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In a market economy, shortages are simply a statement that the buyers value a good or service less than the market price. Medical care shortages are mostly a f

In a market economy, shortages are simply a statement that the buyers value a good or service less than the market price. Medical care shortages are mostly a function that hospitals don't want to pay nurses market rate and then treat them poorly. The exception is doctors. The shortage there is completely driven by their guild (AMA) successfully lobbying for a restriction on the number of medical schools.

realitybitez 1y ago
The AMA specifically restricts residency spots. They cry about medicare funding, but it is all about keeping the supply of doctors artificially low. Unlike tech, there is no free market in medicine, which is why 20% of the national gdp is consumed on healthcare while doctors drive away in BMWs to the bank
- lovich 1y ago
  The doctors are not why the US pays more for medicine than other western countries. It’s also a little rich coming from a software focused board when we make equivalent or better than a lot of doctors
  - mothballed 1y ago
    Doctors can send men in with guns to imprison, and if they resist, kill, those who engage in their profession without going through the gates of their fiefdom, though. In software you can be a nobody off the street, straight out of prison, if someone pays you money to write software then that is that.
    - Avshalom 1y ago
      Anyone with a phone can do that https://en.wikipedia.org/wiki/Swatting#Injuries_or_deaths_due_to_swatting https://en.wikipedia.org/wiki/Swatting#Injuries_or_deaths_du...
    - lovich 1y ago
      The doctors cannot send in men with guns, the government can if it feels that’s against the law, and you’re not going to be killed for just “resisting”. In the software world we also take on zero fucking liability for just building software on the street or is your circle full of people who commonly carry Software Malpractice Insurance? FYI, the men with guns come for software engineers as well if the rich want it. Look up Sergey Aleynikov
      - mothballed 1y ago
        The odds of getting collared for practicing medicine without a license/credentials are orders of magnitude higher than getting collared for writing software, or even practice engineering even though that's sometimes a licensed field. AMA is the biggest gatekeeper in getting there.
        lovich 1y ago
        Yes, the odds of getting arrested for breaking the law are higher than if you don’t break the law. Look you’re obviously against the AMA, and there’s arguments against their guild and its practices that I’m amenable to, but trying to pin the financial problems with our healthcare system on them is ludicrous given how many other large problems are in the system. Insurance middlemen are undoubtedly a bigger cost
  - slipperydippery 1y ago
    It 100% is one of the reasons. We pay medical personnel way higher wages than peer states. US healthcare is so expensive because basically every single part of it costs more than it "should", by quite a bit. Including, yes, doctors.
    - lovich 1y ago
      You’re going to have to do more work to prove the size of the problem is equivalent or larger than the well documented issues with insurance, before you can start pinning the blame on them as a why. If the doctors are causing like 1% of the issue, it’s not likely to be worth the time and energy to rectify vs if you can point to it being like 50% of the issue. I’m pulling those numbers out of my ass so don’t feel like I’m trying to hold you to the literal values but I’d need to see _some_ data to even consider supporting changes to the AMA and laws surrounding them
      - slipperydippery 1y ago
        I did a ton of looking into this over the years. That everything is a little bit at fault, is why if you exhaustively eliminate (say) insurance overhead, it leaves a weird amount of the elevated costs intact. Thinking you’ve found the one main reason makes it easy for opponents of reform to dismiss your solution, because you haven’t found it, because there’s not a main reason. It also means “cut private insurance out of the process” doesn’t fix it Consider: public insurance schemes in the US spend far more for some given amount of care than peer states do, even as provides complain these programs don’t pay enough—that latter part is because all their vendors, suppliers, and