Comment by ToucanLoucan
4 hours ago
> If we want to increase the labor share then we'll drive down healthcare spending.
It may not be simple but it's clear the United States is doing something catastrophically wrong. All the other healthcare systems on the planet in developed countries have problems, sure. But we spend magnitudes more money to receive middling-to-shit healthcare. Medical debt and bankruptcy is a unique American problem that also happens to be the most reliable way for otherwise productive and prosperous members of our society to end up fucking homeless. Because they got SICK. I rarely use the word "evil" but that really fits IMO.
Like you cannot tell me with a straight face that the insurance industry couldn't be blown the fuck off the map tomorrow and literally everyone who doesn't own an insurance company isn't instantly better off.
If the insurance companies disappeared tomorrow, presumably all medical care is paid for at point of use by patients? That would mean stochastically facing catastrophic bills from providers. I am sympathetic to the idea that healthcare providers and systems here should be making no more than in, say, Europe, but an orthopaedic surgeon being paid the $300k USD-equivalent in Germany instead of his $750k USD income today at median would be very unhappy.
> would be very unhappy.
Significantly increasing the supply of doctors would solve that, though.
There are certainly some things that we could do to increase the supply of physicians by reducing the cost of education, expanding access to combined BS/MD programs, and increasing the number of residency slots. But those measures will have marginal effects, and take years to show up in supply numbers. There just aren't a lot more people who are mentally and physically capable of doing this work.
Part of the problem is that we force physicians to waste too much time on administrative work. Some of this could be delegated to cheaper employees or not done at all, thus effectively increasing supply. Administrative overhead is also one of the factors driving physicians to quit and pivot to other careers or retire early, which further constrains supply.
This part is controversial but we'll also have to shift a lot of primary care to Physician Assistants and Nurse Practitioners. Care quality might be lower in some cases but for routine conditions it's probably better to see a PA/NP today instead of waiting weeks for a physician.
> but an orthopaedic surgeon being paid the $300k USD-equivalent in Germany instead of his $750k USD income today at median would be very unhappy.
I'm sure he'll manage.
Sure, but the rare type of person capable of becoming an orthopedic surgeon has other career options. There are some who are drawn to it as a calling because they love caring for patients and would do it regardless of wages. But most respond to economic incentives, so at the margins some will choose to go into technology or finance or something and make more money there.
When we fix the price of something below the market clearing price then there will always be a shortage. This is inevitable. We might decide that having a shortage of orthopedic surgeons is acceptable but let's not pretend that there are no trade-offs.
Germany has a stagnant economy so it's easy for their healthcare system to pay doctors lower wages because they have few other options. Baumol's cost disease is a real factor in healthcare, and it impacts the USA more than most other countries precisely because our overall economic growth has been so robust.
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What the US is doing is nonsensical. Modern Healthcare is an industrial system designed to handle large populations in bulk. But it only works if everyone can get timely access. This is true for things like mass screenings and medication.
The insane thing is denying it to half of the population doesn't really mean the other half gets to save that much money in real terms.