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I'm from Chile (and still live here). I don't know where you got the idea that anybody whot wants to be a doctor can go to a medical school without much effort. Medicine is by far the most exclusive career that you can apply to, they're always the highest scores in our version of the SAT (you can check the scores that are needed for one of our universities here https://www.uchile.cl/admision-y-matriculas/admision-regular...). There are some private colleges that have a lower entry barrier, but they're still far and above the rest of the careers that you can apply to. Their salaries are also ridicously higher than the rest of the population, our minimum wage is 462 USD$ and a doctor can make easily 20 times that amount (and if you're a specialist you can make way more than that). Obviously there are some cases where a doctor can earn less than that, but they are in no way or form just another professional.

Yes, there are plenty of people who would work in the medical field not necessarily for the big pay but because of their calling, to care for the others. A lot of these people can't make it through the med school gauntlet and don't want to risk their mental health while in med school. Plus the crazy and insanely school loans... It's a system that disincentives the people with a calling and instead is replaced by people who can put up and have a stomach for a very complicated and inefficient system. While hospitals are run by MBAs this problem will not go away.

Yeah but compared to American medical schools? Whole different ball game.

10x cheaper, and longer life expectancy.

> The basic solution to make medicine cheaper is supply more medics.

It's shocking how little this is talked about... This is so obviously the root of the problem. People like to blame the free market but there is no free market in medicine. Corporatism is to blame for artificially restricting the supply of doctors and artificially restricting who is allowed to render medical services, both of which benefit the corporate members, the doctors. Of course, those anti-competitive measures are always sold under the guise of protecting the population.

Actually the primary bottleneck in the supply of new doctors is lack of federal (Medicare) funding for residency slots. Every year, students graduate from US accredited medical schools but are unable to enter clinical practice because they can't get matched to a residency program. Ask Congress to increase funding.

https://www.ama-assn.org/press-center/press-releases/ama-fun...

Using an AMA source is disingenuous since it’s a professional cartel with a massive vested interest in keeping doctor supply as limited as possible.

But they are arguing in the source for more doctor supply?

They are blaming the lack of supply on something they don't control. There's a subtle difference.

Do you have a substantive comment to contribute or are you going to stick with baseless low-effort snark? The comment I posted is true and correct. You could verify it with other independent sources if you bothered to do any research.

Yeah sure.

Fighting residency expansion: http://www.usatoday.com/news/health/2005-03-02-doctor-shorta...

Fighting expansion of care to other types of practicioners: https://www.ama-assn.org/practice-management/scope-practice/...

Why would you believe the AMA's line on this? Do you think the professional association that represents all doctors, one of the highest paid and influential professions in the country, has no power to control the amount of residencies are funded by the government? They have no reason to increase the number of doctors, absolutely none. They benefit in every way from having constrained supply.

The AMA is literally lobbying Congress to expand residency program funding, and even putting their own money into it. Did you even read the article?

Yes - they're lobbying now to reverse caps they themselves[1] helped put into place, and like I said, have also limited primary care availability by lobbying against the ability of NPs and PAs to provided basic medical care. It's a complete bunch of talk until they get change done.

By the way, that expansion of 15000 residency positions barely puts a dent in the number of doctors we are lacking[2]. But yeah, a press release from 3 years ago really absolves them of guilt for sure.

[1]: http://www.cnn.com/HEALTH/9708/24/doctor.glut/ [2]: https://www.washingtonian.com/2020/04/13/were-short-on-healt....

An article from 17 years ago reflects the PoV at that time, not today. The AMA has had different positions based on what they thought was best at the that time.

If they cared about expanding access to medical care they'd stop lobbying to prevent PAs and NPs from providing care. A half hearted attempt to add a paltry amount of residencies after 30 years of lobbying which led to the state we're in now does not absolve them of blame.

How does that make any sense? Aren't student graduates actually paid to do those residency programs? If it's too expensive to train them, can't they take a pay cut? How come no other profession requires federal funding for placing/training graduates? Makes absolutely no sense unless you uncritically accept the status quo.

Residents are paid an average salary of $64K. That's less than many entry-level STEM jobs, and they often work up to 80 hours per week. They can't afford to take a pay cut. And hospitals incur other costs for running residency programs which go beyond paying resident salaries.

Most other private sector professions don't require nearly as much postgraduate training before being allowed to work. Prospective lawyers usually take the bar exam less than a year after graduating from law school. Medicine is simply more complex.

What would you propose as an alternative to the status quo? The AMA has proposed a number of improvements, but perhaps there are alternatives?

https://savegme.org/

Even if they supply of doctors was infinite, there is still the problem of demand being basically inelastic. What would the incentive of healthcare providers to lower prices? Inelastic demand means there is no incentive to lower prices, because there is no where else for someone to go and comparison/price shop. If you are hit by a bus, there is no ability for price negotiation to get healthcare.