personnel demand more money than their counterparts in the rest of the OECD states. Every single part of the system costs too much. Switzerland pays more than us for doctors, barely, but also has unusually high healthcare costs for Europe (though not as bad as ours) and is richer than the US. Luxembourg is close but is an outlier for basically everything, they crush us in median income and such as well. Bermuda, a little lower, but it’s an island nation (everything’s more expensive) and, like Lux, richer than the US, another outlier. Nearest comparable looks like Australia, paying doctors an average (this avoids missing the effects of crazy-expensive top-end specialists, as a median might) about 76% what we do. The rest of the OECD’s lower than that. You want one thing that is contributing, but such a trivial amount that it’s hardly worth addressing until everything else is fixed: it’s doctors’ liability insurance. They really want to reduce that cost, for obvious reasons, and Republicans want to fix it because… they hate poor people who’ve been harmed being compensated “too much” I guess… and it does contribute to higher costs, but very little compared to practically everything else. That one gets way more attention than it merits. The unifying factor of other countries’ healthcare schemes that keeps them cheaper than the US doesn’t seem to be that they’ve minimized the role of private insurance (some haven’t!) but that they have explicit (like government-set price lists) or or implicit (via e.g. monopsony) price controls. It seems like you can use any of several approaches, some of which keep private health insurance in a prominent role (Switzerland! Though they at least have the good sense to force them to be nonprofits, IIRC) so long as you have, one way or another, price controls. The only near-exception to this I’m aware of is Singapore, but… it’s Singapore. Plus they do have some explicit price controls, and I think it’s fair to say healthcare providers there might consider there to be a persistent, credible implied threat of more price controls or even harsher measures from the government, should prices rise too much, because… it’s Singapore. [edit] FWIW I do think fixing the insurance situation is an excellent place to start, even the best starting point, and that the insurers in the US are probably beyond salvaging through integrating them into a better system, and should just be eliminated or their role drastically reduced; I think this would make less progress toward fixing prices than some suppose it would, though would still do a lot for that, but it’d, crucially, fix most of the hidden costs of our system, like patient-hours lost to waiting on hold to try to get insurance to pay what they’re supposed to, HR folks messing with insurance-related issues, et c, which are huge and don’t make it into straight cost comparisons with other countries because those aren’t “healthcare costs” (putting a dollar value on that would make us look even worse than we already do)
mothballed 1y ago
>The exception is doctors. The shortage there is completely driven by their guild (AMA) successfully lobbying for a restriction on the number of medical schools. NPs are starting to get around this by getting independent or mostly independent practices in many states. The Doctors can still kick PAs in the teeth because they are usually under the medical board, but they can't do nearly as much to get their greedy claws on NPs because they are governed by a separate nursing board that nurses have more control of.
phil21 1y ago
> The exception is doctors. The shortage there is completely driven by their guild (AMA) successfully lobbying for a restriction on the number of medical schools. It's not just this. It's also that the career is starting to suck. Over half the doctors I know who I met while they were in medical school/residency are now out of the practice. They counted down the days until they had their student debt paid off and bounced to non-patient care roles outside the medical system. The entire profession has been captured by the administrative and managerial class. Doctors have had most of their agency stripped from them, and it's an exhausting career choice for someone who generally has a ton of options at their disposal. I expect the trend to get even worse as more and more pressure gets applied to the medical system both due to demographics and the endless march of making everything corporate.
- deleted 1y ago
  [deleted]

