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> The basic solution to make medicine cheaper is supply more medics. It's shocking how little this is talked about... This is so obviously the root of the prob

> The basic solution to make medicine cheaper is supply more medics. It's shocking how little this is talked about... This is so obviously the root of the problem. People like to blame the free market but there is no free market in medicine. Corporatism is to blame for artificially restricting the supply of doctors and artificially restricting who is allowed to render medical services, both of which benefit the corporate members, the doctors. Of course, those anti-competitive measures are always sold under the guise of protecting the population.

nradov 4y ago
Actually the primary bottleneck in the supply of new doctors is lack of federal (Medicare) funding for residency slots. Every year, students graduate from US accredited medical schools but are unable to enter clinical practice because they can't get matched to a residency program. Ask Congress to increase funding. https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate-medical-education-address-physician-shortages https://www.ama-assn.org/press-center/press-releases/ama-fun...
- kaesar14 4y ago
  Using an AMA source is disingenuous since it’s a professional cartel with a massive vested interest in keeping doctor supply as limited as possible.
  - teh64 4y ago
    But they are arguing in the source for more doctor supply?
    - bombcar 4y ago
      They are blaming the lack of supply on something they don't control. There's a subtle difference.
  - nradov 4y ago
    Do you have a substantive comment to contribute or are you going to stick with baseless low-effort snark? The comment I posted is true and correct. You could verify it with other independent sources if you bothered to do any research.
    - kaesar14 4y ago
      Yeah sure. Fighting residency expansion: http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm http://www.usatoday.com/news/health/2005-03-02-doctor-shorta... Fighting expansion of care to other types of practicioners: https://www.ama-assn.org/practice-management/scope-practice/ama-successfully-fights-scope-practice-expansions-threaten https://www.ama-assn.org/practice-management/scope-practice/... Why would you believe the AMA's line on this? Do you think the professional association that represents all doctors, one of the highest paid and influential professions in the country, has no power to control the amount of residencies are funded by the government? They have no reason to increase the number of doctors, absolutely none. They benefit in every way from having constrained supply.
      - nradov 4y ago
        The AMA is literally lobbying Congress to expand residency program funding, and even putting their own money into it. Did you even read the article?
        kaesar14 4y ago
        Yes - they're lobbying now to reverse caps they themselves[1] helped put into place, and like I said, have also limited primary care availability by lobbying against the ability of NPs and PAs to provided basic medical care. It's a complete bunch of talk until they get change done. By the way, that expansion of 15000 residency positions barely puts a dent in the number of doctors we are lacking[2]. But yeah, a press release from 3 years ago really absolves them of guilt for sure. [1]: http://www.cnn.com/HEALTH/9708/24/doctor.glut/ http://www.cnn.com/HEALTH/9708/24/doctor.glut/ [2]: https://www.washingtonian.com/2020/04/13/were-short-on-healthcare-workers-why-doesnt-the-u-s-just-make-more-doctors/#:~:text=According%20to%20the%20Association%20of,among%20primary%20care%20physicians%20alone https://www.washingtonian.com/2020/04/13/were-short-on-healt....
- olalonde 4y ago
