day.

by zdean 10y ago

abakker 10y ago

Calling medical education and licensing a monopoly is pretty intellectually dishonest. To borrow the OP's analogy, that is like saying drivers with licenses have a monopoly on driving. Seems like a pretty strange argument. Certainly, the medical industry does not face the same competitive pressure from outside, but that is the nature of industry in general. Rather than calling medicine a monopoly, it is more accurate to accuse heal care providers and practitioners of colluding to ensure prices are high. Monopolies by definition cannot collude since there would be nobody to collude with. In the grand scheme of things, I believe medical costs are accurately priced and it is people's wages that are not adjusting correctly.

zdean 10y ago
The AMA controls the requirements for licensing, the schools that can educate for the purpose of licensing, and the number of licenses that can be issued. Exactly what is intellectually dishonest about calling that a monopoly? http://www.economist.com/blogs/freeexchange/2007/09/a_spoonful_of_monopoly_helps_t http://www.economist.com/blogs/freeexchange/2007/09/a_spoonf...
frisco 10y ago
> To borrow the OP's analogy, that is like saying drivers with licenses have a monopoly on driving. Not so, as the number of medical residents is de facto set by Congress (due to how the funding system works), thereby limiting the number of doctors in each specialty.
- sangnoir 10y ago
  If local production capacity is too low, why not import them?
hanoz 10y ago
like saying drivers with licenses have a monopoly on driving ...if drivers got to set the test standard and pass rate.
egocodedinsol 10y ago
> that is like saying drivers with licenses have a monopoly on driving. The critical difference is that there's no limit on the number of people who can get standard driver's licenses, but there is on medical licenses. It's not just the AMA directly, though. Residencies are funded federally, I believe. I'm pretty sure the numbers per specialty are centrally controlled, but I'm not certain how the process works. And I don't know who limits the medical school slots, but I'm under the impression medical schools can't just increase the number of students at will. All that being said, keeping the supply artificially low probably has some benefits.
IndianAstronaut 10y ago
Any system where they control entry not just by a passing threshold but by raw numbers or on a curved exam scale is a monopolistic regime. They aren't just looking for people who can pass the test and meet qualifications but to keep a throttle on numbers.

bluetwo 10y ago

I agree with both sides here. AMA protectionist? Yes. Absolutely. That is their #1 goal even if they don't write that one down. But I'm not sure opening up the gates is exactly what we want either. There are countless examples of charlatans trying to push the line here, and as a consumer, it would be too difficult, especially while fighting a serious disease, to tell who can really help me and who just wants my money. There are better ways to make healthcare more affordable and more effective than to throw away the idea of proper certification. For instance, some states (like the one in which I live) have granted more powers to nurse practitioners. I support this move.

cmdrfred 10y ago
How about I can go pick up my asthma medication without a 6 month visit to verify for the 1000th time that I do, still indeed, have asthma? The only purpose for that is so the physician can bill my insurance company. It wastes both my time and money.
- sedachv 10y ago
  That is the fault of the United States health insurance industry blocking attempts at universal single-payer healthcare and turning Medicare into a privatization scam. Blaming the AMA for that is completely misguided.
  - aianus 10y ago
    We have single player in Canada and it's even worse. I have to book one appt to get referred for a blood test, another to take the blood, and then another appt to get the results! There's even a big sign at the doctors office that says "only one health issue per appointment". Why? So they can scam the system for more cash.
    - sedachv 10y ago
      > We have single player in Canada and it's even worse. Do you have any experience with the US medical system? I lived in Alberta for 7 years and in Quebec for 3 (important to note because it is hard to take you seriously since you did not even mention that healthcare is provincially administered in Canada). > I have to book one appt to get referred for a blood test, another to take the blood, and then another appt to get the results! Here is an alternative explanation to "doctors are incompetent scammers": you need a referral for a specialist so that specialists are not overwhelmed with requests from hypochondriacs who read something on the Internet. Once the test results come back the doctor wants to see you to explain the results and recommend further treatment. That saves everyone time and money and is the opposite of "scam[ming] the system for more cash." The "one health issue per appointment" is not a government policy, it is a policy that some physicians have so that they can see more patients each day.