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Comment by Am4TIfIsER0ppos | Hacker News Reader

Americans keep telling me that their medical system is grossly unregulated so how can that be?

FYI the government here directly sets the number of spaces available for training doctors, dentists, and veterinarians and still complains that there is a shortage.

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The medical system is not grossly unregulated. It is not centrally regulated in DC though there is a lot of regulation from there. It is states and localities that regulate it. For example, in some places, a medical professional can add an MRI without much more permission than safety concerns. But in most places, it needs to be negotiated with the various hospital systems, etc. This obviously drives costs up. Ambulance companies need to get permission from other ambulance companies to add an ambulance. These are just a couple of the examples I have come across, but I am sure there are many other examples.

Government in the US pays 60% of the medical costs in the US. State licensing applies to all levels of healthcare, not just doctors. Doing minor in home care requires some kind of nursing credential with a supervising doctor-type.

The common experience of patients is that they are interacting with private health systems and insurance companies. These systems are grotesquely obscure with prices and it feels like one is being fed to the wolves of capitalism unlike in almost any other market experience in the US. This makes it feel like it is unregulated. But, of course, this can only happen because the government has, by force of law and gun, created a medical cartel, limiting options, prices, and divergent practices.

The AMA, a professional guild (and convicted monopolists), set the residency cap in the USA, not the government.

To be accurate the US Congress set the cap. The AMA lobbied for it.

Some would say it's over-regulated. In either case, there is certainly a large amount of unhealthy regulatory capture that benefits private companies.

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