Also blaming "corporatism" is basically just a meme at this point, because it is just used by libertarians when someone criticizes capitalism. Its the same when communists say "true communism has never been tried".

> What would the incentive of healthcare providers to lower prices?

In case of life or death emergencies, your insurance or ambulance driver would send you to a reasonably priced doctor, and doctors that charge unreasonable prices would go out of business. But my guess is that life or death emergencies do not account for most doctor visits.

> Also blaming "corporatism" is basically just a meme at this point, because it is just used by libertarians when someone criticizes capitalism. Its the same when communists say "true communism has never been tried".

Well, I don't feel like arguing about semantics. Feel free to call the problem I described however you like.

So for life or death decisions, the ambulance driver would first go on some price comparison website or ask the insurance and see "ok, this person wants a doctor in the $10,000-15,000 range, the closest of which is 30m away. The hospital next door costs at least $50,000 minimum, so we will not send them there for life saving medical care." And what incentive would insurance have to send me to a reasonably priced doctor, when they can send me to one in their network which is more expensive but means they keep more money? Also, they could send me to an expensive hospital and then just not pay out. These are both things Obamacare tried to fix [0]. Insurances want to maximize profits, which means paying as little as possible themselves and extracting as much as possible from customers. Your system would only work if insurances had to always pay 100% of medical costs and could never deny care, which is similar to how it works in Germany (at least for some baseline level of care).

Again, what incentive would there be to lower prices? New doctors could just be bought out and the prices jacked up. There are a lot of industries where there is little barrier to entry (for example tech), where the big companies just buy anyone trying to "get in on their territory".

Also, why would the "unreasonable prices" (what would that even look like?) doctors go out of business? They could just provide some kind of "luxury deluxe" ("no poor people here") state of the art care for people who can afford it.

[0] https://www.healthcare.gov/health-care-law-protections/docto....

No, very quickly everyone would know the hospitals that charge way more than the others, and not patronize them.

Emergency services are only like 5% of costs, anyway [367]:

> The percentage of U.S. health spending attributable to the ED has increased from 3.9% (CI, 3.9%-3.9%) in 2006 to 5.0% (CI, 5.0%-5.0%) in 2016.

So the other 95% is more flexible. I know when looking at birthing costs they could vary wildly but it didn't really matter because who cares, they're all in-network anyway.

[367] https://journals.plos.org/plosone/article?id=10.1371/journal...

It feels like you don't understand or don't believe in free enterprise in general, not just when it comes to medicine. All the theoretical issues you mention do not actually occur in industries that are closer to a free market.

There is no cost problem in "tech". In fact, many services are literally free of charge. Despite Google having a near-monopoly on search, it is unable to charge users for it. Demand for software developers has grown massively in the past decades and yet, wages have only slightly gone up.

Anyways, I didn't mean to start a debate on the merits of free enterprise. I was hoping that we could at least agree that artificial limiting the supply of doctors causes medicine to be more costly, regardless of the economic system.

I understand just fine, I just don't share the naive "invisible hand" narrative. I think there are a lot of places where free markets make for better products and services, but not all products and markets are fundamentally the same, so I believe the same prescription of "just remove all limits to a free market -> all problems solved" does not work everywhere.

But Google can charge their "actual" users, i.e. advertisers quite a bit, and it is much harder to do any advertising without also advertising on Google Platforms, such as Search, Maps, Youtube, Adwords, etc. The wages may have only slightly gone up, but the profits definitely have gone up quite a bit, which shows that amount of workers and their pay has little to do with how much money can be made (which I believe is perfectly fine, because tech is not a place where I think free markets create a detriment to society).

I don't want to start a debate on free enterprise in general, just to show that free enterprise is not a once size fits all solution. My argument was just that the supply of doctors has very little to do with the price of medicine, because the market forces that determine price and can lead to lower prices in some markets do not work correctly in this market.

Their analogy is bad, and it’s valuable to call out the nuance.

The statement is a reaction to blaming free market economics when the reality is a scenario of the opaque third party payer system in a highly regulated environment. Consumer gets no price transparency, state regulatory boards made up of current market suppliers control market entry - say what you want about it’s appropriateness but the US medical industry hardly resembles a free market.

“Corporatism” may be a ham-handed way to call this out, but it’s not helping society to lay the medical industry’s problems at the feet of capitalism. This problem of cronyism in markets (especially) exists in communist economies as well. It’s throwing out the baby with the bath water.

> Charging for saving lives. Price discriminating to save lives.

Most first world countries have a solution for this already. It is baffling that the US does not.

>Most first world countries have a solution for this already.

Even second and third world countries have implemented this solution.

Part of the cost is equipment, too. Have you seen the regulations that medical equipment must meet? And the certifications that equipment requires? I’m not talking about big ticket items like MRI machines. I mean just blood pressure cuffs.

I promise you, Canada and Germany and Chile and France also have MRI machines and blood pressure cuffs.

