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I think the largest issue with health care right now is that the US is artificially shrinking the supply of Doctors. This is due to: 1. Size of medical school

I think the largest issue with health care right now is that the US is artificially shrinking the supply of Doctors. This is due to: 1. Size of medical school classes not increasing with population 2. US has an artificially small amount of residency slots. These are largely due to AMA lobbying afaik and bad bills. But if we allowed every qualified medical student to enroll, and gave a residency slot to every graduate. In a decade we would have really shrunk the gap.

iamtheworstdev 8mo ago
the largest issue in American health care is private equity and middle men raising the cost of everything. edit if doctor scarcity were the issue then doctors would have a lot more leverage in salary negotiations than they do, which is to say they don't have much. because the hiring practices are limited by what they can bill, which they have no power over.
- doomslayer999 8mo ago
  Private Equity is the effect not the cause. We need them to create efficiency because of the shenanigans that the AMA guild did in limiting doctor supply. Just allow people to take an exam to get credentialed, we'd have foreign doctors flown in by the hundreds of thousands and care would be as cheap as it is in India.
  - lazyasciiart 8mo ago
    That doesn’t make sense - private equity has done the same thing in completely orthogonal industries, like manufacturing.
  - watwut 8mo ago
    Private Equity does not create efficiency and we do not need them. What they do is to take debt to buy healthy companies, transfer debt onto them and then kill them. None of that is efficiency in any reasonable sense.
  - iamtheworstdev 8mo ago
    private equity doesn't create efficiencies. The real world is not some MicroEcon 101 class. > “As our investigation revealed, these financial entities are putting their own profits over patients, leading to health and safety violations, chronic understaffing, and hospital closures. Take private equity firm Leonard Green and hospital operator Prospect Medical Holdings: documents we obtained show they spent board meetings discussing profit maximization tactics—cost cutting, increasing patient volume, and managing labor expenses—with little to no discussion of patient outcomes or quality of care at their hospitals. And while Prospect Medical Holdings paid out $645 million in dividends and preferred stock redemption to its investors—$424 million of which went to Leonard Green shareholders—it took out hundreds of millions in loans that it eventually defaulted on. Private equity investors have pocketed millions while driving hospitals into the ground and then selling them off, leaving towns and communities to pick up the pieces.” https://www.grassley.senate.gov/news/news-releases/private-equity-in-health-care-shown-to-harm-patients-degrade-care-and-drive-hospital-closures https://www.grassley.senate.gov/news/news-releases/private-e...
- pembrook 8mo ago
  Ugh I wish this braindead populist 'private equity boogieman' meme that's taken ahold of reddit-types would die. No, private equity is not the reason healthcare costs in the US are out of control, you can even ask chatgpt. PE is a 3rd tier mild symptom in certain niche health markets that sits downstream of all the structural root issues created due to the twisted public/private incentive misalignment nightmare of US healthcare.
  - Eisenstein 8mo ago
    People would have an opportunity to change their stance if you explain why they should hold a different one with evidence and persuasion. Berating them and then saying they are wrong without explaining why is not going to change anyone's mind.
    - pembrook 8mo ago
      I used to do that when HN was a more rational, thinking-man's place years ago. It's been poisoned by the hysterical climate of US politics like everything else on the internet, so there are no thinking men left. It's a lost cause. If I were to explain the situation rationally I would get downvoted for not cheering on the shooting of CEOs. Upvote communities are all dead and dying. There are no more interesting conversations happening in them anymore.
exhilaration 8mo ago
Does that matter though? My impression is that most people don't see doctors anymore. Every urgent care visit I've had in the past few years has been with a physicians assistant or nurse. Same for our pediatrician, I can't remember the last time we saw her instead of one of the nurses. I actually have a routine visit with a specialist at one of the top hospital systems in the country in 2 days, and I see in the portal I'm seeing a "CRNP, MSN", not a doctor.
- ecshafer 8mo ago
  This affect is because of the doctor shortage though. I am in the process of trying to find a primary care provider, and I cant find anyone accepting new patients. Bigger places you basically see the doctor for 2 minutes when you actually need one. I went to a ortho surgeon and they had a dozen patients “seeing them” at the same time. As he just went between rooms and nurses prepped everything.
  - fleshdaddy 8mo ago
    I went down a Reddit rabbit hole, a sub called /r/noctor. Basically people, mostly doctors, complaining about the prevalence of nurse practitioners, PAs practicing independently/outside of their scope, etc. The general consensus I see there is that the only people benefiting from this are private equity firms trying to squeeze more profit since they bill the same based on whether you see a doctor or an NP. This in turn has an affect where it doesn’t make sense financially to go through so much school and take on so much debt.
    - renewiltord 8mo ago
      The primary utility of most medical professionals is to act as a gatekeeper to distinguish me from a drug-seeker. They are glorified security guards around medication. Fortunately, I always get what I want.
      - stalfie 8mo ago
        As an internist (not in the US), I would like to put in my two cents to say this is just wrong. The primary utility of most medical professionals is to diagnose and treat a condition correctly. In the ER and elsewhere, the correct diagnosis is indeed often "drug seeking behaviour". And this is also a major aspect of medicine that many relatively healthy people interface with and remember. They are in pain for whatever reason, they desire to be relieved of said pain, and that desire puts them into contact with the skepticism and hesitancy around opiods that physicians have built up out of unfortunate necessity. It's often a hurtful and protracted experience, and so they remember it and form opinions like yours. But this area of contact with medicine is a tiny, very visible tip of a much larger iceberg. Your description of "security guard around medication" is not strictly wrong for my field, seeing as internal medicine is largely about administering the right drug at the right time, but the 99% of the drugs we guard are not desirable at all for any drug-seeker. They are potent, full of side effects, are sometimes potentially deadly. But they do work. And you do not see any of this until you get properly sick, which to most people does not happen very often often (at least until they approach 70). And when it does happen, most people tend to focus on the one little side of the ice berg they come into contact with. But it is there, and it is about much more than distinguishing you from a drug seeker.
deleted 8mo ago
[deleted]
watwut 8mo ago
AMA was lobbying for more residencies for years. And residencies are the bottleneck.

