11–20 of 48 posts
Health economist here. This is a great piece top to bottom. There is no credible objection I'm aware of to any of the deregulation proposals included herein. The American Medical Association will object, because they don't want the competition because it will have a negative effect on its members' incomes. If you think health care is too expensive in the US, the changes proposed herein are Job 1. There is no reason w…
Health economist here. This is a great piece top to bottom. There is no credible objection I'm aware of to any of the deregulation proposals included herein. The American Medical Association will object, because they don't want the competition because it will have a negative effect on its members' incomes. If you think health care is too expensive in the US, the changes proposed herein are Job 1. There is no reason w…
I have a hard time rectifying the claim that you are a health economist with the fact that you don’t appear to understand that the bottleneck for increasing the supply of doctors is the number of residency slots. Foreign medical school certifications are largely accepted at face value but graduating a foreign residency program largely is not. I think it’s pretty much universal that each country wants doctors to go th…
Don't tell my PhD thesis adviser, I guess? He could have sworn he approved a dissertation about health economics but you've uncovered my secret, or something? (And what was I working on for all that time then? It was years of my life! Apparently nothing?!?)
> the bottleneck for increasing the supply of doctors is the number of residency slots.
No, _you_ are misunderstanding what change I want. There is no reason at all for a German, Mexican, British, etc. practicing doctor to have to do a US residency at all after they finish whatever training qualifies them to be a doctor in their home countries.
Read the article again. US medical education takes much longer than medical education almost anywhere else in the world, yet our outcomes are almost always worse along nearly any measurable dimension.
You will say: "yeah, but that's the result of many factors!" Great - I agree. But in that case it really isn't obvious that the extra years of medical education in the US do a lot for patient outcomes.
In fact, not only do I want more residency slots in the US, I want to reconsider that whole residency system, especially for doctors trained abroad.
> I think it’s pretty much universal that each country wants doctors to go through their own version of residency.
Why? That's a big part of the problem. There is literally no reason in the world for a German doctor who has been practicing there for a few years to have to come here and do a residency again. It makes no sense. You wouldn't do it for a C programmer, right?
Example: "Sorry - you learned C in Germany. If you want to program here, you'll have to get a four-year degree in CS again."
This obviously makes no sense. C is (ideally) the same language wherever it is written. And yet, while you have the same number of kidneys as a German and the same nervous system as Russian ... are you seeing the point I'm trying to make? Why require years of extra training for a doctor from one of those countries to work here? That keeps them out of our market and keeps prices high.
> A much more sensible system would to make medical school free so that the salaries don’t have to start off so high.
Let me pull out my economist card again and say: "this is not how that works." Salaries are not high because medical school is expensive. Salaries are high because supply is restricted. That's how supply and demand work.
Earlier quoted context omitted.
I have a hard time rectifying the claim that you are a health economist with the fact that you don’t appear to understand that the bottleneck for increasing the supply of doctors is the number of residency slots. Foreign medical school certifications are largely accepted at face value but graduating a foreign residency program largely is not. I think it’s pretty much universal that each country wants doctors to go th…
To be perfectly honest, i have found primary care doctors pretty useless in the last 5 - 10 years, not only did i find that their answers were things i could easily find on google, i also noticed that most of them didn't actually care about patient well being. It seems like most doctors these days are only in it for the money, which is fine if they are actually providing a valuable service, but low level doctors are…
Earlier quoted context omitted.
I have a hard time rectifying the claim that you are a health economist with the fact that you don’t appear to understand that the bottleneck for increasing the supply of doctors is the number of residency slots. Foreign medical school certifications are largely accepted at face value but graduating a foreign residency program largely is not. I think it’s pretty much universal that each country wants doctors to go th…
The limit of residency slots is in the article. > A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. That's not how any labor market works. Your salary isn't determined by how much debt you rack up. Doctor's salary's are high because the supply of doctor's is so low (especially primary care). The article covers all the points you're debating (much bette…
Health economist here. This is a great piece top to bottom. There is no credible objection I'm aware of to any of the deregulation proposals included herein. The American Medical Association will object, because they don't want the competition because it will have a negative effect on its members' incomes. If you think health care is too expensive in the US, the changes proposed herein are Job 1. There is no reason w…
> they don't want the competition because it will have a negative effect on its members' incomes. Is it the perception that increased competition will have negative effects on members' incomes or is that actually true? I swear I remember a story, study, allegory about a second doctor moving to town and both incomes went up.
Generally true in other areas. Health care is not that exceptional a market, though it is exceptional in several respects. We do generally observe in health care specifically that increases in market concentration increase prices.
> I swear I remember a story, study, allegory about a second doctor moving to town and both incomes went up.
I'll take a look if you can find it. It's possible. One story I can imagine would be something like: First Doctor can see more patients b/c he can send his more complicated patients to Second Doctor's specialty practice. And Second Doctor moved from a smaller town w/ fewer patients in the specialty.
