5 ms·

Shouldn’t competition eliminate over billing? It doesn’t because there isn’t much competition due to lack of supply of doctors. Why is there a lack of supply o

Shouldn’t competition eliminate over billing? It doesn’t because there isn’t much competition due to lack of supply of doctors. Why is there a lack of supply of doctors? Because the ama deliberately lobbied congress to decrease available residency.

timschmidt 2y ago
We also don't honor medical degrees obtained from non-US institutions. I know several folks who were doctors in India or elsewhere, who have blue collar jobs in the US because their schooling is not recognized here.
- throwaway48476 2y ago
  Not every med school graduate matches for a residency in the US.
  - timschmidt 2y ago
    If your point is that artificially limiting supply of trained medical personnel leads to reduced access, inflated prices, and worse outcomes overall, then I'd agree.
    - throwaway48476 2y ago
      It's a factor. I just think it would be easier to make sure there are residencies for US graduates whose training is more aligned with US Healthcare than to import foreign doctors who also require training for transition.
      - timschmidt 2y ago
        I'm not sure which would be easier, or if that's even a useful measure. Both seem like points of leverage to [in/de]crease supply. I think we should do everything we can do educate, enable, and employ citizens to the highest degree of which they are capable or desire. I feel similarly about putting the talent of new immigrants to work as well, and I don't see inherent conflict there. Growing the pie can mean larger shares for all.
        throwaway48476 2y ago
        Not all resources can be grown like pie, notably land. Economics is the study of scarcity.
        timschmidt 2y ago
        Are you afraid of running out of land? https://johnmjennings.com/how-much-of-the-u-s-is-inhabited/ https://johnmjennings.com/how-much-of-the-u-s-is-inhabited/
        throwaway48476 2y ago
        Not all land is equally habitable, and there's also important things like the environment. Farmland dirt wouldn't be blowing away if there was interspersed forests to slow the wind down. I'm tired of the infinite growth cultists who are willing to sacrifice every 2nd order effect so line can go up.
        timschmidt 2y ago
        > I'm tired of the infinite growth cultists You sound like one of those Malthusian cultists. :P Fortunately for us all, Thomas Robert Malthus was wrong in 1798 or none of us would be here today. That he would continue to be wrong today should be no surprise. Relevant criticism of his rather gloomy take on population growth abounds: https://en.wikipedia.org/wiki/Malthusianism#Criticism https://en.wikipedia.org/wiki/Malthusianism#Criticism It seems to me like he didn't factor in the effects of the development and widespread application of new technologies to old problems.
        throwaway48476 2y ago
        As an individual I'm interested in maximizing quality of life, not maximum number of lives. And no, I am not wromg. Houston has no zoning and was able to keep growth going and build lots of new houses. Of course they did so in a flood plain. Because growth cultists are willing to sacrifice everything, even lives for growth to continue just a little longer no matter the cost.
camhart 2y ago
Doctors per capita is actually up (according to wikipedia at least). So there's more Doctors available now than there used to be. https://en.wikipedia.org/wiki/Physicians_in_the_United_States#:~:text=While%20an%20impending%20%22doctor%20shortage,increased%20at%20a%20greater%20percentage https://en.wikipedia.org/wiki/Physicians_in_the_United_State....
- alwillis 2y ago
  The types of doctors aren't evenly distributed—for a while there was shortage of primary care doctors. Depending on where you live, it can take months to see a specialist.
- logicchains 2y ago
  It's still overall far fewer than in many other countries: https://worldpopulationreview.com/country-rankings/doctors-per-capita-by-country https://worldpopulationreview.com/country-rankings/doctors-p...
- ninetyninenine 2y ago
  Going up doesn’t mean anything. Compare relative amounts per capita to OTHER countries.
sdenton4 2y ago
Hard to so around for a good deal when you're bleeding out and all the prices are hidden anyway.
rhplus 2y ago
How can there be competition when no one will tell you their prices? Pick any major city in the US and tell me how an ordinary consumer can compare prices for a simple procedure like a chest xray. It’s not possible. Now how does one shop around for a cancer doctor or an ER visit? Medicine is not a classical marketplace. Homo economicus doesn’t play his part.
- ninetyninenine 2y ago
  How can competing doctors even afford to not tell anyone there prices if a competitor can gain a huge advantage simply by telling people there prices? There’s not enough supply. Not enough competition such that all doctors can pull off this bs.
  - throwaway48476 2y ago
    Last time around trump mandated that all providers publish their price lists but most providers just ate the fines instead of doing it.
    - ninetyninenine 2y ago
      Because not enough competition. The person with the cheapest price in a competitive environment obviously wants to advertise his prices.
      - throwaway48476 2y ago
        In the case where real choice is possible, yes.
        ninetyninenine 2y ago
        The choice is possible here. There are many doctors. Each doctor CAN display there prices. They don't want to. Why? Because there's not enough competition for them to need to.
rich_sasha 2y ago
Sometimes free market doesn't lead to competition. UK national railway is sort of free market. The state runs the network, sells the tickets and decides the routes, but provides are chosen in open tenders - lowest price wins. They get paid for operating the route for the state-owned network. But it then usually turns out that the only operator who can bid on the new tender for the route is the existing one. After all, they have a ready supply of trains meeting the technical spec! And if, say, the drivers go on strike demanding yet another pay rise, the providers shrug their arms and ask the state for a top up. After all, the state doesn't have an alternative either. Free markets lead to maximizing corporate profits, but it's not a given that these correlate to a positive outcome for the society.
- ninetyninenine 2y ago
  Right. But doctors are regulated by government and the regulation is for a good reason but it also has bad side effects. Doctors are not part of a free market. Supply is regulated like a cartel.
- Fluorescence 2y ago
  I don't think you've got that right. There is an extra level: Network Rail - the gov owned infrastructure, rails etc. Rolling Stock - privately owned trains Operators - lease rolling stock, employ staff, sell tickets The problem we have is that the operators are barely profitable so always cutting quality/service because there is this other layer of private rolling stock company acting as landlords which are sucking all the profit out. We have a similar problem with energy. There are the customer facing providers which are basically a brand and a call centre which are selling the power from energy generation companies. When they get trapped in some bad contract as a gamble on the energy market, they go bust. It feels like a deliberate con that the customer facing providers, the brands the public knows about, keep going bust and earn public ire from their crap services but they are really scapegoats for a less visible layer of private company which are doing the real profiteering as landlords.

