More Subsidization, More Doctors?
By Ian
(NB: Please excuse the haste and possible inconsistencies of this post. I can honestly say this is the first time I've posted to T&B when I've been exceedingly annoyed.)
I just turned on the radio -- NPR, my usual when it's not C-SPAN -- to hear a report by Patricia Neighmond on a study about a potential shortage of doctors. (I've not located the full study yet. I'll have to listen to the report again.)
Essentially, the problem is this: while the population grows and thus the demand for health care, the US is graduating only about enough doctors to replace the ones that are retiring. Population and demand will soon outstrip supply. In the course of the interview, Neighmond lets the guest opine on how the country might confront such a problem. And how does the man respond?
"It's the right time to spend more money on training more doctors." (A paraphrase, but a close one.) And it went by the Neighmond with nary a comment.
In a world of skyrocketing malpractice premiums, higher insurance bills for patients, and ballooning court awards to winners of court trials (see first item), are we sure that it's the cost of the education that is the problem here? Why might it not be, oh, I don't know...the fact that the strong financial incentives to incur the debt in the first place are being eroded through massive regulation by the AMA, FDA, the federal government and more? With all the technique and expertise it takes to be a doctor in the world's most advanced health care industry, are we really certain making it easier for more people to go to school is the best idea? Wouldn't we expect to draw more of the wrong kind of people to medical school if we make entrance easier? Might we not see such a surge in demand for attending medical school that schools might start to accept more people in order to capture more of the funds (perfectly acceptable to me on the part of the hospitals -- but why should I be on the hook for the income of a university because someone's gotten some of this "training money"?). Oh, certainly there might be some dedicated folks that such a policy would draw, much the same as there really are good people working for the government (there are, I promise, I've worked with them). But at the margin, why should we make the temporary price of education lower when we could allow the future profit stream to rise and thus induce a lot more people to become doctors?
This strikes me as similar to the problem with the supply of teachers. In order to get more teachers, states frequently drop the requirements for becoming one. This allows in more people, but they are not necessarily the ones best qualified to become a teacher. As a result, we have more people getting little to no better results from the education system. It seems to me that the requirements are moving in precisely the wrong direction. Harder qualifications to enter the profession could limit the pool, allow wages to rise and begin to draw the people who either have the innate ability or the willingness to work hard in order to achieve the financial and emotional rewards of becoming a teacher. Meanwhile, better trained teachers might better handle the larger class size that will result from the short-run reduction in supply of teachers.
Why is the default position -- "clearly the government needs to spend more money to fix the problem" -- accepted so blindly by some reporters? There are good reasons we don't have doctors sitting on the Council of Economic Advisers, and why we don't have economists doing brain surgery. Why not take a moment to realize that a good person to comment on economic incentives might be someone who actually studies the issue to some extent? Was a phone call to a local college really too time consuming for Neighmond?
After all, do we want more doctors? Or do we want more good doctors?
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