Actually the primary bottleneck in the supply of new doctors is lack of federal (Medicare) funding for residency slots. Every year, students graduate from US accredited medical schools but are unable to enter clinical practice because they can't get matched to a residency program. Ask Congress to increase funding.

https://www.ama-assn.org/press-center/press-releases/ama-fun...

Using an AMA source is disingenuous since it’s a professional cartel with a massive vested interest in keeping doctor supply as limited as possible.

Do you have a substantive comment to contribute or are you going to stick with baseless low-effort snark? The comment I posted is true and correct. You could verify it with other independent sources if you bothered to do any research.

Yeah sure.

Fighting residency expansion: http://www.usatoday.com/news/health/2005-03-02-doctor-shorta...

Fighting expansion of care to other types of practicioners: https://www.ama-assn.org/practice-management/scope-practice/...

Why would you believe the AMA's line on this? Do you think the professional association that represents all doctors, one of the highest paid and influential professions in the country, has no power to control the amount of residencies are funded by the government? They have no reason to increase the number of doctors, absolutely none. They benefit in every way from having constrained supply.

An article from 17 years ago reflects the PoV at that time, not today. The AMA has had different positions based on what they thought was best at the that time.

If they cared about expanding access to medical care they'd stop lobbying to prevent PAs and NPs from providing care. A half hearted attempt to add a paltry amount of residencies after 30 years of lobbying which led to the state we're in now does not absolve them of blame.

The AMA is literally lobbying Congress to expand residency program funding, and even putting their own money into it. Did you even read the article?

Yes - they're lobbying now to reverse caps they themselves[1] helped put into place, and like I said, have also limited primary care availability by lobbying against the ability of NPs and PAs to provided basic medical care. It's a complete bunch of talk until they get change done.

By the way, that expansion of 15000 residency positions barely puts a dent in the number of doctors we are lacking[2]. But yeah, a press release from 3 years ago really absolves them of guilt for sure.

[1]: http://www.cnn.com/HEALTH/9708/24/doctor.glut/ [2]: https://www.washingtonian.com/2020/04/13/were-short-on-healt....

But they are arguing in the source for more doctor supply?

They are blaming the lack of supply on something they don't control. There's a subtle difference.

How does that make any sense? Aren't student graduates actually paid to do those residency programs? If it's too expensive to train them, can't they take a pay cut? How come no other profession requires federal funding for placing/training graduates? Makes absolutely no sense unless you uncritically accept the status quo.

Residents are paid an average salary of $64K. That's less than many entry-level STEM jobs, and they often work up to 80 hours per week. They can't afford to take a pay cut. And hospitals incur other costs for running residency programs which go beyond paying resident salaries.

Most other private sector professions don't require nearly as much postgraduate training before being allowed to work. Prospective lawyers usually take the bar exam less than a year after graduating from law school. Medicine is simply more complex.

What would you propose as an alternative to the status quo? The AMA has proposed a number of improvements, but perhaps there are alternatives?

https://savegme.org/

Even if they supply of doctors was infinite, there is still the problem of demand being basically inelastic. What would the incentive of healthcare providers to lower prices? Inelastic demand means there is no incentive to lower prices, because there is no where else for someone to go and comparison/price shop. If you are hit by a bus, there is no ability for price negotiation to get healthcare.

Also blaming "corporatism" is basically just a meme at this point, because it is just used by libertarians when someone criticizes capitalism. Its the same when communists say "true communism has never been tried".

> What would the incentive of healthcare providers to lower prices?

In case of life or death emergencies, your insurance or ambulance driver would send you to a reasonably priced doctor, and doctors that charge unreasonable prices would go out of business. But my guess is that life or death emergencies do not account for most doctor visits.

> Also blaming "corporatism" is basically just a meme at this point, because it is just used by libertarians when someone criticizes capitalism. Its the same when communists say "true communism has never been tried".

Well, I don't feel like arguing about semantics. Feel free to call the problem I described however you like.

So for life or death decisions, the ambulance driver would first go on some price comparison website or ask the insurance and see "ok, this person wants a doctor in the $10,000-15,000 range, the closest of which is 30m away. The hospital next door costs at least $50,000 minimum, so we will not send them there for life saving medical care." And what incentive would insurance have to send me to a reasonably priced doctor, when they can send me to one in their network which is more expensive but means they keep more money? Also, they could send me to an expensive hospital and then just not pay out. These are both things Obamacare tried to fix [0]. Insurances want to maximize profits, which means paying as little as possible themselves and extracting as much as possible from customers. Your system would only work if insurances had to always pay 100% of medical costs and could never deny care, which is similar to how it works in Germany (at least for some baseline level of care).

Again, what incentive would there be to lower prices? New doctors could just be bought out and the prices jacked up. There are a lot of industries where there is little barrier to entry (for example tech), where the big companies just buy anyone trying to "get in on their territory".

Also, why would the "unreasonable prices" (what would that even look like?) doctors go out of business? They could just provide some kind of "luxury deluxe" ("no poor people here") state of the art care for people who can afford it.

[0] https://www.healthcare.gov/health-care-law-protections/docto....

No, very quickly everyone would know the hospitals that charge way more than the others, and not patronize them.

Emergency services are only like 5% of costs, anyway [367]:

> The percentage of U.S. health spending attributable to the ED has increased from 3.9% (CI, 3.9%-3.9%) in 2006 to 5.0% (CI, 5.0%-5.0%) in 2016.

So the other 95% is more flexible. I know when looking at birthing costs they could vary wildly but it didn't really matter because who cares, they're all in-network anyway.

[367] https://journals.plos.org/plosone/article?id=10.1371/journal...

It feels like you don't understand or don't believe in free enterprise in general, not just when it comes to medicine. All the theoretical issues you mention do not actually occur in industries that are closer to a free market.

There is no cost problem in "tech". In fact, many services are literally free of charge. Despite Google having a near-monopoly on search, it is unable to charge users for it. Demand for software developers has grown massively in the past decades and yet, wages have only slightly gone up.

Anyways, I didn't mean to start a debate on the merits of free enterprise. I was hoping that we could at least agree that artificial limiting the supply of doctors causes medicine to be more costly, regardless of the economic system.

I understand just fine, I just don't share the naive "invisible hand" narrative. I think there are a lot of places where free markets make for better products and services, but not all products and markets are fundamentally the same, so I believe the same prescription of "just remove all limits to a free market -> all problems solved" does not work everywhere.

But Google can charge their "actual" users, i.e. advertisers quite a bit, and it is much harder to do any advertising without also advertising on Google Platforms, such as Search, Maps, Youtube, Adwords, etc. The wages may have only slightly gone up, but the profits definitely have gone up quite a bit, which shows that amount of workers and their pay has little to do with how much money can be made (which I believe is perfectly fine, because tech is not a place where I think free markets create a detriment to society).

I don't want to start a debate on free enterprise in general, just to show that free enterprise is not a once size fits all solution. My argument was just that the supply of doctors has very little to do with the price of medicine, because the market forces that determine price and can lead to lower prices in some markets do not work correctly in this market.

Their analogy is bad, and it’s valuable to call out the nuance.

The statement is a reaction to blaming free market economics when the reality is a scenario of the opaque third party payer system in a highly regulated environment. Consumer gets no price transparency, state regulatory boards made up of current market suppliers control market entry - say what you want about it’s appropriateness but the US medical industry hardly resembles a free market.

“Corporatism” may be a ham-handed way to call this out, but it’s not helping society to lay the medical industry’s problems at the feet of capitalism. This problem of cronyism in markets (especially) exists in communist economies as well. It’s throwing out the baby with the bath water.