[mattficke]

This is basically the Kaiser model. Kaiser's doctors are salaried, rather than getting paid per procedure. Works pretty well!

(I think the actual answer to the question in the OP is, at least in part, to license more doctors. Then the cartel doesn't have as much pricing power and medical care is less of a luxury good. The rich person should really hire a lobbyist.)

[infecto]

I had Kaiser for a year and I actually enjoyed it. I saw a couple specialist but I never had any major work done so perhaps I am biased. It is funny to say it since I believe Kaiser originally was one of the opponents of a single payer system but using Kaiser kind of felt like what a government health care system should be. Very low friction. Oh I need blood work or whatever done, walk down the hall. Everything felt more convenient.

[spaetzleesser]

Same here. I enjoyed knowing there is one place where I can go and have everything done. They also sent reminders about vaccinations and checkups. I have moved away from CA so I don't have Kaiser anymore. I generally rarely go to a doctor and if I ever get sick I don't even know where to go :-(

[lotsofpulp]

The golden days of the doctor “cartel” (and people in the healthcare chain in general) are over.

https://www.beckersasc.com/asc-news/9-cms-pay-cut-for-physic...

The 80s/90s/00s were probably the golden years for them, but they got in the political spotlight, and combined with the decreasing proportion of young to old people, the government is going to push down cuts to whoever lacks political power to push back. Such as smaller businesses like independent doctor offices and pharmacies.

The government has already increased supply by letting Nurse Practitioners and Physician Assistants do stuff that doctors used to do, and I suspect a lot more price discrimination is on the way. Expect the average quality of care to fall (may not be a bad thing if overqualified people were treating pink eye), and paying more will result in being seen by someone more qualified.

[Robotbeat]

Increasing the supply doesn't mean the average quality of care will fall.

If I pay doctors $400,000 a year to work 80 hours a week and then double the number of doctors and pay them $200,000 a year to work 40 hours per week, the quality of care would almost certainly improve but costs would be constant. And actually, do we pay doctors a premium for those overtime hours where they're actually probably less effective? If so, our costs would go down as quality of care improves.

[ProjectArcturis]

In theory, if you want to train twice as many doctors, you have to relax admissions criteria to let in twice as many people, and the new admitees wouldn't have qualified under the previous system.

[GloriousKoji]

But what if the limiting factor of admission criteria isn't scoring well but things like crippling amount of debt, archaic culture of hazing and adversity to stupid hours?

[Robotbeat]

Right. Are doctors ubermensch who are the cream of the crop or did they just have a high tolerance for abuse? I’m not sure being ultra-selective gets you people who are fundamentally better doctors nor are the returns gonna be very linear even if they were. I’d much rather have enough well-rested doctors than have more “select” but highly stressed, sleep deprived doctors.

[convolvatron]

you're kind of assuming that the metrics that the use to admit students are predictive of care quality. thats certainly not true, but who knows how not true?

[ProjectArcturis]

I'm kind of surprised that med schools haven't dramatically opened up their admissions, like law schools have over the past 20 years. It's such an obvious source of funds for the school.

[dsr_]

The med schools are accredited by (a body completely governed by) the AMA. Number of seats is part of the accreditation.

The AMA does not want more competition and lower income per doctor.

[lotsofpulp]

AMA claims the real bottleneck is residency funding, since you cannot practice as a doctor without residency, and for some reason, only the federal government funds residencies, and the feds have not changed funding in many, many years.

Also, increasing class sizes is not without its down sides. Pharmacy schools cashed in and blew up the number of pharmacists in the last 10 years, and now the pharmacists’ employers have so much power in the negotiations due to so much supply of labor, that they can make pharmacists accept metrics which pharmacists know are excessive and unsafe since no one can possibly do the job properly in the time they are expected to check the medications and counsel people in.

A pharmacist family member says the law is to counsel patients, but the reality is anyone who did that would be fired and replaced so, in reality, people are not getting the counseling they deserve when they pick up the medications, and pharmacists are not able to properly double check the doctors.