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Comment by hcarvalhoalves | Hacker News Reader

> If supply and demand don't set the number of surgeons, then who does?

Public policy. Have public education and graduate X number of doctors every year no matter what.

Free market doesn’t work well for essential services. Lobbying will artificially restrict supply to make more money at everyone else’s detriment. Demand for health is unbounded and any patient will value life over capital, so without forcing oversupply it will be exploitative.

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If there is an organization which is arbitrarily limiting supply, it is not accurate to call it the "free market".

Graduating X doctors per year seems like a much worse solution than allowing to graduate however many are willing to learn.

You can contrast it with the sciences

There's a joke that grad school and med school are polar opposites - med school is hard to get into and easy to get out of, while a PhD is easy to start and hard to finish

Being a postdoc sucks, and you have to be pretty willing to do something radically different than what you did as a student - but it isn't the end of the world.

I can't see a situation where it makes health in the US worse overall to increase the number of students.

There's no point in graduating more doctors per year if there are no residency program slots for them. We already have some students every year who graduate with an MD degree but are unable to practice because they can't obtain the necessary post-graduate training. We need to address that bottleneck first.

> no residency program slots for them

which is an artificial limitation. More positions can be generated easily, since there's a high demand for medical care and the costs currently are high to obtain medical care.

Until those residency programs have doctors sitting idle and twiddle their thumbs, the lack of position is just artificial in order to make it more competitive.

You appear to have a misunderstanding of the motivations and incentives here. The limit on residency program slots is not to make them more competitive but rather to hold down Federal government Medicare spending. If you want to help solve the problem then please ask your members of Congress to increase Medicare funding for residency programs.

https://savegme.org/

So instead of having one surgen work 100 hours, a novel concept might be 3 at 33.3 hours?

Surgeons have to complete the same amount of training regardless of how many hours they end up working per week after training. There is just no practical way to train three times as many surgeons: the teaching hospitals have nowhere near enough capacity.

In japan, they have large teaching hospitals where patients get treatment from several doctors, effectively free of charge, because you're paired with one senior doctor and several training doctors.

US teaching hospitals already have multiple residents delivering patient care under the supervision of an attending physician.

> if there is an organization which is arbitrarily limiting supply, it is not accurate to call it the "free market".

Free market is like communism: when it doesn’t work we can complain it wasn’t the true thing.

You're confused. Scandinavia has the same organizations that limit the number of doctors trained in the same way.

I think the people in the bread lines in the USSR may have disagreed.

You can go ask the people on the bread lines what they think today. There are 34 million people living with food insecurity in the US alone. A triumph of efficient resource allocation!

Nice, "food insecurity", sounds like a weasel wording of "definitely have food, hence the obesity epidemic, but not securely".

The USSR was very efficient at resource allocation. Those who "needed" the resources the most got it. Of the resources that existed, that is.

Socialists would love this system to return, as, in their narcissism, they consider it inevitable that they'll be chosen among those who "need" it.

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