Canada doesn't have enough MRI machines. Wait times are long and increasing.

https://www.fraserinstitute.org/studies/waiting-your-turn-wa...

All healthcare systems impose some sort of rationing. Canada rations care by imposing long queues for non-emergency cases, with significant variations between provinces. Affluent Canadians frequently travel to the US as medical tourists and pay for treatment out of pocket in order to skip the lines.

There are also major differences in MRI scanners. A 3.0T unit can produce higher resolution images than a 1.5T unit, and this makes a difference in patient care quality. Countries like Chile are more likely to have the cheaper units.

https://doi.org/10.1097/rli.0000000000000801

Well I’m waiting in the US. Appointment times for a dermatologist are out to 6 months earliest.

The Fraser institute is a libertarian think tank so even if their data is right I don’t trust their conclusion. So what if 3% of people are waiting on a procedure? This needs to be apples to apples compared to other countries, per capita healthcare spending, life expectancy before drawing conclusions

Funny, I do the same thing, medical tourism in Chile. Like all Hispanics. We all get all medicine in Latin America, never in America, to the extent it's avoidable. It used to be the other way around, like I knew a kid who kept traveling for medical tourism from Chile to America because he had a rare heart thing, rare disease.

There should be flying ambulances, like international flights taking emergency patients to where they can be treated economically instead of getting signature after signature squeezed out of them, one per hour starting inside the ambulance.

> Affluent Canadians frequently travel to the US as medical tourists and pay for treatment out of pocket in order to skip the lines.

This is exacerbated in the US itself, where only the top 10% have access to expensive and timely medical treatment.

I would argue that, at the very least, Canada does offer medical treatment to everyone.

There's old ways to take blood pressure that haven't been expensified by American medicine.

> "Lowest medicine costs in the OECD, blows every other developed country out of the water. America is the most expensive and Chile is the cheapest."

I just happened to have this RAND corporation ranking of "most expensive insulin in the world" from 2018 handy; America is first, Chile is second.

https://worldpopulationreview.com/country-rankings/cost-of-i...

Looking at this it’s mind boggling how much the US is being overcharged vs all other countries. How are Americans putting up with paying 400%-900% more than any other country?

It's not "putting up with". What are they going to do otherwise, not take insulin?

Demand action from their representatives. Works in a lot of other areas but not in health care. I guess the lobbies are too strong.

Those so-called "representatives" created the problem in the first place by restricting the supply with drug patents, FDA regulations, import restrictions, and limitations on the number of new doctors and medical facilities, and now you want to "demand action" from them on behalf of patients? Good luck. They're representing someone all right, but it's their donors, not their official constituency.

That, BTW, is a consequence of the system responsible for selecting and influencing those in power and not any particular individual, so voting in someone new won't change anything. And that goes for much more than just health care.

OK yeah the medication is expensive, the pharmacies are rigged. Farmacias Ahumada, Farmacias Cruz Verde, and Salcobrand are three divisions of the same single...trust, basically. The Chilean pharmacy monopoly. Enforced with eg intermarriage. However, now there's lots more pharmacies, it's opening up. And I am personally boycotting Cruz Verde in almost all circumstances because I saw a shill of theirs (a real life shill, not on a forum, in a brick-and-mortar retailer) shilling for Cruz Verde[1] at a pharmacy that actually competed with them. There's some.

But I don't know, did you try the municipal pharmacy in Recoleta? Way cheaper.

[1] Note for admins: this is not the same as calling someone a shill on the forum, I went and gave my account and signed an affidavit in the complaints and suggestions book, with the help of the guard who also witnessed the shill, and backed by a third witness who conversed with the shill like I did. I told them by all means use this in court, I'll vouch on the witness stand, and I'm doing this with the same moral authority and motivation of being a hero according to Roman Law, in a very similar set of conditions that led to my actions and consequent recognition as a hero by the victims in the spur of the moment, ten years ago.

Chile might have cheaper healthcare, although I doubt it, but that's completely obscured by their health insurance. They copied the US health insurance racket almost perfectly, and that's what needs fixing much more than healthcare costs.

The only real solution is to completely abolish privatized healthcare. No more discrimination between the poor and the rich when it comes to something as critical as that. When everyone has to row the same boat, then the rich will finally have a good reason to make sure the poor don't drown.

EDIT: I don't remember Chile having that much cheaper healthcare, either. I lived there for 14 years and it was just as much of a constant drain on my salary as it is here in the US. And those who couldn't afford good insurance were pretty much screwed, just like here in the US. And the real costs were buried deep and obscured by insurance waffle, just like here in the US.

> Doctors say they are the only profession that saves lives...

Yeah. Because rescue workers, fire fighters, EMT's, nurses, etc., etc. don't count. (As if the ways in which America's medical establishment treats those people didn't make that obvious enough. And the alpha sociopath in the room always deserves 100% of the credit for anything good happening...right?)

My impression is that other countries (ones not poisoned by the AMA) don't have this particular problem nearly so much.