timschmidt 2y ago

We also don't honor medical degrees obtained from non-US institutions. I know several folks who were doctors in India or elsewhere, who have blue collar jobs in the US because their schooling is not recognized here.

throwaway48476 2y ago
Not every med school graduate matches for a residency in the US.
- timschmidt 2y ago
  If your point is that artificially limiting supply of trained medical personnel leads to reduced access, inflated prices, and worse outcomes overall, then I'd agree.
  - throwaway48476 2y ago
    It's a factor. I just think it would be easier to make sure there are residencies for US graduates whose training is more aligned with US Healthcare than to import foreign doctors who also require training for transition.
    - timschmidt 2y ago
      I'm not sure which would be easier, or if that's even a useful measure. Both seem like points of leverage to [in/de]crease supply. I think we should do everything we can do educate, enable, and employ citizens to the highest degree of which they are capable or desire. I feel similarly about putting the talent of new immigrants to work as well, and I don't see inherent conflict there. Growing the pie can mean larger shares for all.
      - throwaway48476 2y ago
        Not all resources can be grown like pie, notably land. Economics is the study of scarcity.
        timschmidt 2y ago
        Are you afraid of running out of land? https://johnmjennings.com/how-much-of-the-u-s-is-inhabited/ https://johnmjennings.com/how-much-of-the-u-s-is-inhabited/
        throwaway48476 2y ago
        Not all land is equally habitable, and there's also important things like the environment. Farmland dirt wouldn't be blowing away if there was interspersed forests to slow the wind down. I'm tired of the infinite growth cultists who are willing to sacrifice every 2nd order effect so line can go up.
        timschmidt 2y ago
        > I'm tired of the infinite growth cultists You sound like one of those Malthusian cultists. :P Fortunately for us all, Thomas Robert Malthus was wrong in 1798 or none of us would be here today. That he would continue to be wrong today should be no surprise. Relevant criticism of his rather gloomy take on population growth abounds: https://en.wikipedia.org/wiki/Malthusianism#Criticism https://en.wikipedia.org/wiki/Malthusianism#Criticism It seems to me like he didn't factor in the effects of the development and widespread application of new technologies to old problems.
        throwaway48476 2y ago
        As an individual I'm interested in maximizing quality of life, not maximum number of lives. And no, I am not wromg. Houston has no zoning and was able to keep growth going and build lots of new houses. Of course they did so in a flood plain. Because growth cultists are willing to sacrifice everything, even lives for growth to continue just a little longer no matter the cost.

