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Comment by zdean | Hacker News Reader

MDs also have the benefit of an artificial monopoly (vs factory workers) that I imagine will fight hard to keep its members employed.

https://www.cato.org/publications/policy-analysis/medical-mo...

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Calling medical education and licensing a monopoly is pretty intellectually dishonest. To borrow the OP's analogy, that is like saying drivers with licenses have a monopoly on driving. Seems like a pretty strange argument.

Certainly, the medical industry does not face the same competitive pressure from outside, but that is the nature of industry in general.

Rather than calling medicine a monopoly, it is more accurate to accuse heal care providers and practitioners of colluding to ensure prices are high. Monopolies by definition cannot collude since there would be nobody to collude with.

In the grand scheme of things, I believe medical costs are accurately priced and it is people's wages that are not adjusting correctly.

The AMA controls the requirements for licensing, the schools that can educate for the purpose of licensing, and the number of licenses that can be issued. Exactly what is intellectually dishonest about calling that a monopoly?

http://www.economist.com/blogs/freeexchange/2007/09/a_spoonf...

> To borrow the OP's analogy, that is like saying drivers with licenses have a monopoly on driving.

Not so, as the number of medical residents is de facto set by Congress (due to how the funding system works), thereby limiting the number of doctors in each specialty.

If local production capacity is too low, why not import them?

> that is like saying drivers with licenses have a monopoly on driving.

The critical difference is that there's no limit on the number of people who can get standard driver's licenses, but there is on medical licenses.

It's not just the AMA directly, though. Residencies are funded federally, I believe. I'm pretty sure the numbers per specialty are centrally controlled, but I'm not certain how the process works. And I don't know who limits the medical school slots, but I'm under the impression medical schools can't just increase the number of students at will.

All that being said, keeping the supply artificially low probably has some benefits.

like saying drivers with licenses have a monopoly on driving

...if drivers got to set the test standard and pass rate.

Any system where they control entry not just by a passing threshold but by raw numbers or on a curved exam scale is a monopolistic regime. They aren't just looking for people who can pass the test and meet qualifications but to keep a throttle on numbers.

I agree with both sides here. AMA protectionist? Yes. Absolutely. That is their #1 goal even if they don't write that one down.

But I'm not sure opening up the gates is exactly what we want either. There are countless examples of charlatans trying to push the line here, and as a consumer, it would be too difficult, especially while fighting a serious disease, to tell who can really help me and who just wants my money.

There are better ways to make healthcare more affordable and more effective than to throw away the idea of proper certification.

For instance, some states (like the one in which I live) have granted more powers to nurse practitioners. I support this move.

How about I can go pick up my asthma medication without a 6 month visit to verify for the 1000th time that I do, still indeed, have asthma? The only purpose for that is so the physician can bill my insurance company. It wastes both my time and money.

That is the fault of the United States health insurance industry blocking attempts at universal single-payer healthcare and turning Medicare into a privatization scam. Blaming the AMA for that is completely misguided.

We have single player in Canada and it's even worse. I have to book one appt to get referred for a blood test, another to take the blood, and then another appt to get the results!

There's even a big sign at the doctors office that says "only one health issue per appointment". Why? So they can scam the system for more cash.

> We have single player in Canada and it's even worse.

Do you have any experience with the US medical system? I lived in Alberta for 7 years and in Quebec for 3 (important to note because it is hard to take you seriously since you did not even mention that healthcare is provincially administered in Canada).

> I have to book one appt to get referred for a blood test, another to take the blood, and then another appt to get the results!

Here is an alternative explanation to "doctors are incompetent scammers": you need a referral for a specialist so that specialists are not overwhelmed with requests from hypochondriacs who read something on the Internet. Once the test results come back the doctor wants to see you to explain the results and recommend further treatment. That saves everyone time and money and is the opposite of "scam[ming] the system for more cash."

The "one health issue per appointment" is not a government policy, it is a policy that some physicians have so that they can see more patients each day.

It was a standard STD test at the beginning of a new relationship and the results were negative so it was clearly a scam. This was in Ontario.

> the results were negative so it was clearly a scam

Great use of logic.

I still do not understand why you are blaming the general practitioner clinic for referring you to a specialist. If you want same-day STD testing there are a lot of private test centers in Canada. For example, top Google search result: https://www.stdcheck.com/canada/

It's obviously a scam to call me in and bill the government $50-100 to read me my negative result in person. I don't understand how you can defend this practice.

Is there an option to get results online?

That's been available here/US and it has come in handy.

A single payer system significantly throttles what physicians can charge. They are paid per visit, so you do get this kind of behavior.

If you look at the average earnings, Canadian physicians make ~320K gross salary [1], but they need to pay expenses out of that (reception staff, office, etc.). They do well, but they are not in strata of hedge fund managers.

We should probably just pay them a flat rate, but on the balance the Canadian system is much more cost effective than the US free market system.

[1] http://globalnews.ca/news/2898641/how-much-is-your-doctor-ma...

Why would insurance companies want to pay for more visits than medically required?

Insurance companies trying to avoid paying doctors is exactly the problem - today, in order to get reimbursed to even break even doctors in the US are forced into overcharging:

https://www.youtube.com/user/davidbelk46/videos

So because doctors feel that they are not compensated fairly that justifies them using the legal system to stand between patients and lifesaving medications of their own financial benefit?

I guess doctors don't believe in the free market.

Replace "doctors" with "US health insurance companies" and you have a true statement.

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