At the end of last year, a major network (ABC) finally ran a small piece on the shameful situation with organ shortages touching on the only workable solution to the problem: allow a free market. The piece follows below:
In the US, 15 people per day die waiting for a transplant. They can spend their money to buy caskets, tombstones and funeral services - but they cannot buy the organs that will save their own life.
Reason outlines the basics:
The normal way to handle shortages is to let prices rise to the market-clearing price. With organs, it might work this way: A cadaveric donor’s family might be able to sell their dear departed’s organs to patients who need them. Better yet, consenting living donors would be able to bargain with transplantees or their insurance companies for the sale of, say, a kidney or a piece of liver (both can be surgically removed without causing much permanent harm to the seller). But there is nothing resembling a market in human organs in the United States.
This argument is thoroughly explained (as well as the history of the issue) in a 2005 lecture by David Kaserman.
Why the Opposition Doctor?
Consider why doctors (specifically medical unions) are opposed to the practice. They will say it is because they fear for the health of sellers and buyers. Sellers might lie about their medical history to make money, or get taken advantage of to get out of financial trouble.
But really, look at the deal the medical establishment is currently getting: in an organ transplant operation - doctors get paid, hospital gets paid, insurance companies gets paid, medical supply companies get paid and the other professionals associated all get a piece of the action. But the person who first supplied the organ can only legally get a pat on the back. If he gets paid, he goes to jail.
Remember that medical unions are just as protectionist as other unions. In fact, it could be argued that the medical unions have even more power than groups such as the Teamsters and the NEA. The AMA and local medical unions have been successful at outlawing most of their competition in labor, maintaining a shortage of “qualified” labor, keeping their profits and prices very high, preserving the tremendous profits and shortages of drugs and colluding with the government to build the tremendously inefficient TPA model that most private and public health care systems utilize.
In essence, the doctor is not your friend here. He wants to maintain his extra special privileges and profits - and he doesn’t want to complete for it. He wants it by using the guns of government enforcement - all in the name of protecting your health.
Opposition by Others
There is a lot of opposition to the practice for non-medical professionals because the idea of buying and selling body parts feels icky. But why? What is icky about people barely hanging onto life, or chained to large machines and expensive medical treatments having an opportunity to buy an organ that someone else was willing to part with?
This argument is was taken to it’s logical conclusion by J.H. Huebert:
Some might say that legalized organ sales would cheapen us, or put a price tag on human life. But if we’re thinking that way, why stop at organs? Why allow doctors to charge anything for saving lives? Why allow grocers to charge for food, also essential to life? We allow prices for those things because we understand that otherwise, we wouldn’t have nearly enough of them.
Imagine the kind of markets that could be created. Part of one’s life insurance policy could be that upon an untimely death, one’s organs would be sold to pay for funeral costs, a child’s education or towards a charitable organization. The fact is that money would encourages donations - in the present scenario, they are discouraged. The need far outweighs the available supply.
The fact is, even if we do not like what people chose to do with their own bodies and property, we have no right to go in with guns blazing and throw them in jail.
I think the main argument against has always been that of a slippery slope. By allowing people to sell body parts, where does it stop? Can I sell my hand as a transplant for a rich guy that wants it? Can I deliberately kill myself so that my family benefits from selling my body parts? Does it make sense to unplug me from the machines to sell off my body parts? Of course, all these arguments rely on the assumption that I don’t really own my body, and can’t be trusted to make intelligent decisions when a cash incentive is dangled before my face. This is the form most protectionist policies take, assuming that people will act irrationally and against their own best interest for a profit. Whether this is considered a reasonable assumptions determines one’s place on the control/free market scale.
Just for fun:
Can I sell my hand as a transplant for a rich guy that wants it?
Yes.
Can I deliberately kill myself so that my family benefits from selling my body parts?
Yes.
Does it make sense to unplug me from the machines to sell off my body parts?
Yes (pending you agree to it).
Thus, you get the logical end of libertarianism. At least it’s consistent. Wrong yes, but logically consistent.
