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Comment by bonoboTP | Hacker News Reader

> There is a tremendous share of medicine specialties facing shortages

The supply of doctors is artificially strapped by the doctor cartel/mafia. There are plenty who want to enter but are prevented by artificial limits in the training.

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Medical professionals are highly paid, thus an education in medicine is proportionally expensive. An education in medicine is expensive, thus younger medical professionals need to be highly paid in order to afford their debt. Until the vicious cycle is here is broken (e.g. less accessible student loans? and more easily defaultable is one way to spell less accessible), things are not going to improve. And there’s also the problem that you want your doctors to be highly paid, because it’s a stressful, high-responsibility job with stupidly difficult education.

US doctors are ridiculously overpaid compared to the rest of the developed world, such as the UK or western EU. There's no evidence that this translates to better care at all. It's all due to their regulatory capture. One possible outcome is that healthcare costs continue to balloon and eventually it pops and the mafia gets disbanded and more immigrant doctors will be allowed to practice, driving prices to saner levels.

How doctors are licensed in the US compared to western Europe might explain why health care costs are higher in the US, but it does not explain why health care costs are rising so much. That's because health care costs are rising at similar rates in western Europe (and most of the rest of the first world).

For example from 2000 to 2018 here's the ratio of per capita health care costs in 2018 to the costs in 2000 for several countries:

2.1 Germany 1.8 France 2.0 Canada 1.7 Italy 2.6 Japan 2.6 UK 2.3 US

Here's cost ratios over several decades compared to 1970 costs for the US, the UK, and France:

     1980 1990 2000 2010 2020
  US  3.2  8.2 13.9 24.1 36.3
  UK  3.1  6.3 15.3 27.8 40.5
  FR  3.4  7.6 14.9 21.1 28.5

Here's the same data showing the the cost ratio decade to decade instead of from 1970:

     1980 1990 2000 2010 2020
  US  3.2  2.6  1.7  1.7  1.5
  UK  3.1  2.0  2.4  1.8  1.5
  FR  3.4  2.2  2.0  1.4  1.4

My data source was https://data.oecd.org/healthres/health-spending.htm but it looks like data.oecd.org reorganized their site so that redirects to https://www.oecd.org/en/data/indicators/health-spending.html which seems to have the data but with a much more limited interface.

Doctor salary is not the only or perhaps even the main factor in healthcare expensiveness, but taking on the overall cost disease in healthcare would broaden the scope too wide for this thread, I think.

Also, I admit that the balloon may in fact never pop, since one theory says that healthcare costs so much simply because it can. It just expands until it costs as much as possible but not more. I'm leaning towards accepting Robin Hanson's signaling-based logic to explain it.

The supply of doctors would be much greater if incompetent people were allowed into the training pathway, for sure.

Bad news...they're already there!

Yep, this is precisely what they argue. They don't simply say they want to keep their high salary and status due to undersupply. They argue that it's all about standards, patient safety etc. In the US, even doctors trained in Western Europe are kept out or strangled with extreme bureaucratic requirements. Of course, again the purported argument is patient safety. As if doctors in Europe were less competent. Health outcome data for sure doesn't indicate that, but smoke and mirrors remain effective.

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