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Comment by Accujack | Hacker News Reader

>Deregulate medicine. The AMA restricts the supply of Doctors way too much to achieve $500,000 salaries . .

This is a stupid conspiracy theory. A very brief check shows the average salary of a doctor in the US is less than $200k annually. The AMA does not have the authority over licensing of doctors to restrict anything.

Deregulating medicine can easily be shown to be a disaster in the making... since the Reagan years, regulations on health care have been relaxed like most other limits placed on corporations and it's led to poor quality care, the highest health care spending in the world, and rent seeking middlemen pocketing billions.

Health care in the US needs to be a government provided single payer system.

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Well, the conspiracy has an office on Michigan Avenue in Chicago, a couple of hundred employees and a nice website. It's the Accreditation Council for Graduate Medical Education. They control accreditation for medical residencies, including the number of doctors that are allowed to graduate from each accredited program each year, and in what specialties.

Until 2014 there was some competition in this with Doctors of Osteopathy, who had their own residency accreditation, but then they merged them, presumably so that they wouldn't start cranking out a bunch of DOs and devalue the profession.

This is not the AMA directly, but the AMA is one of the members of the ACGME.

>This is not the AMA directly, but the AMA is one of the members of the ACGME.

As they should be. The largest association of doctors in the US SHOULD have a say in what constitutes a standard medical residency program in the US.

The idea that health care is expensive because hidden organizations are limiting the number of doctors in the US is a stupid conspiracy theory, period. Health care in the US is expensive because of out of control corporations that have been less and less regulated by anyone in the past 50 years.

They explicitly limit the number of residencies. You only get the number of slots they say in your residency program.

This is just like calling OPEC a stupid conspiracy theory.

Residency slots are limited by federal government funding, not the AMA.

Why would the federal government and its budget have commanding influence over programs that are run by for-profit corporations?

They’re largely non-profit, but they’re still large businesses that happen to lack shareholders.

You went from "it's a conspiracy theory" to "it's true but this is the way it should be"

No, I did not. The mentioned organization establishes standards for residency programs. Just because the AMA participates does not mean they're "in control" of slots in residency programs, and in fact that organization itself does not control slots available.

You shop at a drugstore, does that mean you're part of the Big Pharma cabal?

That's the way with all conspiracy theories but it's usually longer than an hour for the about-face to happen.

The health care market needs functioning price signals regardless of who is paying. The fact that most providers cannot tell you up front how much something will cost should be plainly illegal. Providers charging different prices depending on who is paying should be plainly illegal. Fraudulent billing that displays a huge fake price and an "adjustment" should be plainly illegal. You can't point to regulations having been relaxed as an indication of much, because it's exactly the wrong regulations that have been removed, while the corrupt-entrenching ones have stayed - "insurance" companies forming cartels of "provider networks" should be blatantly illegal on anti-competitive grounds, but was seemingly viewed as a mechanism of competition back in the 80s or 90s and enshrined into law!

Furthermore speaking from personal experience it's not like Medicare is some panacea of needing care -> getting care. That system is full of its own rules limiting what it'll cover, reams of paperwork to justify things as medically necessary, etc. It only seems better because everyone is used to dealing with it and denials seem less opaque, but it's still ultimately rooted in top-down paternalism and controlling care, rather than patient-focused incentives.

Agreed. The idea of "medicare for all" was a half step that was attempted because it was deemed to be more politically saleable than "socialist" health care to very partisan voters.

Expanding the present medicare system without massive changes not only be likely to decrease the quality of care but would be horrifically inefficient.

The US needs a rework of its health care system from the Federal level down, probably using something like the South Korean system as a model (which notably is NOT socialized medicine).

Let's hope the single payer isn't Medicare then, because you would have a lot fewer hospitals. Here's the money quote straight from the horse's mouth "In 2021, Medicare’s payments to hospitals continued to be below hospitals’ costs in aggregate" https://www.medpac.gov/document/march-2023-report-to-the-con...

Medicare and Medicaid are subsidized by a shadow tax on working people. Commercial insurance, like the majority of readers of this website get through their employers, pays roughly double the cost per procedure as Medicare and Medicaid. Your health premiums would be lower if we all paid the same price, but your taxes would be higher.

Extending the current medicare system to simply cover everyone would be a stupid thing to do. Anyone involved with the problem knows that more changes are needed than to simply open the floodgates, and assumes that it will take a lot of work. I don't know why you don't understand that.

>Medicare and Medicaid are subsidized by a shadow tax on working people.

Straight out of the GOP list of talking points. Are you upset that your "hard earned dollars" are going to people who don't deserve them?

>Medicare and Medicaid are subsidized by a shadow tax on working people

It's right there on the damn W2, how is that a "shadow" tax?

>Commercial insurance, ..., pays roughly double the cost per procedure as Medicare and Medicaid.

And also every other developed country! Why is "the average american or their health plan pays double everyone else" a good thing?

>Your health premiums would be lower if we all paid the same price, but your taxes would be higher.

Also laughable. Somehow our citizens pay way more than anyone else in the world, and largely don't have better life expediencies (women giving birth in america die shockingly often!). We pay more into private healthcare systems than the rest of the world pays into public systems.

If the costs are too high, you need a combination of cost controls and increased supply, not more funds to throw into the furnace. You also cut out as much of the admin as possible, as that is very low value spend vs delivering care.

I like taxes, with them I buy civilization. I want my taxes to go up, and my medical premiums to go away. Covering everyone is simply more economically efficient in aggregate vs the current Rube Goldberg system design, where the US spends more on healthcare than every other OECD country for worse outcomes.

I'm not sure that salaries tell the whole story. A lot of doctors are also part-owners of the clinical businesses. The company that provides my care is doctor owned. I've read that the malpractice insurance business is also largely doctor owned.

You should read more and expand your sources of information.

Here's a place to start... a list of the top 10 hospital systems in the US:

https://www.definitivehc.com/blog/top-10-largest-health-syst...

Hospital systems are mostly following the same path as other corporations have, merging and acquiring until there are only a few dominant firms, at which point those firms will have the market in a death grip.

There are clinics and small partnerships where doctors are part owners, but they're a tiny minority in the US. For the most part, to be a doctor in the US you have to have admitting privileges at a hospital.

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