I don’t see how this is any different from the commidification of anything else (labor, protection, property, etc). It’s not the logical end of libertarianism but of Capital itself.
I’m sorry, but not everything in life (or death) has a price tag. Some things are too valuable to be played with in the free market. There is more to life than economics.
A person can save another’s life by donating a kidney–in my opinion, that has a lot more value than selling one.
(Now, if there were ways to make that donating process easier, I’d be in favor of that.)
I know of nothing in life that is not economics in the broadest sense.
A person can save one. But no one, not ever yourself, runs on selflessness. The world was founded on God’s selfishness, it is run by man’s selfishness and that is the world we live in. This zero-price donating experiment has led to thousands of lost lives. That is the price tag of the current system. For every life that is saved, many more die. And for something as fallacious and unquantifiable as “there is more to life than economics.”
You mean, like payment?
I’m sorry, but not everything in life (or death) has a price tag. Some things are too valuable to be played with in the free market. There is more to life than economics.
Unfortunately, to Marxists and libertarians, economics is all there is. Everyone is ALWAYS out for their best interests; self-sacrifice is not an option.
Economics is all there is. It is like saying gravity doesn’t exist in California, the Atlantic Ocean and Ecuador.
Also: guilt by association fallacy.
Perhaps in the broad way your worldview is colored by economics, mine is colored by linguistics. Or something else. We each view the world through our own set of experiences, presuppositions and prejudices.
Colin:
No, I don’t. I mean things like better public education on what it would involve to be a donor, making health insurance include such things, etc.
Ahh… so heath insurance companies, doctors, medical companies, DME vendors, technology companies and hospitals should be paying and getting paid for their involvement - just not the guy who actually owns the organ?
Disclaimer, I am married to an ob/gyn. I don’t follow the logic about docs. If people were allowed to sell parts there would be more transplant surgeries not less. So why on economic grounds would docs object? Who would they be competing against? It wouldn’t affect the surgeons fees in any way if the donor was paid, so why should they care? What extra privileges and profits do docs get from the voluntary donor systems? Are you somehow calling the entire medical establishment such as hospitals, insurance companies, etc., etc. doctors? What is a medical union anyway? Never heard of one and I have credentialed my wife in 5 states and 2 countries. Do you mean state medical boards? If so their function is not at all compatible with what you are saying.
As far as a “shortage” of docs, you have the tail is wagging the dog on this one. The shortage is real and is going to get much, much worse especially in the specialties. But it will be because people are getting out of medicine left and right with a lot less people interested in coming in. Almost all docs are working a lot more hours for a lot less money than 10-15 years ago. Medical school applications are in the toilet. The residencies are almost 40% foreign grads in ob/gyn. Since visas are almost impossible to get they will not be staying in the US to practice. Many people are saying that investing 4 years in a really good university, 4 years in medical school, and 4 to 8 years in residency at $50,000 a year doesn’t make sense to earn between 100k and 200k. Some of our friends say their last student loan payment will be with their first social security check. Not far from the truth.
what the heck is a tpa model??
point not clear. a cost of $50,000 a year for 8 years of school. there is a salary of maybe $35,000 for residency years. this would be for 80-110 hour weeks.
Bob, doctors themselves may not object but the doctor’s unions do (The AMA is a union, as are the state versions as well). If the pie of available revenue for kidneys was divvied up to the guy whose giving his kidneys (remove $30,000 or so out of the operation), that’s a significant diversion of revenue.
The AMA is definitely a protectionist racket. It prevents more competition in medicine and ensures that people who want to practice medicine must go through years of training and pay a lot of money. If I practice medicine voluntarily on another person, I would be thrown in jail because of the union and the government regulations.
With regard to the shortage, it’s all economics. While what you are saying is probably true (I just don’t know, but I have no reason to doubt you), the shortage is also being compounded by the economic restrictions on the system and the price controls (on operations such as organ transplants).
TPA stands for “Third Party Administration.” The fact that the current health care model is defined by several middlemen doing the buying and selling causing distortions in supply and demand, is leading to high costs and inefficient distribution.
