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Comment by analog31 | Hacker News Reader

So it's a step towards a complete policy. What is the complete policy? Granted we might not see it enacted now, but it would at least clarify where the administration was headed.

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Increasing supply of doctors by increasing residency funding, decreasing education costs, and decreasing the sacrifice that needs to be made to become a registered doctor.

I have no idea why doctors need to sacrifice their entire 22 to 30 year old lives constantly slaving away, working on call, sometimes 24 hours at a time.

Relax some of the draconian, outdated hazing rules. Attract more smart people, make it so young people can have lives and become doctors.

That might address the cost of labor. The cost of medicine on the other hand is simple, the government should be funding research into medicines and then offering it for sale at basically the cost of production. Only other way is to reform patents and whatnot, but it seems easier to just do the research with the top tier research facilities the US already has via the higher education system.

There’s probably some other issues such as tort reform and medical equipment costs that need to be address too. But I think all prices can be brought down by increasing supply.

Indeed, bringing down the cost of med school might also have the effect of attracting people with a working class background, who see it as a form of labor, not as a return on an investment.

I'm not sure what the impact of tort reform would be. It's possible to look up how much is paid in premiums, but we don't know who owns the malpractice insurance industry, and I've read that it's doctors.

There’s two costs to the US legal environment: Insurance premiums and defensive medicine. It’s in the doctor’s interest to run every test because it’s free to him, but failure to do so raises his risks. So you wind up spending money non-productively and you have a non-zero rate of false positives, unnecessary treatment, etc.

Interestingly, I think they may be bringing that cost under control. I had an injury recently, and it took 2 trips to the doctor (each one with a fee) before they agreed to do a cat scan (with another fee) and find out what was actually wrong with me.

100% with you on the idea of increasing the supply of doctors and shortening medical education.

My dad is an ophthalmologist and he does basically 3 surgeries that take up most of his work time: LASIK, cataract surgery, and cornea transplants.

Was it really necessary for him to do 13 years of schooling to learn how to do those 3 surgeries? I really don’t think so. I feel like we could train doctors in about 6 years (2 years of focused medical training + 4 years of residency / apprenticeship with a practicing doctor). If we’re honest about what doctors are learning, they would have about the same amount of time learning about their actual specialty compared to now, without so many hoops to jump through.

The current system is a cartel that must be reformed.

We also should consider international competition. There are competent doctors in India who could do expensive surgeries like hip replacements for 1/10 the cost AND get better results than the average hospital in the US.

At least we could sell health insurance across state lines...

The AMA effectively controls the number of Doctors. They do this by limiting the number of accredited Medical schools and the number of students those Schools can accept. This is primarily to artificially drive up salaries.

The current tax code incentivizes insurance as compensation, which drastically distorts the market. The ACA made things even worse by introducing the individual mandate.

Indeed when ACA was passed, it was acknowledged that it was intended to reform access to health care, not the cost of health care. It was a compromise that appeased the insurance industry.

The ACA made things better than they were by eliminating maximum benefit amounts, implementing out of pocket maximums, implement maximum age rating factors, and removing all pre existing condition clauses guaranteeing access to healthcare. The individual mandate ensured that all of these increases in access to healthcare could be paid for by forcing young and healthy people to pay premiums. Without the individual mandate, premiums would have had to be even higher, causing even more people to not buy insurance, etc.

That the tax code was not updated to remove the tax benefit for employers, or give it to individuals is a shortcoming (and has long been a handout to big businesses prior to ACA). What really needed to happen was forcing everyone into healthcare.gov onto a single marketplace so healthy lives wouldn’t be locked up in employer sponsored risk pools. Then the costs would truly be shared across the whole population, and sufficient healthy lives would exist to enable multiple insurance companies to compete.

Or we could have gone with taxpayer funded healthcare and made it all simpler. But that obviously wasn’t in the cards.

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