In the aggregate and outside of special cases more supply will bring prices down.
Earlier quoted context omitted.
I have a hard time rectifying the claim that you are a health economist with the fact that you don’t appear to understand that the bottleneck for increasing the supply of doctors is the number of residency slots. Foreign medical school certifications are largely accepted at face value but graduating a foreign residency program largely is not. I think it’s pretty much universal that each country wants doctors to go th…
> I have a hard rectifying the claim that you are a health economist with the fact that you don’t appear to understand ... Don't tell my PhD thesis adviser, I guess? He could have sworn he approved a dissertation about health economics but you've uncovered my secret, or something? (And what was I working on for all that time then? It was years of my life! Apparently nothing?!?) > the bottleneck for increasing the sup…
You should have stated it this way. In your original post you referenced medical school and that gave the impression that you aren’t aware of the credentialing process to becoming a licensed physician. You had written:
There is no reason why Mexican, Canadian, British, Indian, German, ... doctors should not be allowed to come and practice in the US with more than some cursory verification that they actually attended a medical school where they are from.
There is actually a valid reason to make it hard for doctors to move from one country to another. Training doctors is time consuming and expensive. There is a moral aspect to luring doctors trained in poor countries to rich countries.
David Carr would like a word with you regarding your belief that supply/demand alone accounts for the pay of doctors. The supply would not go down if med school was free but starting salaries were x% what they currently are. The experiments have been run. Countries with mostly free higher education have lower doctor pay than the U.S.
Earlier quoted context omitted.
The limit of residency slots is in the article. > A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. That's not how any labor market works. Your salary isn't determined by how much debt you rack up. Doctor's salary's are high because the supply of doctor's is so low (especially primary care). The article covers all the points you're debating (much bette…
My response was about the claim that OP is a health economist while not understanding where the bottleneck in the supply for doctors comes from. I believe you are incorrect as it pertains to doctor salaries. Demand is high and supply relatively low. That is true but this isn’t the only factor that goes into determining pay. That’s an overly simplistic view of things. Supply/demand does not account for everything in t…
Earlier quoted context omitted.
My response was about the claim that OP is a health economist while not understanding where the bottleneck in the supply for doctors comes from. I believe you are incorrect as it pertains to doctor salaries. Demand is high and supply relatively low. That is true but this isn’t the only factor that goes into determining pay. That’s an overly simplistic view of things. Supply/demand does not account for everything in t…
I don't agree the cost of university is driving the salaries here. It's all about how many doctors are available to meet demand. If there are less, it's going to drive up salaries. There are other countries where the cost of getting a degree in a certain specialty is very low due to state subsidies but the salaries are very high once they graduate since they are scarce.
Earlier quoted context omitted.
> I have a hard rectifying the claim that you are a health economist with the fact that you don’t appear to understand ... Don't tell my PhD thesis adviser, I guess? He could have sworn he approved a dissertation about health economics but you've uncovered my secret, or something? (And what was I working on for all that time then? It was years of my life! Apparently nothing?!?) > the bottleneck for increasing the sup…
There is no reason at all for a German, Mexican, British, etc. practicing doctor to have to do a US residency at all after they finish whatever training qualifies them to be a doctor in their home countries. You should have stated it this way. In your original post you referenced medical school and that gave the impression that you aren’t aware of the credentialing process to becoming a licensed physician. You had wr…
When your goal is to increase supply in the US and drive down prices, then no, there is not a valid reason to do this.
> Training doctors is time consuming and expensive. There is a moral aspect to luring doctors trained in poor countries to rich countries.
FWIW I don't completely disagree with this. But that's kind of a crappy thing to say to a Turkish doctor who wants to flee the Erdogan Sultanate, or a Sudanese doctor who wants to make more than a pittance every month.
I'm not willing to condemn some poor Pakistani doctor to a life much less comfortable than he could enjoy here AND force US citizens to pay extremely high prices for medical care to protect the incomes of US doctors. If you are, cool.
Before you get indignant with me: you yourself could train as a nurse practitioner pretty quickly and cheaply (if you are in the US) and then go practice in Sudan or 100 other countries. They'd love to have you. If you only speak English, try India, Ghana, Nigeria, ...
You would be providing a great benefit to the Sudanese. Don't want to? Then why condemn some Sudanese doctor to the same just because he was born there instead of here?
> David Carr would like a word with you...
I don't know who this is.
> regarding your belief that supply/demand alone accounts for the pay of doctors.
I will happily believe this, both on my own authority as an actual informed expert in the field AND on the basis of the research of numerous colleagues of mine, who have in the aggregate devoted several hundred years of work to understanding this topic.
> The supply would not go down if med school was free but starting salaries were x% what they currently are.
This would be a notably interesting result in economics if it were true. It is not true. Doctors salaries are not responsive to the cost of medical school.