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Health economist here. This is a great piece top to bottom. There is no credible objection I'm aware of to any of the deregulation proposals included herein.

Health economist here. This is a great piece top to bottom. There is no credible objection I'm aware of to any of the deregulation proposals included herein. The American Medical Association will object, because they don't want the competition because it will have a negative effect on its members' incomes. If you think health care is too expensive in the US, the changes proposed herein are Job 1. There is no reason why Mexican, Canadian, British, Indian, German, ... doctors should not be allowed to come and practice in the US with more than some cursory verification that they actually attended a medical school where they are from. There is no reason for anyone in the US to be denied a slot at medical school (not a particular medical school, but some medical school in general). One final note: please don't be fooled into have sympathy for the large debts doctors incur through medical school. This is not the population which is deserving of student debt relief. I'm happy to shorten their education, of course, but doctors are consistently among the very highest paid people in American society. Retiring even a million dollars in debt (much larger than any number in this article) is not that hard on a highly-paid specialists' salary, which can easily average half a million dollars per year. The author of the piece has proposed to do further pieces on an "Abundance Agenda" for the US. Essentially this looks at ways to increase supply in things which are currently expensive but don't have to be. I haven't read other parts of it but I strongly recommended following him and looking further into the idea.

pfranz 5y ago
> they don't want the competition because it will have a negative effect on its members' incomes. Is it the perception that increased competition will have negative effects on members' incomes or is that actually true? I swear I remember a story, study, allegory about a second doctor moving to town and both incomes went up.
- huitzitziltzin 5y ago
  > Is it the perception that increased competition will have negative effects on members' incomes or is that actually true? Generally true in other areas. Health care is not that exceptional a market, though it is exceptional in several respects. We do generally observe in health care specifically that increases in market concentration increase prices. > I swear I remember a story, study, allegory about a second doctor moving to town and both incomes went up. I'll take a look if you can find it. It's possible. One story I can imagine would be something like: First Doctor can see more patients b/c he can send his more complicated patients to Second Doctor's specialty practice. And Second Doctor moved from a smaller town w/ fewer patients in the specialty. In the aggregate and outside of special cases more supply will bring prices down.
- zozbot234 5y ago
  In theory, it could go the other way. More supply, better specialization among doctors, higher productivity at the margin, more income. The final effect is ambiguous. What is true is that patients would benefit, even if doctors were to earn more after all.
syki 5y ago
I have a hard time rectifying the claim that you are a health economist with the fact that you don’t appear to understand that the bottleneck for increasing the supply of doctors is the number of residency slots. Foreign medical school certifications are largely accepted at face value but graduating a foreign residency program largely is not. I think it’s pretty much universal that each country wants doctors to go through their own version of residency. My wife is a physician. She needs a large salary to pay off her large medical debt. When the medical debt is paid off her salary will still be large. A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. There are people with hundreds of thousands in med school debt who didn’t match. We should feel sorry for those people.
- allcentury 5y ago
  The limit of residency slots is in the article. > A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. That's not how any labor market works. Your salary isn't determined by how much debt you rack up. Doctor's salary's are high because the supply of doctor's is so low (especially primary care). The article covers all the points you're debating (much better than I).
  - lupire 5y ago
    Primary care is a low paying job because nurses and PAs can provide primary care.
  - N1H1L 5y ago
    > That's not how any labor market works. Your salary isn't determined by how much debt you rack up. True, or else college dropouts from a private school will have higher incomes than a state school undergrad, which is not the case at all.
  - syki 5y ago
    My response was about the claim that OP is a health economist while not understanding where the bottleneck in the supply for doctors comes from. I believe you are incorrect as it pertains to doctor salaries. Demand is high and supply relatively low. That is true but this isn’t the only factor that goes into determining pay. That’s an overly simplistic view of things. Supply/demand does not account for everything in this situation. If med students came out of med school with zero debt then the healthcare industry could make being a doctor sufficiently lucrative with salaries that are smaller than they currently are. Lowering the salary a bit in this scenario would not lower supply. You should read about David Carr’s work.
deleted 5y ago
[deleted]
commandlinefan 5y ago
> doctors are consistently among the very highest paid people in American society Isn't that at least in part because there's so little competition though?
throwaway4220 5y ago
> This is not the population which is deserving of student debt relief. Residents don’t need debt relief but they also don’t need hostility. look up FAANG salaries and TC I will bet you undergrad education will get debt relief

pfranz 5y ago

> they don't want the competition because it will have a negative effect on its members' incomes. Is it the perception that increased competition will have negative effects on members' incomes or is that actually true? I swear I remember a story, study, allegory about a second doctor moving to town and both incomes went up.

huitzitziltzin 5y ago
> Is it the perception that increased competition will have negative effects on members' incomes or is that actually true? Generally true in other areas. Health care is not that exceptional a market, though it is exceptional in several respects. We do generally observe in health care specifically that increases in market concentration increase prices. > I swear I remember a story, study, allegory about a second doctor moving to town and both incomes went up. I'll take a look if you can find it. It's possible. One story I can imagine would be something like: First Doctor can see more patients b/c he can send his more complicated patients to Second Doctor's specialty practice. And Second Doctor moved from a smaller town w/ fewer patients in the specialty. In the aggregate and outside of special cases more supply will bring prices down.
zozbot234 5y ago
In theory, it could go the other way. More supply, better specialization among doctors, higher productivity at the margin, more income. The final effect is ambiguous. What is true is that patients would benefit, even if doctors were to earn more after all.

syki 5y ago

I have a hard time rectifying the claim that you are a health economist with the fact that you don’t appear to understand that the bottleneck for increasing the supply of doctors is the number of residency slots. Foreign medical school certifications are largely accepted at face value but graduating a foreign residency program largely is not. I think it’s pretty much universal that each country wants doctors to go through their own version of residency. My wife is a physician. She needs a large salary to pay off her large medical debt. When the medical debt is paid off her salary will still be large. A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. There are people with hundreds of thousands in med school debt who didn’t match. We should feel sorry for those people.

allcentury 5y ago
The limit of residency slots is in the article. > A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. That's not how any labor market works. Your salary isn't determined by how much debt you rack up. Doctor's salary's are high because the supply of doctor's is so low (especially primary care). The article covers all the points you're debating (much better than I).
- lupire 5y ago
  Primary care is a low paying job because nurses and PAs can provide primary care.
- N1H1L 5y ago
  > That's not how any labor market works. Your salary isn't determined by how much debt you rack up. True, or else college dropouts from a private school will have higher incomes than a state school undergrad, which is not the case at all.
- syki 5y ago
  My response was about the claim that OP is a health economist while not understanding where the bottleneck in the supply for doctors comes from. I believe you are incorrect as it pertains to doctor salaries. Demand is high and supply relatively low. That is true but this isn’t the only factor that goes into determining pay. That’s an overly simplistic view of things. Supply/demand does not account for everything in this situation. If med students came out of med school with zero debt then the healthcare industry could make being a doctor sufficiently lucrative with salaries that are smaller than they currently are. Lowering the salary a bit in this scenario would not lower supply. You should read about David Carr’s work.

deleted 5y ago

[deleted]

commandlinefan 5y ago

> doctors are consistently among the very highest paid people in American society Isn't that at least in part because there's so little competition though?

throwaway4220 5y ago

> This is not the population which is deserving of student debt relief. Residents don’t need debt relief but they also don’t need hostility. look up FAANG salaries and TC I will bet you undergrad education will get debt relief