iamtheworstdev 8mo ago

the largest issue in American health care is private equity and middle men raising the cost of everything. edit if doctor scarcity were the issue then doctors would have a lot more leverage in salary negotiations than they do, which is to say they don't have much. because the hiring practices are limited by what they can bill, which they have no power over.

doomslayer999 8mo ago
Private Equity is the effect not the cause. We need them to create efficiency because of the shenanigans that the AMA guild did in limiting doctor supply. Just allow people to take an exam to get credentialed, we'd have foreign doctors flown in by the hundreds of thousands and care would be as cheap as it is in India.
- lazyasciiart 8mo ago
  That doesn’t make sense - private equity has done the same thing in completely orthogonal industries, like manufacturing.
- watwut 8mo ago
  Private Equity does not create efficiency and we do not need them. What they do is to take debt to buy healthy companies, transfer debt onto them and then kill them. None of that is efficiency in any reasonable sense.
- iamtheworstdev 8mo ago
  private equity doesn't create efficiencies. The real world is not some MicroEcon 101 class. > “As our investigation revealed, these financial entities are putting their own profits over patients, leading to health and safety violations, chronic understaffing, and hospital closures. Take private equity firm Leonard Green and hospital operator Prospect Medical Holdings: documents we obtained show they spent board meetings discussing profit maximization tactics—cost cutting, increasing patient volume, and managing labor expenses—with little to no discussion of patient outcomes or quality of care at their hospitals. And while Prospect Medical Holdings paid out $645 million in dividends and preferred stock redemption to its investors—$424 million of which went to Leonard Green shareholders—it took out hundreds of millions in loans that it eventually defaulted on. Private equity investors have pocketed millions while driving hospitals into the ground and then selling them off, leaving towns and communities to pick up the pieces.” https://www.grassley.senate.gov/news/news-releases/private-equity-in-health-care-shown-to-harm-patients-degrade-care-and-drive-hospital-closures https://www.grassley.senate.gov/news/news-releases/private-e...
pembrook 8mo ago
Ugh I wish this braindead populist 'private equity boogieman' meme that's taken ahold of reddit-types would die. No, private equity is not the reason healthcare costs in the US are out of control, you can even ask chatgpt. PE is a 3rd tier mild symptom in certain niche health markets that sits downstream of all the structural root issues created due to the twisted public/private incentive misalignment nightmare of US healthcare.
- Eisenstein 8mo ago
  People would have an opportunity to change their stance if you explain why they should hold a different one with evidence and persuasion. Berating them and then saying they are wrong without explaining why is not going to change anyone's mind.
  - pembrook 8mo ago
    I used to do that when HN was a more rational, thinking-man's place years ago. It's been poisoned by the hysterical climate of US politics like everything else on the internet, so there are no thinking men left. It's a lost cause. If I were to explain the situation rationally I would get downvoted for not cheering on the shooting of CEOs. Upvote communities are all dead and dying. There are no more interesting conversations happening in them anymore.

