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Comment by bad-joke | Hacker News Reader

> If the subsidy were eliminated and insurance untied to employer you would have a huge step in the direction of unleashing market forces.

That's exactly how things were in the 1930s. Healthcare was unaffordable to the degree of public outcry, which is why universal healthcare legislation was introduced repeatedly and stifled by the AMA every time. In fact, early health insurance programs were designed to bypass pay-as-you-go medical fees because they weren't meeting the needs of the hospital or patients. It wasn't a tenable system.

It seems we're regressing.

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In 1930's the national spending of healthcare was like 4% of GDP, while now it is like 17%. If we could go back to the 1930's on that I'd take it.

The problem is not that the AMA was able to attack socialized healthcare, but that the AMA was able to dictate who would be able to practice medicine, what their education should be, how much they should charge and how they would organize.

Any american could go abroad to a country like say, Argentina, get free medical education and come back and treat patients without half a million dollars debt. But its illegal.

We live in an aging society, so the GDP metric is misleading.

Although, we certainly do spend irrational amounts on healthcare, partly because consumers don't bear consequences for going with the pricey procedures.

There's also numerous layers of regulatory capture, artificial scarcity, and rent-seeking in order to protect various industry-wide or regional cartels. The combination of that with consumers who have no reason to care about price is a potent recipe for price gouging.

The AMA is one of those. Hospital associations, medical device associations, phamaceutical associations, electronic medical record companies, and so on all take their cut.

The idea that debt is limiting the number of doctors is laughable.

I think public investment in educating medical providers is too small (it shouldn't be profitable to wrap a provider in like 5 people...), but doctors that aren't total fuck-ups are doing great by the time they are 45. We are likely in a supply constrained situation right now, prices would be nicer if there was excess supply.

Are you sure it's illegal? Like 80+ percent of the doctors in my metro area got their degrees in India (where they immigrated from). There is some form of reciprocity going on.

I don't know what india has, but i can assure you that India's doctors would all emigrate to the US if they could work as a doctor there.

Foreign doctors still need a US residency. The number of slots for residencies is capped. I could imagine a world where the US signs reciprocal agreements with EU countries to honor their medical professional training without a residency. I cannot imagine the same for India or Argentina.

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