Paying for organs would save thousands of lives every year in the United States. Unfortunately, there is no reason to think Congress will legalize this in the foreseeable future.
Fortunately, there is an already-legal way to put a big dent in the organ shortage — allocate donated organs first to people who have agreed to donate their own organs when they die. The United Network for Organ Sharing, which manages the national organ allocation system, has the power to make this simple policy change. No legislative approval is required.
Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren’t willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs
Americans who want to donate their organs to other registered organ donors don’t have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.
Paying for organs would save thousands of lives every year in the United States. Unfortunately, there is no reason to think Congress will legalize this in the foreseeable future.
Fortunately, there is an already-legal way to put a big dent in the organ shortage — allocate donated organs first to people who have agreed to donate their own organs when they die. The United Network for Organ Sharing, which manages the national organ allocation system, has the power to make this simple policy change. No legislative approval is required.
Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren’t willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs
Americans who want to donate their organs to other registered organ donors don’t have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.
Thanks for the info Dave
ok so you are saying that the insurance companies are blocking this so they don’t have to pay for the organs. That’s not doctors. Or the ama for that matter. Doctors spend an unbelievable amount of time and money trying to get paid by insurance companies, who stall and disallow payments at every single turn. Why would doctors be supporting them? The only price controls I am aware of is the willingness of insurance companies to pay and the statutory controls on medicare payments. I used to design medical billing software would be interested in learning how this has changed.
The ama is not a union. It is a professional association. The ama provides many functions, one of which is lobbying. Something the ama is not very good at by the way. Compared to the trial lawyers lobby the ama is not even sand box league. Many doctors, including my wife do not belong to the ama.
Medical school accreditation and standards are through the Liaison Committee on Medical Education (LCME) which is not affiliated in any way with the ama.
Residency training accreditation and standards are through Accreditation Council for Graduate Medical Education (ACGME). This organization is also not affiliated with the ama in any way.
Physicians are accredited by being tested at various stages of their training by United States Medical Licensing Exam (USMLE). Not affiliated
with the ama in any way. Then they must be licensed by a state medical board (not affiliated with the ama) to practice. By the way none of this stuff is cheap, I wrote the checks from my salary for the whole process.
I don’t know about you, but if someone is replacing my one and only liver, heart, whatever I really, really, really want them to have many years of training.
If you think that entry to medical school is the barrier you might be interested to know there are several european countries (france and italy if I remember right) that allow open enrollment to medical school. The only caveat is you must pass the first year to continue, no retries allowed. They actually graduate less doctors per capita than the US.
The the current (TPA as you call it) health model is for people or companies to buy health insurance then when they are sick the insurance companies are supposed to pay for it. There are horrible inefficiencies in having thousands of insurance companies all with different paperwork and rules (not to mention nice profits, lobbying costs, advertising, etc.), tens of thousands of doctors offices running their own very complex billing operations, trillions of very complex forms to be filled out and kept track of, trial lawyers, etc., etc.. American healthcare costs something like $5500 per capita while the rest of the industrialized world is about half that. It’s called free market.
You can’t have it both ways. If you believe in a free market then this is the way it is. If you want to standardize to cut costs then you will have some degree and form of socialized medicine.
Bob, while the AMA might not call itself a “union,” the functions you describe and it has historically and presently engaged in - ensuring protection for members through collective action - is the definition of a union.
While I am not aware of the nuances in other protectionist organizations (including government) the sum of the parts is a legal system of privilege, even to the point of outlawing competition. The AMA has a sizable role in this, as do many other entities.
I do want them to have years of training, but the fact that it is forced by law is protectionism for people thusly trained. What about other forms of medicine that many be untraditional or even outlawed under the current regime? This is not in the spirit of science and freedom - but in special benefits to a privileged few. If people want to pay their truck-driving neighbor to do a root canal, they should be allowed to.
This is not set up by the free market. I would advise you to read this summary which explains how this scenario has been created by the unintended consequences of government intervention in the market. It’s like saying that Haliburton is operating under the free market.
The free market wouldn’t subsidize regular/routine medicine with insurance. Nor would it tie benefits to jobs. Nor would TPAs get tons of profits from governments and insurance companies.
