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Comment by gosub100 | Hacker News Reader

Computers and software used to be extremely expensive about 30 years ago, yet private industry advanced the state of the art and brought the prices down.

There seems to be very little talk about making medical education cheaper and more accessible. Why wouldn't it be cheaper if we had more MDs and nurses? What if we made it easier to become an MD ?

The insurance system is a cartel and they are greedy. However the regulations (upheld by the government) enable it.

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We've done that to some extent via the legal enablement of nurse practitioner and physician assistant led care. Of course, largely speaking all they do is supervise the recording of patient metrics and prescribe drugs in label-consistent ways, but that often works out reasonably well for the patient. When the patient needs specialty care then the NP or PA simply punts them into the winds of referrals and insurance justifications.

I'm not sure there's any realistic way to enhance the availability of specialists. You can't 'stub' your way through providing the care of a skilled gastroenterologist by substitution with a NP, though PAs in specialty care are becoming common.

Why not open more medical schools? And eliminate the matching system? If you want to be an ____-ologist, here is the list of requirements. Meet the requirements and you are the ___ologist. Not whether or not a practice group likes you, or your parents knew which colleague to talk to. Don't allow the supply of MDs to be constrained.

The bigger restriction is number of residency positions which has been limited by government funding constraints. Also you need sufficient skilled doctors to train these residents. There is also the issue of physician burnout and preferences of doctors to be specialist vs being in primary care. So what often happens is foreign medical grads apply for these kind of roles. Also foreign medical doctors have a couple of requirements to work in the US. Get their foreign degree reviews to meet requirements, pass the US medical exams and finally they have to redo their residency even if they have significant experience. Some of this is largely controlled at the state level. Some states are considering loosening the residency part to a shorter period for primary care position for foreign doctors that are willing to work in underserved areas. I know California is also reducing restrictions on foreign dentists.

Because your congressman gets lots of donations from doctors and hospitals. Doctors like to drive fancy cars.

In places with Catholics, you usually get the bishops advocating for the local Catholic hospital system.

So government (my congressman) IS the problem! Thanks for reinforcing what Reagan said 40 years ago.

Sure, but what these types of people fail to understand is that the only way to solve the problem is also government.

It turns out the real world is a big complicated messy place and there's rarely a simple answer like "delete government!"

This cult of personality in American politics is such a curse.

It really is. I’m not a fan of Reagan’s politics, but I respect his point of view.

But the weird deification of him, now displaced by the new guy’s cult of personality is so awful and toxic. He’s either a giant among men or a demon, and both positions are wrong.

I think the weirdness is the recent condemnation of him by the far-left. They are shitting on a guy who has been dead for 20 years. It's absolutely bizarre. It seemed to start about 2020 out of the blue.

Ironically, your guy Reagan was paid and supported by the AMA to fight “socialized medicine” and increasing the number of doctors in the 1960s.

Health care is so different though because the market doesn't work.

If you are facing death, no one wants the off brand, budget cancer treatment. No one is going to shop around for the best value cancer treatment.

If you have a heart attack, no one is going to call around for the best price on the ambulance.

It is like a luxury market. People shop around for the best doctor/treatment with no regard at all for the price.

So it is like complaining that a luxury service market is expensive.

The only way around this is a completely state run health care system that you have no choice.

Without relgulation, the profit seekers would remain in power and the same applies to more medical staff.

The insurance system is a profit seeking institution, that functions as intended. Why dont you talk about that BURNING aspect?

You didn't address a single thing I said

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