realitybitez 1y ago

The AMA specifically restricts residency spots. They cry about medicare funding, but it is all about keeping the supply of doctors artificially low. Unlike tech, there is no free market in medicine, which is why 20% of the national gdp is consumed on healthcare while doctors drive away in BMWs to the bank

lovich 1y ago
The doctors are not why the US pays more for medicine than other western countries. It’s also a little rich coming from a software focused board when we make equivalent or better than a lot of doctors
- mothballed 1y ago
  Doctors can send men in with guns to imprison, and if they resist, kill, those who engage in their profession without going through the gates of their fiefdom, though. In software you can be a nobody off the street, straight out of prison, if someone pays you money to write software then that is that.
  - Avshalom 1y ago
    Anyone with a phone can do that https://en.wikipedia.org/wiki/Swatting#Injuries_or_deaths_due_to_swatting https://en.wikipedia.org/wiki/Swatting#Injuries_or_deaths_du...
  - lovich 1y ago
    The doctors cannot send in men with guns, the government can if it feels that’s against the law, and you’re not going to be killed for just “resisting”. In the software world we also take on zero fucking liability for just building software on the street or is your circle full of people who commonly carry Software Malpractice Insurance? FYI, the men with guns come for software engineers as well if the rich want it. Look up Sergey Aleynikov
    - mothballed 1y ago
      The odds of getting collared for practicing medicine without a license/credentials are orders of magnitude higher than getting collared for writing software, or even practice engineering even though that's sometimes a licensed field. AMA is the biggest gatekeeper in getting there.
      - lovich 1y ago
        Yes, the odds of getting arrested for breaking the law are higher than if you don’t break the law. Look you’re obviously against the AMA, and there’s arguments against their guild and its practices that I’m amenable to, but trying to pin the financial problems with our healthcare system on them is ludicrous given how many other large problems are in the system. Insurance middlemen are undoubtedly a bigger cost
- slipperydippery 1y ago
  It 100% is one of the reasons. We pay medical personnel way higher wages than peer states. US healthcare is so expensive because basically every single part of it costs more than it "should", by quite a bit. Including, yes, doctors.
  - lovich 1y ago
    You’re going to have to do more work to prove the size of the problem is equivalent or larger than the well documented issues with insurance, before you can start pinning the blame on them as a why. If the doctors are causing like 1% of the issue, it’s not likely to be worth the time and energy to rectify vs if you can point to it being like 50% of the issue. I’m pulling those numbers out of my ass so don’t feel like I’m trying to hold you to the literal values but I’d need to see _some_ data to even consider supporting changes to the AMA and laws surrounding them
    - slipperydippery 1y ago
      I did a ton of looking into this over the years. That everything is a little bit at fault, is why if you exhaustively eliminate (say) insurance overhead, it leaves a weird amount of the elevated costs intact. Thinking you’ve found the one main reason makes it easy for opponents of reform to dismiss your solution, because you haven’t found it, because there’s not a main reason. It also means “cut private insurance out of the process” doesn’t fix it Consider: public insurance schemes in the US spend far more for some given amount of care than peer states do, even as provides complain these programs don’t pay enough—that latter part is because all their vendors, suppliers, and personnel demand more money than their counterparts in the rest of the OECD states. Every single part of the system costs too much. Switzerland pays more than us for doctors, barely, but also has unusually high healthcare costs for Europe (though not as bad as ours) and is richer than the US. Luxembourg is close but is an outlier for basically everything, they crush us in median income and such as well. Bermuda, a little lower, but it’s an island nation (everything’s more expensive) and, like Lux, richer than the US, another outlier. Nearest comparable looks like Australia, paying doctors an average (this avoids missing the effects of crazy-expensive top-end specialists, as a median might) about 76% what we do. The rest of the OECD’s lower than that. You want one thing that is contributing, but such a trivial amount that it’s hardly worth addressing until everything else is fixed: it’s doctors’ liability insurance. They really want to reduce that cost, for obvious reasons, and Republicans want to fix it because… they hate poor people who’ve been harmed being compensated “too much” I guess… and it does contribute to higher costs, but very little compared to practically everything else. That one gets way more attention than it merits. The unifying factor of other countries’ healthcare schemes that keeps them cheaper than the US doesn’t seem to be that they’ve minimized the role of private insurance (some haven’t!) but that they have explicit (like government-set price lists) or or implicit (via e.g. monopsony) price controls. It seems like you can use any of several approaches, some of which keep private health insurance in a prominent role (Switzerland! Though they at least have the good sense to force them to be nonprofits, IIRC) so long as you have, one way or another, price controls. The only near-exception to this I’m aware of is Singapore, but… it’s Singapore. Plus they do have some explicit price controls, and I think it’s fair to say healthcare providers there might consider there to be a persistent, credible implied threat of more price controls or even harsher measures from the government, should prices rise too much, because… it’s Singapore. [edit] FWIW I do think fixing the insurance situation is an excellent place to start, even the best starting point, and that the insurers in the US are probably beyond salvaging through integrating them into a better system, and should just be eliminated or their role drastically reduced; I think this would make less progress toward fixing prices than some suppose it would, though would still do a lot for that, but it’d, crucially, fix most of the hidden costs of our system, like patient-hours lost to waiting on hold to try to get insurance to pay what they’re supposed to, HR folks messing with insurance-related issues, et c, which are huge and don’t make it into straight cost comparisons with other countries because those aren’t “healthcare costs” (putting a dollar value on that would make us look even worse than we already do)

mothballed 1y ago

>The exception is doctors. The shortage there is completely driven by their guild (AMA) successfully lobbying for a restriction on the number of medical schools. NPs are starting to get around this by getting independent or mostly independent practices in many states. The Doctors can still kick PAs in the teeth because they are usually under the medical board, but they can't do nearly as much to get their greedy claws on NPs because they are governed by a separate nursing board that nurses have more control of.

phil21 1y ago

> The exception is doctors. The shortage there is completely driven by their guild (AMA) successfully lobbying for a restriction on the number of medical schools. It's not just this. It's also that the career is starting to suck. Over half the doctors I know who I met while they were in medical school/residency are now out of the practice. They counted down the days until they had their student debt paid off and bounced to non-patient care roles outside the medical system. The entire profession has been captured by the administrative and managerial class. Doctors have had most of their agency stripped from them, and it's an exhausting career choice for someone who generally has a ton of options at their disposal. I expect the trend to get even worse as more and more pressure gets applied to the medical system both due to demographics and the endless march of making everything corporate.

deleted 1y ago
[deleted]