  How does that make any sense? Aren't student graduates actually paid to do those residency programs? If it's too expensive to train them, can't they take a pay cut? How come no other profession requires federal funding for placing/training graduates? Makes absolutely no sense unless you uncritically accept the status quo.
  - nradov 4y ago
    Residents are paid an average salary of $64K. That's less than many entry-level STEM jobs, and they often work up to 80 hours per week. They can't afford to take a pay cut. And hospitals incur other costs for running residency programs which go beyond paying resident salaries. Most other private sector professions don't require nearly as much postgraduate training before being allowed to work. Prospective lawyers usually take the bar exam less than a year after graduating from law school. Medicine is simply more complex. What would you propose as an alternative to the status quo? The AMA has proposed a number of improvements, but perhaps there are alternatives? https://savegme.org/ https://savegme.org/
teh64 4y ago
Even if they supply of doctors was infinite, there is still the problem of demand being basically inelastic. What would the incentive of healthcare providers to lower prices? Inelastic demand means there is no incentive to lower prices, because there is no where else for someone to go and comparison/price shop. If you are hit by a bus, there is no ability for price negotiation to get healthcare. Also blaming "corporatism" is basically just a meme at this point, because it is just used by libertarians when someone criticizes capitalism. Its the same when communists say "true communism has never been tried".
- olalonde 4y ago
  > What would the incentive of healthcare providers to lower prices? In case of life or death emergencies, your insurance or ambulance driver would send you to a reasonably priced doctor, and doctors that charge unreasonable prices would go out of business. But my guess is that life or death emergencies do not account for most doctor visits. > Also blaming "corporatism" is basically just a meme at this point, because it is just used by libertarians when someone criticizes capitalism. Its the same when communists say "true communism has never been tried". Well, I don't feel like arguing about semantics. Feel free to call the problem I described however you like.
  - teh64 4y ago
    So for life or death decisions, the ambulance driver would first go on some price comparison website or ask the insurance and see "ok, this person wants a doctor in the $10,000-15,000 range, the closest of which is 30m away. The hospital next door costs at least $50,000 minimum, so we will not send them there for life saving medical care." And what incentive would insurance have to send me to a reasonably priced doctor, when they can send me to one in their network which is more expensive but means they keep more money? Also, they could send me to an expensive hospital and then just not pay out. These are both things Obamacare tried to fix [0]. Insurances want to maximize profits, which means paying as little as possible themselves and extracting as much as possible from customers. Your system would only work if insurances had to always pay 100% of medical costs and could never deny care, which is similar to how it works in Germany (at least for some baseline level of care). Again, what incentive would there be to lower prices? New doctors could just be bought out and the prices jacked up. There are a lot of industries where there is little barrier to entry (for example tech), where the big companies just buy anyone trying to "get in on their territory". Also, why would the "unreasonable prices" (what would that even look like?) doctors go out of business? They could just provide some kind of "luxury deluxe" ("no poor people here") state of the art care for people who can afford it. [0] https://www.healthcare.gov/health-care-law-protections/doctor-choice-emergency-room-access/#:~:text=Access%20to%20out%2Dof%2Dnetwork,of%2Dnetwork%20provider%20or%20hospital https://www.healthcare.gov/health-care-law-protections/docto....

