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This analysis in the end doesn't show what it claims to show and actually proves the reverse - US Health care spending is much larger than other countries, it eats up significant fraction of productivity gains in other sectors (rises faster than income as shown by the 1.8 slope in the very first graph), and does not lead to better health outcomes. It actually proves we would be better off if we spent less and focused on lifestyle.

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> US Health care spending is much larger than other countries

The thing is that in USA (and Canada) radiologist compensation went from 300k/yer to 500k/year over the last 10 yeas. It's the same radiologist. While spending is growing quantity of doctor per population is diminishing.

In USA/Canada there is cartel enforced cap on how many new doctors can be minted per year, and this cap is not even scaling up with the population growth.

The immediate limit is a government (Medicare) funding cap on the number of residency (graduate medical education) program slots. At one time the American Medical Association lobbied to put that cap in place but they reversed course years ago. Congress still hasn't acted, and so every year there are some students who graduate from medical school but are unable to practice.

https://savegme.org/

What I could never understand is why government funding is needed for residency spots in the first place. From the outside, it seems like residents are cheap labour for hospitals. Even without getting any money from the government, the value of residents' labour should exceed their relatively small salary—so hospitals should be incentivized to hire many more residents. What are the economics (or regulations) of residency that make this not work?

It's tough to get an accurate sense of the economics of teaching hospitals. Much of the analysis comes down to highly subjective management accounting decisions about how to allocate fixed costs to various cost centers. Residents (especially the junior ones) require a lot of supervision by attending physicians, and much of that work isn't directly billable. The fact that those hospitals aren't rushing to voluntarily take on more residents indicates that the programs are net losers without government subsidies.

Wife is a doctor at a Miami suburb hospital (it's relatively well known), so I can tell you with confidence that the hospitals CAN absolutely pay $64K/year salary of residents on their own. It's just that they are cheap and do the bare minimum.

But yeah, AMA should stop requiring 8 years of education + 3 years of residency to become a garden-variety doctor. I can look up UpToDate, which most doctors and residents do, to diagnose and treat myself for most common illnesses IF I can purchase medication from pharmacy on my own.

The costs of employing a resident are a lot more than just salary, but as I noted above the numbers are kind of fuzzy. Certainly most teaching hospitals can take on a few more residents but would mean less money for a new MRI machine or administrator salaries or charity care or nice landscaping or whatever. So it's a matter of priorities. For better or worse, most organizations are always going to do the minimum.

There are a few colleges now offering accelerated 6 year MD degrees so hopefully that option will become more common. A lot of primary care is also being picked up by physician assistants who have less education.

> In USA/Canada there is cartel enforced cap on how many new doctors can be minted per year, and this cap is not even scaling up with the population growth.

This. The primary purpose of the AMA is to prevent doctors from existing and providing care, all in order to drive up their wealth and status.

Korea has a similar problem right now, their doctors just flexed their power to gain the upper hand economically[1].

[1] https://www.npr.org/2024/09/15/nx-s1-5113082/as-medical-stri...

You should be very careful with this narrative. It invariably concludes that the market should be flooded with doctors. They are minted by medical schools, so naturally the mechanism to flooding the market involves opening more of them and dumbing down the graduation requirements.

I live in a country where that exact process is happening right now in real time. It's not pretty. The level of charlatanism and straight up incompetence in this country is off the charts. There are people graduating medical school right now who don't know how to diagnose a heart attack, let alone treat it. And these are the people manning the emergency services. Because wages were driven down, no doctor worth his salt is gonna accept that job. Why work in some shithole hospital when you can be a dermatologist? Emergency services turned into "reassigned to Antartica" tier jobs only failed doctors put up with. I don't even want to think about the number of people who are dying as a result of this.

> They are minted by medical schools, so naturally the mechanism to flooding the market involves opening more of them and dumbing down the graduation requirements.

Nope, in the US we have an extra filter that takes perfectly good med school grads and throws away a large fraction for no good reason other than their bad luck in not getting into a residency program. These are people who passed four years of quite rigorous medical school at great expense, and we effectively ruin their lives (and create artificial health care shortages) by denying them careers arbitrarily. In the US it doesn't matter if you're in the top 1% of the graduating class in the best medical school in the country: if you don't get into a residency program (required before you can be an MD) your medical career is over before it begins.

Even if we did nothing but guarantee a 1-1 relationship between graduates of our medical schools and residency program seats we would have more doctors and would not be watering down our talent pool of doctors one iota.

On the other hand, the medical school admissions process in Canada has become such a pissing contest between people who are extraordinarily high achieving. I don’t think the difference between someone who got a 99th percentile MCAT and a 95th percentile MCAT will ever make a difference in patient outcomes.

10 years ago radiology residency spots were going unfilled in the usa. Now there aren’t enough radiologists. but if chatgpt can do radiology in 10 years, once again residency spots will go unfilled or worse.

> It actually proves we would be better off if we spent less and focused on lifestyle.

Speaking purely anecdotally, I can 100% get behind this. I live in a more rural area, work outside regularly, and a large majority of what I eat is either grown locally (without pesticides/herbicides) or I grow it myself. I haven't been to a doctor in 7 or 8 years and am in better shape, and feel better, than I ever have.

Its amazing the difference fresh air, fresh food, and time working in the sun and dirt can make.

How old are you?

I work from home, sit on my ass all day, love to eat processed foods and also haven't been to the doctor in 7+ years but feel great. But I'm (just) under 40.

A lot of stuff doesn't catch up to you until you're older.

I'm also almost 40.

It absolutely could make no difference in the long run, though I do know quite a few people in our age group (including siblings) already dealing with an assortment of health issues, regular doc visits, medications, etc.

I’m 51 and I’m healthier than I was 20 years ago because I improved my nutrition and started moving my body on a regular basis. I go to the doctor about once a year for a physical and I actually had a provider tell me recently that she rarely sees someone my age as healthy as I am.

I’m 56 and have almost never gone to a doctor in my life other than in recent years for routine checkups and blood tests for prostate cancer (family history). Never been on meds (maybe antibiotics briefly once many years ago?). Lived most of my life outside the US though, and have always focused on a healthy lifestyle. I might just be genetically lucky but I’m convinced lifestyle has a lot to do with it (and not waiting to switch to a healthy lifestyle in your 40s)

I mean, not being sick enough to need a doctor for 7 or 8 years is super common for people in cities too. And rural living people do get diseases and injuries requiring doctors too.

Well that is partly why I made clear that I was just sharing my anecdotal experience, everyone is different and there is no one miracle cure.

Though I would find it hard to believe that fresh air, fresh food, and a bit of time working outside each day would make anyone's health worse.

Injuries and trauma care in general are absolutely a different story. While I am less certain about the net positive of many modern treatments that only treat symptoms and ignore root causes, modern trauma care seems to have a massive pile of evidence showing how beneficial it is.

What was it claiming exactly that it proved to be reverse?

> we would be better off if we spent less and focused on lifestyle.

I didn't see any claim opposite of this.

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