[narrator]

For one, doctors educational costs are astronomical in the U.S compared to other countries. The amount of people able to become doctors is artificially limited. Drug prices are unregulated. The cost of developing drugs is high and has been getting higher.

Hospitals have little price transparency and the cost of same procedures at different hospitals is wildly different. The same bag of saline can cost 10x more at one hospital vs another. In markets where there is price transparency, like Lasik surgery or other elective procedures, the prices are far more sane.

One thing that spending double as a percent of GDP on health care and getting worse outcomes proves is that THE SOLUTION TO THE PROBLEM IS NOT TO SPEND MORE MONEY. Unfortunately, this is the only thing American politics knows how to do as more money means more money for every special interest with their hand out.

[chimeracoder]

> The amount of people able to become doctors is artificially limited.

It is not artificially limited, and this is a common misconception that simply won't go away.

The bottleneck is currently the number of people who can complete residency training. Residency programs are not self-sufficient, so most of them are funded by Medicare. That's not an artificial limit - that's a natural one (the sheer economics of the process).

[SilasX]

And (per previous discussion [1]) that doesn't explain it. If there is still excess demand for MD degrees, then there is still room for potential MDs to borrow any shortfall that residency subsidies won't cover.

The argument is like saying that Hamilton showings are limited by how much the government will pay in subsidies for the tickets. No. The demand is enough to cover expansion.

And even if it weren't there's still the issue of how much training is actually required to fill the functional role of a doctor. I'm pretty sure that there's some fat to cut out when you're making someone go all the way through a bachelors before they can even start.

[1] https://news.ycombinator.com/item?id=13593944

[chimeracoder]

> If there is still excess demand for MD degrees, then there is still room for potential MDs to borrow any shortfall that residency subsidies won't cover.

Because the amount of loan debt physicians have to take on is already massive, and very few want to increase that by an additional $112,000 (which is the amount Medicare provides). There are some, but empirically, not many.

The term of that loan is comparable to many mortgages, and there's enough uncertainty at this point in the expected payout that many qualified would-be doctors are incentivized to choose other professions instead, where they can make a pretty good living (and, possibly, a better one) much sooner and without the risk of taking out an additional series of six-figure loans on top of whatever may be outstanding from undergraduate education.

> The argument is like saying that Hamilton showings are limited by how much the government will subsidize ticket prices by.

Broadway ticket prices are a really bad analogy, because prices are intentionally sold below market-clearing rate for a whole slew of reasons that aren't directly comparable to the medical profession.

[SilasX]

>Because the amount of loan debt physicians have to take on is already massive, and very few would want to increase that by an additional $112,000 (which is the amount Medicare provides).

Sure, you think it's expensive, but the demand is still there, people are willing to work for (net of costs) less than they currently are. That supports the claim that the service is priced above the market clearing level. (Edit: and they wouldn't be increasing debt by that full $112k; they could simply provide 80% of the existing subsidy per slot instead of the current 100%.)

>Broadway ticket prices are a really bad analogy, because prices are intentionally sold below market-clearing rate for a whole slew of reasons that aren't directly comparable to the medical profession.

No, that makes it a better analogy, because it's a case of good sold below it's market clearing price but which has excess demand capable of paying a (much) higher MCP, and where it's more obvious that the bottleneck isn't (and can't be) insufficient subsidies.

[chimeracoder]

> Sure, you think it's expensive, but the demand is still there, people are willing to work for (net of costs) less than they currently are. That supports the claim that the service is priced above the market clearing level.

* There are more people who apply for publicly-funded GME every year than there are positions available, yes.

* However, almost nobody (roughly speaking) applies for self-funded residency positions (which do exist).

I don't know how those two facts combine to say that "the demand is there" - there is not excess demand at market-clearing rates. There is only excess demand at a subsidized rate. People are not willing to work for less than they currently are; the supply is highly substitutable, and we're already seeing the effects of that.

[SilasX]

I added an edit that there is plenty of room between full current subsidy and 0% subsidy.

You're doubling down on the strawman of adding new slots at 0% subsidy, and you're not considering the possibility that the requirements are too stringent to begin with. (Full bachelor's plus MD plus full residency.)

Edit: Also, it wouldn't be "seeing the effects" of it until the number of med school applications = number of med school slots.

[SilasX]

>Drug prices are unregulated. The cost of developing drugs is high and has been getting higher.

What do drug prices have to do with the cost of an office consultation?

[k-mcgrady]

>> For one, doctors educational costs are astronomical in the U.S compared to other countries.

Doesn't this apply to all US educational costs (at the college level)? On the other hand doctors in the US seem to get paid a lot more than in, say, the UK.