Health Care Doublethink

“The first lesson of economics is scarcity: There is never enough of anything to satisfy all those who want it. The first lesson of politics is to disregard the first lesson of economics”, Thomas Sowell

As of 2004, there were about 850,000 practicing doctors in the U.S. (AMA Physician Characteristics and Distribution in the US, 2004, ISBN 1-57947-418-7). About 40% of them are in primary care, and about 60% in specialties. There are now just over 300,000,000 Americans in this country, so there is about 1 primary care doctor for every 1000 Americans, clearly not enough. Moreover, these doctors are not distributed evenly about the country; they are heavily concentrated in metropolitan areas, so for much of America the real ratio is about 1 primary care doctor for every 4000-5000 people.

Now politicians love to score points by promising universal health care and lower health care costs at the same time. Currently the government is contemplating reducing already low Medicare payments to physicians by about 21% to reduce Medicare costs.

To become a doctor takes 4 years of undergraduate school, 4 years of medical school, and 3 to 8 years of internship and residency, depending on the specialty selected. So that is something like 11-16 years of 80-100 hour work weeks, high tuition costs and little or no pay. Physicians typically end this training with debts in the $100,000-$300,000 range.

So we want more young people to undergo the arduous and expensive process of becoming physicians, so that there will be enough doctors to give every American good health care. And at the same time we want to sharply reduce physician’s incomes, and therefore the incentive to undergo the arduous and expensive training. Only politicians could propose something this stupid!

There are things politicians could do to really improve health care. The first would be to limit the excessive malpractice litigation which costs doctors so much and provides a strong incentive for excessive expensive tests (to protect against later malpractice charges). Lobbying organizations for lawyers, using selective data, argue strenuously that there is no excessive litigation, and that insurance costs aren’t really that much, but the facts on the ground show otherwise. Substantial numbers of physicians are leaving high risk fields like obstetrics because of the high cost of malpractice insurance (which can run as high as $250,000 or more per year in some areas of the country).

But of course, politicians at the federal level are heavily indebted to the legal profession (in fact, the majority are lawyers themselves), so they are hardly likely to pass any effective legislation that would significantly impact the legal profession.

Another thing politicians could do would be to remove the current federal restrictions against buying medications by mail from Mexico or Canada. In many cases drug companies charge far less for the same drugs in these countries than they do in the U.S. The FDA argues that there may be quality control problems with these “foreign” drugs, but this is just a cover for their tacit support of the drug companies, because in a number of cases the drugs sold in the U.S. are actually manufactured out of the country anyway –some of them in Canada or Mexico.