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Comment by Moshe_Silnorin | Hacker News Reader

Healthcare will always be overpriced so long as we allow this guild system to limit the supply of doctors for its own member's profit. Everything else is window dressing.

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If that's the case then how come in other countries with similar strong unions/guilds healthcare costs are so much lower? Nobody complains the BMA is increasing the price of healthcare in the UK.

> Everything else is window dressing

I think most reasonable people can figure out a) the difference between the US healthcare system and nearly all other countries, and b) what that difference might mean for costs. Here's a hint, it's not "the guild system limiting the supply of doctors".

Coming from a country where the number of MDs per capita is 100x that of the US, I am sorry to tell you that this would not have the impact you think it would have. As of now, no first world country seems to have found a real solution to healthcare prices. My personal opinion is that doctor salaries have a minor impact on prices. Healthcare system structure and culture (as in how much do insurance companies control, and how readily you perform expensive tests) is much more important, I think.

YES. Salaries are not that high, either, for people in medical academia and now in HMOs as well. One can justify paying a neurosurgeon 430 per year - after 8 years of post-graduate training, and if you count college and medschool, that is 16 years. During all that time a future neurosurgeon mostly acquired debt, while working 120 hours per week.

According to the WHO the country with the most MD's per capita is Cuba with 7.5 per 1000, while the US has 2.5 per 1000. So at best you come from a country with 3x that of the US, not 100x.

Edit: http://gamapserver.who.int/gho/interactive_charts/health_wor...

Indeed, I was misinformed. The ratio is much lower than I thought. I think my point still holds, though.

You are asking me to believe that 2 in 10 people in your country are doctors? And accepting this, prices haven't come down?

I was told that the US had far less MDs than what is actually reported by the WHO. My bad for not checking my sources. However, we apparently have 40 MDs per 10'000. My main point was that doctors salaries have a minor impact on the cost of the whole system, and i think that still holds, though. If you calculate the ratio of the in-pocket sum that goes to the MD compared to the whole bill for a hospital stay, I do not think it is that high. So even if you are right about the guild problem, I don't think that makes it a solution. I admit I did not look at official numbers about that, though.

Guild systems do not inevitably resort to overbilling. They may resort to being overpriced but not to overbilling or lack of transparency in billing. I've not heard of doctor salaries being the reason for the U.S. spending far more per capita than other nations. It definitely contributes to this but my impression is that it is a very small part of this. Do you have evidence to the contrary?

Note that the same guild system is in force in just about every other country.

This is basic supply/demand. We have an increase in demand with the supply of doctors apparently staying stagnant. I think that's the point of this particular thread – not necessarily the billing issue.

Yep. The AMA/AAMC is essentially screwing the rest of the US so that they can keep doctors' salaries artificially high. There are tons of medical school applicants who get rejected every year, and not because they can't become doctors, but because medical school sizes have remained constant while the country's population (and demand for healthcare) has increased drastically.

The problem is not medical school spots, it's residency spots. Having medical school graduates is useless if they can't get licensed or board certified.

How is that a problem? About 130 medical schools graduate on average 100 MDs every year, that is 13,000. Available residency spots are near 29,000. so, the rest of the spots are filled by FMGs, foreign medical graduates.

My wife recently completed her residency. She has $370,000 in student loans. In order to pay off the loans she needs a high salary. The high salary doesn't go away once the school loans are paid off. It'd make a whole lot more sense for the country to just pay for higher education upfront. We'd be fine with her making half her salary and have the loans forgiven. It'd be much cheaper for society to do this.

Indiana, and other states, have programs that will pay for your medical degree provided you go to an in-state institution and work with the under served. Now the definition of under served, just means people with not enough doctors per capita. In the case of Indiana, this includes large portions of the inner-circle of Indianapolis. So you could work with a 30-45 minute commute inside the circle (465) and go home to lovely Carmel Indiana. You'd have access to a diverse cultural center and no loans.

While it doesn't help your wife, this information can help readers that either want to go into medicine themselves, or have family members seeking such employment.

You think that doctors profit from the current system? How exactly?

Applications to med schools have been down for the last few years, and the trend is worrisome. Your doctor-bashing stance is common but uninformed.

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