I read the summary several times and don’t understand the point. Yes, health care is a tax deductible expense. But so are wages. From an employee tax burden prospective it’s a pretty much a wash if you pay someone more or give health insurance and pay less. You don’t get any more or less deduction for either one as a business owner. The only advantage is the employee gets his health care paid in pre tax not post tax dollars so there is a loss of tax revenue to the federal government. However the premiums paid to the health insurer are the same either way. So if you eliminate employer paid health insurance and everyone paid their health insurance directly how would this effect the costs of providing health care in any way? Other than paying in after tax dollars and losing any advantage of employers getting discounts from the insurance companies. Many less people would have health insurance if they had to pay out of pocket. Oddly enough uninsured people frequently increase the cost of health care. They tend to wait until they are sicker (more expensive to treat) to see a doctor and heavily overutilize expensive ER facilities.
From the article:
“Why is American health care so expensive? The federal government increases the cost of insurance by regulating insurance deductibles. Given the administrative costs of insuring routine health care, it would make more sense for consumers to pay out of pocket, instead of through insurance. Health care deductibles would enable us to economize on the administrative costs of insurance, but federal law won’t allow this. Also, DeLoach and Platania also ignore the AMA monopoly on the supply of physicians. The American Medical Association has a history of restricting entry into the medical profession. AMA control on the supply of physicians has not helped health care affordability.”
I really don’t understand what they are saying. The consumer pays a high deductible out of pocket, then what? Are they saying that the deductible should be so high the consumer just pays all medical routine medical expenses so there won’t be insurance coverage other than catastrophic events? Catastrophic only health care is freely available on the market. Anyone can purchase it. It is very unpopular. So are they saying the the distortions caused by allegedly requiring low deductibles could be fixed by other regulations requiring catastrophic only? I notice that these kinds of articles always fail to cite the relevant statutes. Could you cite the statute that restricts deductions in the federal register. I am not aware of any other than in medicare. Some state insurance boards have varying regulations on this, although usually for reasons other than financial.
You seem truly feel that the various unrelated bodies regulating the training of physicians represent some vast conspiracy to regulate the supply of doctors. Are you opposed to all licensing? Using your argument there should be no reason your dentist shouldn’t hop into a tractor trailer having never driven anything but a vw and tool down the freeway along side you and your family at 80mph. Maybe your contractor should be free to hire the local homeless wino to wire up your house (after all he claims to know to do it).
You keep using the term tpa but jumping between describing it as a process and an entity. Who are these middlemen? Money goes from person/business to insurance company/government(medicare/medicaid) to hospital/doctor. The only middleman I am aware of are some data collection companies that batch claims for submission, but they don’t make bumpkis.
yes, that is my contention. Licensing is fine - just don’t make it mandatory. It leads to this kind of absurdity (”music” and “pool table” licenses. I and I think 99% of people out there aren’t going to let people operate on us without some form of credentialing. And for those that don’t, that’s their own problem. We more easily admit that it is protectionism to require barber’s and florist’s licenses, but can’t see the same problem with medicine and, say, law. These are the same things, only for white-collar workers.
But many of these groups should not exist. I don’t need people to buy other vital things for me: food, water, etc… it is even optional in real estate, but the market has demanded some of that. Why in the world should health care be any different? Oh right, because there is massive meddling on the part of government to try and encourage/stimulate some things while discouraging/prohibiting other things. And now we all pool together millions of people to pay for doctor’s visits! Insane!
interesting,
point one. I agree that licensing for protectionism is a problem. But I not sure how you would make voluntary licensing work. How do you eliminate fraud? One of the most important functions of state medical boards is trying to ferret out physicians who have hidden some type of problem or have fraudulent documents. The FAA does the same function for pilots. CDL licensing does that for truck drivers. Etc, etc, etc. If you eliminate these bodies, do you plan for each person to do the research themselves for each and every person they interact with? How would all this work?
point two. Which of the groups mentioned should not exist? Are you proposing that all medical expenses should be paid out of pocket? If it bothers you so much you are certainly free to do this yourself. If not we are back to catastrophic coverage. It is freely available now, how would you go about forcing everyone to use it, short of more “government meddling? Or is government meddling in pursuit of your objectives ok?
