Philip Greenspun offers up a well-worn rant on how we can't expect to bring health care costs down while we have such a limited supply of doctors. He's right as far as he goes but he disencumbers himself of any responsibility to consider two important responses to the problem, both right under his nose.
One., maybe we need more doctors. He cites an OECD per capita average physician population of 3.1; the U.S. has about 2.4; France has 3.3; Israel has 3.8. He might want to consider what we get for such a limited supply, aside from (already) the highest costs in the developed world. A principled libertarian would want to do away with state licensing of physicians altogether. Short of delicensing, in recent years, we have made some important changes at the margin to expand the realm of physician's assistants, nurse practioners and suchlike. It is certainly worth while to consider what else we can do to limit the professional conspiracy in restraint of trade and to reduce the sphere of doctor's economic rents.
Two, he says that all measures to reduce cost are bound to fail "short of sending American patients to Europe or Cuba for treatment, are doomed to fail." Well, hey, big guy. Be interesting to know how much we could revolutionize American medicine if patients could take their Medicare abroad. It's clear that plenty of private patients vote this way with their dollars already. Does Greenspun objecct to letting Medicare patients enjoy the same freedom of choice?
2 comments:
I have some sympathy for Greenspun's argument. After a while you pick on the fact that doctors hate you because you're making them so late by being sick and all. And they'd rather have you die than to work on a Saturday.
Anyway, check out the number of MDs granted. It's hardly budged for 30 years:
2009 Statistical Abstract - First Professional Degrees Earned in Selected Professions
Nobody is saying it should be easier to get out of medical school or easier to pass the qualifying exams. But it should probably be easier to get in. Considering how fierce the competition to get in is, and how inaccurate tests and interviews must be at predicting who the best doctors will be in advance of eight years of training, I'd bet a lot of people who would be great doctors never get a foot in the door.
Nope, it's not that it's hard to get into med school. The problem is, it's hard to pay for once you are in. You could own a nice house in a nice suburb outright for what a medical education costs these days. That's one hell of a debt burden to carry once you're out of school, or for your parents to carry for you?
Why bother, when you could head for Wall Street and pay off all your student loans — and then probably make a down payment on your first co-op apartment — with your first year's bonus?
Keep standards high, but substantially decrease medical school tuitions or replace loans by grants, scholarships and subsidies, and the problem is solved.
Crankily yours,
The New York Crank
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