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 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 no reason for anyone in the US to be denied a slot at medical school (not a particular medical school, but some medical school in general).
One final note: please don't be fooled into have sympathy for the large debts doctors incur through medical school. This is not the population which is deserving of student debt relief. I'm happy to shorten their education, of course, but doctors are consistently among the very highest paid people in American society. Retiring even a million dollars in debt (much larger than any number in this article) is not that hard on a highly-paid specialists' salary, which can easily average half a million dollars per year.
The author of the piece has proposed to do further pieces on an "Abundance Agenda" for the US. Essentially this looks at ways to increase supply in things which are currently expensive but don't have to be. I haven't read other parts of it but I strongly recommended following him and looking further into the idea.
My wife is a physician. She needs a large salary to pay off her large medical debt. When the medical debt is paid off her salary will still be large. A much more sensible system would to make medical school free so that the salaries don’t have to start off so high. There are people with hundreds of thousands in med school debt who didn’t match. We should feel sorry for those people.
> 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 better than I).
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.
Isn't that at least in part because there's so little competition though?
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.
Residents don’t need debt relief but they also don’t need hostility.
look up FAANG salaries and TC I will bet you undergrad education will get debt relief
But to me this is another one of those cases where poor government policy boosts prices. Hospitals already have an incentive to buy up small practices to reduce competition, but if hospitals are paid double the price for the same procedure compared to an ambulatory clinic, the government is just incentivizing concentration in the market.
https://www.ama-assn.org/sites/ama-assn.org/files/styles/rel...
Just letting lurkers know the article is not about PhD programs or academia in general, as I half expected
