American Medical Care

https://news.ycombinator.com/item?id=45734582

We can put a stop to this by ending the monopoly the AMA holds and by ending the regulatory capture hospitals have over the system. Open up healthcare to any entrepreneur who wants to make a difference and you will see prices drop to 1/100th of what they are now and you will see the quality of care go up 100x.

https://www.openhealthpolicy.com/p/medical-residency-slots-congress?fbclid=IwZXh0bgNhZW0CMTAAYnJpZBExbVdCYzVkMU1ETDNOZ3NpbAEeh7mQLuPlAbGY-2U6ix6iy-MbZ3GNGE66wHGCeypYLszwfjtHw39TVptkzZw_aem_Aub3m4co7OtSUoxEeoXu0A

Doctors directly lobby for and got these limits – “CMS residency funding was capped beginning in 1997 at 1996 levels, and has only been raised once since then in Section 126 of the Consolidated Appropriations Act of 2021. From 1987 to 1997 the number of residents grew by 20.6%, while from 1997 to 2007 the growth in residencies was only 8%. The 2021 law attempts to address several issues by slowly increasing residencies in specific underserved situations such as rural areas. This officially just began with 200 new residencies nationwide this year, climbing to 1,000 additional residencies per year in five years. It is only a drop in the bucket compared to the 140,000 resident doctors in the US in 2020, the majority of whom were federally funded. Using a rough estimate from Census population data for 2000 and 2020, there are at least 50 million, or 18%, more people in the nation today than when the law was passed, making the current change a rather small effort. This growth in population without a corresponding growth in the doctors we train each year leads to higher salaries for doctors and higher costs for patients. More people are demanding the time of a similar number of doctors, driving up the price of doctor’s time, even before accounting for the US’ aging population.”

This is simply the laws of supply and demand. Doctors have lobbied for many years for regulations that strictly limit the number of new doctors and they have gotten them. Health care is an inelastic demand service – meaning you would pay anything to get help. So when you artificially constrict the supply, you drive the prices sky high. Hence our current disastrous healthcare situation in the USA where 66% of bankruptcies filed are from medical bills and doctors collect nearly a fifth of our total GDP despite only constituting a tiny fraction of one percent of the population.

Ralph Althouse I had a recent dental appointment that was very disappointing. I spent thirty minutes trying to get the office to process my insurance information, then had a dental assistant spend literally two minutes scratching at my teeth and telling me they are fine, then the dentist glanced at them for thirty seconds and saying the same. For this “service”, I was billed over a thousand dollars. My original link is a long list of people with similar overbilling experiences by doctors, dentists, and hospitals.

Doctors like to imagine they are a magical higher species exempt from the laws of economics due to having the most powerful lobbying force on the planet working on their behalf, but the truth is medical care is a service (an important service to be sure), just like plumbing or electrical or building websites for pay. Demand is inelastic – people would pay anything for medical care when they need it as they will die otherwise. But taking advantage of that by artificially restricting supply to increase prices and doctors profits is the worst kind of evil.

The solution is simple – get rid of all of the regulations and allow anyone to provide medical care. People needing medical care will still seek reputable providers and if bad actors appear, sue them in court till they are no longer in business. The courts can be a much more effective system of regulation than overbearing bureaucrats.

I am an entrepreneur and would love to start a better type of medical care. I envision a medical facility where people enter, be seen by a general doctor for diagnosis, then would receive basic types of care from specialists trained in extremely narrow areas at low cost. People would only be moved up to more expensive nurses and doctors in more complicated cases or issues that don’t resolve quickly. Stuff like stitches, teeth cleaning, the common cold, and much more could easily be handled by entry level folks for vastly lower costs.

Or another option for those who love regulations and bureaucracy would be to triple the number of funded residencies available each year. That would triple the number of graduating new doctors and quickly increase the supply of doctors and thus drop prices. I like this option less as the lobbyists will get this reduced again before long.

Ralph Althouse I have 260 full time employees (250ish in my web design company and 5 on my farm). I have hundreds more contractors of all sorts I have worked with. By far the worst experiences I have had dealing with people have been with those in the medical profession. Giant egos, incompetence, and obfuscated pricing. When hiring farm hands, I have found about half of the folks are incompetent or dishonest. When hiring medical professionals, I have found about three quarters are incompetent or dishonest – and all of them hate any sort of accountability.

Sure, our insurance system needs reform. It should be mostly entirely replaced so consumers take direct control of their own expenditures again. But the core of the failure of our healthcare system lies with the corrupt regulations doctors and nurses and hospitals have built up that prevent any real competition and keep prices so high they are killing our nation.

Ralph Althouse Every industry follows the basic laws of economics, including supply and demand and pricing. Healthcare is no exception. The laws of economics can be twisted and distorted by government regulations, such as we have seen in the modern USA. Or disguised by special interest groups trying to gain advantages.

I have known many dentists and doctors who mistakenly believe they are very good at business and economics due to their very high income levels. Many of them end up losing money in business ventures outside of medicine where they do not have the government granted monopoly and limited competition and inelastic demand advantages they have in medicine. Hubris and ego are a high risk for people who see success in a field.

One honest question: many doctors I have run across have been extremely territorial and defensive of their industry. Religious folks and fraternity members are often less protective. I would think a profession based on science would encourage investigation and thinking of improvements rather than fighting it? Why is this?