exhilaration 8mo ago

Does that matter though? My impression is that most people don't see doctors anymore. Every urgent care visit I've had in the past few years has been with a physicians assistant or nurse. Same for our pediatrician, I can't remember the last time we saw her instead of one of the nurses. I actually have a routine visit with a specialist at one of the top hospital systems in the country in 2 days, and I see in the portal I'm seeing a "CRNP, MSN", not a doctor.

ecshafer 8mo ago
This affect is because of the doctor shortage though. I am in the process of trying to find a primary care provider, and I cant find anyone accepting new patients. Bigger places you basically see the doctor for 2 minutes when you actually need one. I went to a ortho surgeon and they had a dozen patients “seeing them” at the same time. As he just went between rooms and nurses prepped everything.
- fleshdaddy 8mo ago
  I went down a Reddit rabbit hole, a sub called /r/noctor. Basically people, mostly doctors, complaining about the prevalence of nurse practitioners, PAs practicing independently/outside of their scope, etc. The general consensus I see there is that the only people benefiting from this are private equity firms trying to squeeze more profit since they bill the same based on whether you see a doctor or an NP. This in turn has an affect where it doesn’t make sense financially to go through so much school and take on so much debt.
  - renewiltord 8mo ago
    The primary utility of most medical professionals is to act as a gatekeeper to distinguish me from a drug-seeker. They are glorified security guards around medication. Fortunately, I always get what I want.
    - stalfie 8mo ago
      As an internist (not in the US), I would like to put in my two cents to say this is just wrong. The primary utility of most medical professionals is to diagnose and treat a condition correctly. In the ER and elsewhere, the correct diagnosis is indeed often "drug seeking behaviour". And this is also a major aspect of medicine that many relatively healthy people interface with and remember. They are in pain for whatever reason, they desire to be relieved of said pain, and that desire puts them into contact with the skepticism and hesitancy around opiods that physicians have built up out of unfortunate necessity. It's often a hurtful and protracted experience, and so they remember it and form opinions like yours. But this area of contact with medicine is a tiny, very visible tip of a much larger iceberg. Your description of "security guard around medication" is not strictly wrong for my field, seeing as internal medicine is largely about administering the right drug at the right time, but the 99% of the drugs we guard are not desirable at all for any drug-seeker. They are potent, full of side effects, are sometimes potentially deadly. But they do work. And you do not see any of this until you get properly sick, which to most people does not happen very often often (at least until they approach 70). And when it does happen, most people tend to focus on the one little side of the ice berg they come into contact with. But it is there, and it is about much more than distinguishing you from a drug seeker.

deleted 8mo ago

[deleted]

watwut 8mo ago

AMA was lobbying for more residencies for years. And residencies are the bottleneck.