camhart 2y ago

Doctors per capita is actually up (according to wikipedia at least). So there's more Doctors available now than there used to be. https://en.wikipedia.org/wiki/Physicians_in_the_United_States#:~:text=While%20an%20impending%20%22doctor%20shortage,increased%20at%20a%20greater%20percentage https://en.wikipedia.org/wiki/Physicians_in_the_United_State....

alwillis 2y ago
The types of doctors aren't evenly distributed—for a while there was shortage of primary care doctors. Depending on where you live, it can take months to see a specialist.
logicchains 2y ago
It's still overall far fewer than in many other countries: https://worldpopulationreview.com/country-rankings/doctors-per-capita-by-country https://worldpopulationreview.com/country-rankings/doctors-p...
ninetyninenine 2y ago
Going up doesn’t mean anything. Compare relative amounts per capita to OTHER countries.

sdenton4 2y ago

Hard to so around for a good deal when you're bleeding out and all the prices are hidden anyway.

rhplus 2y ago

How can there be competition when no one will tell you their prices? Pick any major city in the US and tell me how an ordinary consumer can compare prices for a simple procedure like a chest xray. It’s not possible. Now how does one shop around for a cancer doctor or an ER visit? Medicine is not a classical marketplace. Homo economicus doesn’t play his part.

ninetyninenine 2y ago
How can competing doctors even afford to not tell anyone there prices if a competitor can gain a huge advantage simply by telling people there prices? There’s not enough supply. Not enough competition such that all doctors can pull off this bs.
- throwaway48476 2y ago
  Last time around trump mandated that all providers publish their price lists but most providers just ate the fines instead of doing it.
  - ninetyninenine 2y ago
    Because not enough competition. The person with the cheapest price in a competitive environment obviously wants to advertise his prices.
    - throwaway48476 2y ago
      In the case where real choice is possible, yes.
      - ninetyninenine 2y ago
        The choice is possible here. There are many doctors. Each doctor CAN display there prices. They don't want to. Why? Because there's not enough competition for them to need to.

rich_sasha 2y ago

Sometimes free market doesn't lead to competition. UK national railway is sort of free market. The state runs the network, sells the tickets and decides the routes, but provides are chosen in open tenders - lowest price wins. They get paid for operating the route for the state-owned network. But it then usually turns out that the only operator who can bid on the new tender for the route is the existing one. After all, they have a ready supply of trains meeting the technical spec! And if, say, the drivers go on strike demanding yet another pay rise, the providers shrug their arms and ask the state for a top up. After all, the state doesn't have an alternative either. Free markets lead to maximizing corporate profits, but it's not a given that these correlate to a positive outcome for the society.

ninetyninenine 2y ago
Right. But doctors are regulated by government and the regulation is for a good reason but it also has bad side effects. Doctors are not part of a free market. Supply is regulated like a cartel.
Fluorescence 2y ago
I don't think you've got that right. There is an extra level: Network Rail - the gov owned infrastructure, rails etc. Rolling Stock - privately owned trains Operators - lease rolling stock, employ staff, sell tickets The problem we have is that the operators are barely profitable so always cutting quality/service because there is this other layer of private rolling stock company acting as landlords which are sucking all the profit out. We have a similar problem with energy. There are the customer facing providers which are basically a brand and a call centre which are selling the power from energy generation companies. When they get trapped in some bad contract as a gamble on the energy market, they go bust. It feels like a deliberate con that the customer facing providers, the brands the public knows about, keep going bust and earn public ire from their crap services but they are really scapegoats for a less visible layer of private company which are doing the real profiteering as landlords.