[computator]

It's intriguing that medical care is always the worst kind of service, by far, in every country in the developed world, compared to every other kind of product or service we depend on. Compare it to food, electricity, gasoline, clothing, water, cell service, haircuts, transportation, movies. If you're not in a rural location, you can buy food or a restaurant meal 24-hours a day in less than an hour. There's complex infrastructure and supply chains around food production, but it works, and works fast. But you can't start most medical treatment without waiting days, weeks, or even months. In lots of places you can't even see a family physician or primary care doctor without waiting days.

Why is it? It is because medical care is more "personalized" and less of a commodity? Because it's heavily controlled by government? Is it the liability (medical people can get sued for a lot more than a bad haircut)? Due to much higher expectations of what is acceptable medical care compared to, say, food?

It doesn't seem obvious to me why the economics of medical care should be so different than everything else we use and depend on.

[nradov]

The economics of healthcare in most developed countries are highly distorted through government intervention. This causes shortages and queues, but it also helps to hold costs down and provide access for poor people who might otherwise not be able to afford it at all.

For comparison look at cosmetic surgery in the USA. It isn't covered by insurance so patients pay out of pocket. Only the affluent can afford it but the business is highly competitive and most procedures are available with little or no waiting and high quality.

Liability is only a minor factor. Some US states have severely limited non-economic damages in medical malpractice cases but that only brought costs down slightly.

[chaostheory]

> Compare it to food, electricity, gasoline, clothing, water, cell service, haircuts, transportation, movies

Compared to other essential professions, doctors need 8 years of schooling and another 4 years for apprenticeship. As for nurses, they are both abused and underpaid. Maybe AI and subsidizing medical schooling can help? Raising the retirement age should also help. A large portion of the population does not pay into the healthcare system.

[nvm0n1]

Do all doctors need that much or is it just the homogenizing effect of licensing? You could argue that programmers need many years of schooling and apprenticeship to become useful if you set the bar of utility at the same place Google used to, but in reality most people can be useful way before that. Also self-learning makes a big difference but isn't recognized by the medical licensing system.

[candiodari]

You need X doctors per 100000 people. Point. That means the budget for training physicians needs to expand with population, 8 years ahead of time. Instead it’s been dropping and dropping, while the government also made the job of physician much less attractive. And there’s still a Numerus clausus. The idea that remote communities have a local physician is already a romantic idea from the past.

And don’t worry. Student physicians these days are working as a nurse before even the second year in many places. Of course, this is effectively used as a way to save money, not to have sufficient personnel, and that means these students are often standing there alone, not learning much, making mistakes.

The government’s idea seems to be to just allow more immigrant doctors… except immigrant doctors largely go to 2 countries, and even there it’s not enough. And, as per usual, policy fails, government doubles down on failed policy. Meanwhile, professors in medical faculties are keenly aware that they can’t let more people in and failing a student is more 72h shifts for everyone… so the quality of doctors, or at least the bottom level, is going downhill fast too.

The scary bit is that if the system fails beyond a certain point, it’ll require large investment for a decade before you even see the first improvements. And, of course, it will make a lot of victims. We don’t even really know how far that point is.

[nradov]

Physician education is already highly subsidized. AI can potentially improve productivity a little in areas like charting and clinical decision support but don't expect miracles.

The full Social Security retirement age is already 67. There isn't much room to push it higher. By that age many workers, especially those who have done manual labor, are disabled to an extent. It's just not realistic to expect them to continue working.