Why doesn't Mr Stoll understand the need for markets in medicine
Reader comment on: The WSJ's MediScare
Submitted by Dr Frank (United States), Aug 4, 2011 23:44
Mr Stoll, you are usually such a reliable free market guy, but you have a consistent blind spot in medicine. Market forces have been abrogated by government intervention dating at least to the 1940s when the tax codes were changed to make employment the only reasonable way to get medical insurance (which was a fix for a wage freeze the congress had imposed - how clever). Medicare and Medicaid, along with rafts of regulation, have futhered the decline of market forces in medicine.
Mr. Stoll, you want, I want, and your mom wants smart doctors. Your implication that med schools are keeping out well qualified applicants to further a guild (yes, you implied it), is false. Certainly, we can follow the Dutch model which opened the med schools wide, and let lots of less qualified practitioners flood the marketplace. More doctors means lower prices. More dumb doctors also means mediocre medicine. Who do you want to have those lesser docs, sir? Certainly not your mom. Maybe my mom?
We need smart doctors. We need highly trained doctors. That can only be accomplished if doctors are well paid. To justify the bad pay from Medicare by comparing it to the awful pay from Medicaid, is silly. If you want the smartest and best educated doctors you are going to have to pay them well. If you don't, the best candidates will go to law school or business school; both of which are quick and easy compared to medical training.
Allow markets to function again (get the damn government out!), and prices will decline, making medicine more affordable for all. At the same time, clever practitioners will be able to improve their compensation. That's what markets do. I know you know that. The site is called Future of Capitalism. Why the blind spot every time you write about medicine?
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The Future of Capitalism replies:
What do you mean by "get the damn government out!"? Abolish Medicare, Medicaid, NIH research funding, and government subsidies for medical training? Most doctors I know didn't decide to go into medicine by considering business or law school and deciding they could make the most money by going to medical school. Rather, they had some non-financial motives, such as wanting to heal people or liking the work. Maybe the financial motive played a role in going to medical school rather than nursing school. But doctors will make more than nurses even after a 2% cut in reimbursement rates. Life expectancy in the Netherlands is higher than it is here in America, so the Dutch seem to be getting by okay despite the "mediocre medicine" there.
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