nradov 4y ago

Actually the primary bottleneck in the supply of new doctors is lack of federal (Medicare) funding for residency slots. Every year, students graduate from US accredited medical schools but are unable to enter clinical practice because they can't get matched to a residency program. Ask Congress to increase funding. https://www.ama-assn.org/press-center/press-releases/ama-fund-graduate-medical-education-address-physician-shortages https://www.ama-assn.org/press-center/press-releases/ama-fun...

kaesar14 4y ago
Using an AMA source is disingenuous since it’s a professional cartel with a massive vested interest in keeping doctor supply as limited as possible.
- teh64 4y ago
  But they are arguing in the source for more doctor supply?
  - bombcar 4y ago
    They are blaming the lack of supply on something they don't control. There's a subtle difference.
- nradov 4y ago
  Do you have a substantive comment to contribute or are you going to stick with baseless low-effort snark? The comment I posted is true and correct. You could verify it with other independent sources if you bothered to do any research.
  - kaesar14 4y ago
    Yeah sure. Fighting residency expansion: http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm http://www.usatoday.com/news/health/2005-03-02-doctor-shorta... Fighting expansion of care to other types of practicioners: https://www.ama-assn.org/practice-management/scope-practice/ama-successfully-fights-scope-practice-expansions-threaten https://www.ama-assn.org/practice-management/scope-practice/... Why would you believe the AMA's line on this? Do you think the professional association that represents all doctors, one of the highest paid and influential professions in the country, has no power to control the amount of residencies are funded by the government? They have no reason to increase the number of doctors, absolutely none. They benefit in every way from having constrained supply.
    - nradov 4y ago
      The AMA is literally lobbying Congress to expand residency program funding, and even putting their own money into it. Did you even read the article?
      - kaesar14 4y ago
        Yes - they're lobbying now to reverse caps they themselves[1] helped put into place, and like I said, have also limited primary care availability by lobbying against the ability of NPs and PAs to provided basic medical care. It's a complete bunch of talk until they get change done. By the way, that expansion of 15000 residency positions barely puts a dent in the number of doctors we are lacking[2]. But yeah, a press release from 3 years ago really absolves them of guilt for sure. [1]: http://www.cnn.com/HEALTH/9708/24/doctor.glut/ http://www.cnn.com/HEALTH/9708/24/doctor.glut/ [2]: https://www.washingtonian.com/2020/04/13/were-short-on-healthcare-workers-why-doesnt-the-u-s-just-make-more-doctors/#:~:text=According%20to%20the%20Association%20of,among%20primary%20care%20physicians%20alone https://www.washingtonian.com/2020/04/13/were-short-on-healt....
olalonde 4y ago
How does that make any sense? Aren't student graduates actually paid to do those residency programs? If it's too expensive to train them, can't they take a pay cut? How come no other profession requires federal funding for placing/training graduates? Makes absolutely no sense unless you uncritically accept the status quo.
- nradov 4y ago
  Residents are paid an average salary of $64K. That's less than many entry-level STEM jobs, and they often work up to 80 hours per week. They can't afford to take a pay cut. And hospitals incur other costs for running residency programs which go beyond paying resident salaries. Most other private sector professions don't require nearly as much postgraduate training before being allowed to work. Prospective lawyers usually take the bar exam less than a year after graduating from law school. Medicine is simply more complex. What would you propose as an alternative to the status quo? The AMA has proposed a number of improvements, but perhaps there are alternatives? https://savegme.org/ https://savegme.org/

teh64 4y ago

Even if they supply of doctors was infinite, there is still the problem of demand being basically inelastic. What would the incentive of healthcare providers to lower prices? Inelastic demand means there is no incentive to lower prices, because there is no where else for someone to go and comparison/price shop. If you are hit by a bus, there is no ability for price negotiation to get healthcare. Also blaming "corporatism" is basically just a meme at this point, because it is just used by libertarians when someone criticizes capitalism. Its the same when communists say "true communism has never been tried".

olalonde 4y ago
> What would the incentive of healthcare providers to lower prices? In case of life or death emergencies, your insurance or ambulance driver would send you to a reasonably priced doctor, and doctors that charge unreasonable prices would go out of business. But my guess is that life or death emergencies do not account for most doctor visits. > Also blaming "corporatism" is basically just a meme at this point, because it is just used by libertarians when someone criticizes capitalism. Its the same when communists say "true communism has never been tried". Well, I don't feel like arguing about semantics. Feel free to call the problem I described however you like.
- teh64 4y ago
  So for life or death decisions, the ambulance driver would first go on some price comparison website or ask the insurance and see "ok, this person wants a doctor in the $10,000-15,000 range, the closest of which is 30m away. The hospital next door costs at least $50,000 minimum, so we will not send them there for life saving medical care." And what incentive would insurance have to send me to a reasonably priced doctor, when they can send me to one in their network which is more expensive but means they keep more money? Also, they could send me to an expensive hospital and then just not pay out. These are both things Obamacare tried to fix [0]. Insurances want to maximize profits, which means paying as little as possible themselves and extracting as much as possible from customers. Your system would only work if insurances had to always pay 100% of medical costs and could never deny care, which is similar to how it works in Germany (at least for some baseline level of care). Again, what incentive would there be to lower prices? New doctors could just be bought out and the prices jacked up. There are a lot of industries where there is little barrier to entry (for example tech), where the big companies just buy anyone trying to "get in on their territory". Also, why would the "unreasonable prices" (what would that even look like?) doctors go out of business? They could just provide some kind of "luxury deluxe" ("no poor people here") state of the art care for people who can afford it. [0] https://www.healthcare.gov/health-care-law-protections/doctor-choice-emergency-room-access/#:~:text=Access%20to%20out%2Dof%2Dnetwork,of%2Dnetwork%20provider%20or%20hospital https://www.healthcare.gov/health-care-law-protections/docto....