[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.

[chimeracoder]

There is no "full current subsidy" - the existing contributions from Medicare are already a partial subsidy.

But this is kind of a meaningless debate after a point, because the number of unmatched residents is already an upper bound on the number of additional matches (you certainly wouldn't have more people interested when you increased the price to them). And even then, we wouldn't see a huge difference - the number of unmatched domestic applicants isn't enough to make a meaningful dent in the labor supply of practicing physicians - and that's assuming all of the unmatched doctors are as properly qualified as their matched counterparts.

In other words, no, we're not at the exact market-clearing rates for the medical education market, and we consistently bias in one direction from that equilibrium, but we're measurably not far off from it.

[SilasX]

>There is no "full current subsidy" - the existing contributions from Medicare are already a partial subsidy.

In the context, I meant "100% of current level"; I didn't mean to imply that it was "full" in that sense (and my point didn't depend on such).

>t this is kind of a meaningless debate after a point, because the number of unmatched residents is already an upper bound on the number of additional matches (you certainly wouldn't have more people interested when you increased the price to them)

You wouldn't have enough doctors if residents had to bear $1 extra in costs? That is implausible.

With respect, this exchange does not feel productive.