I’m really not arguing here. Nor am I defending the health system in america which absolutely provides very poor results for the price or the ama which my wife (and many other docs) never even joined. I just don’t understand your plan or your point. You keep saying this doesn’t work and this is government meddling and there is some vast mysterious pool of money floating around but you totally fail to cite any factual basis for your contentions. Where is all this money from and where does it go other than as I outlined? Then you propose no workable solutions to the supposed problems you talk about. If I acquiesce that these are the problems then what are the solutions?
We have all manner of private certification and licensing boards right now. These still have the exact same function. Most people are not going to go to an unlicensed doctor, and if they do - they bear the risk. Same with ASE certification for mechanics and so on. We literally have all kinds of market based regulatory and certification groups in many industries now. What I want you to see is that you can eliminate the mandatory aspect, without eliminating the body.
I am proposing that I do not know what should happen. I am not an expert nor is any one man, in government or industry. The decision needs to be arrived at through free people making mutually beneficial exchanges. My *guess* is that it would look like a typical risk-based market solution. Insurance would be had for catastrophe, regular medicine would be paid out of pocket or might be a separate benefit (but not through risk management such as insurance). My point is, we are not being allowed to make those decisions for ourselves right now.
You argument that it is “freely available” is misleading (not deliberately, of course). It’s the same way that private education is “freely available” - in spite of a gross government-made market distortion in favor of public schools. The point is to mandate nothing. To encourage nothing. Government is not capable pragmatically or morally to run our lives. Insisting that it does so leads to inevitable problems greater than the so-called benefits.
You are missing my point. I don’t have a plan. I don’t have the white paper for fixing our health care system. No one does. Just as I have no right and no expertise to run your life. You should be free and responsible to chose that plan yourself. Mine is not an argument of planning, but of framework - a free market. We have empirical and theoretical evidence that central planning is a total failure. We have the same that shows the theoretical and empirical benefits of the invisible hand. If we want a free market, then we must give up the notion that one expert or body of experts is qualified to run the whole show. If we want socialism, then we accept the principle that others are best at running our lives. If we accept those as maxims - absolutes, then ultimately we must move towards either totalitarianism (total government control) or anarchism (no government control). Your argument is predicated on the idea that someone must deliberately plan and mandate these things - it is the glasses through which you see my “solution” and why it seems like nonsense to you. But that is because I reject the most fundamental premise.
Total control or anarchy? Are you arguing for no government of any kind at all? I think that government has a limited number of legitimate functions. I also think that many, especially the federal, governments have way overstepped their constitutional and historical bounds. The extent and balance of these functions is what the whole democratic process is about.
I would still be pretty dubious about self regulating industry based bodies. Yes SAE works, but there have been some pretty egregious (and expensive, think S&L bailout) examples of bodies that haven’t. If you really believe that the temptation to cheat for financial gain would be overcome by purity of purpose then good on you mate. You must be younger and less cynical than me.
What exactly is stopping you or anyone else from either using catastrophic health care coverage or just doing doing without coverage and paying out of pocket? Why don’t you and anyone who feels as you do take this option? Who is running your life and forcing you to take part in a healthcare insurance plan that you don’t want. I’m not defending the current mess, but anyone that wants too can opt to not participate.
You still haven’t answered my original question from way back when. Where is all this money involved in organ transplants? Who does it come from and where does it go? You have made a grand accusation that a large number of people in medicine, insurance, government, and pharmaceuticals are involved in a vast conspiracy to profit from this. Please back it up with citations of regulations, peer reviewed papers and studies, etc.,etc.. Or at least flowchart it for me, I am very curious about this. No cheating, anecdotal cannot be substantiated by anecdotal.
We are having fun on this one.
Now might be a good time to mention that Colin is essentially anarcho-capitalist.
His view is that pursuit of financial gain through integrity will provide a stronger disincentive against cheating than the threat of force that government can impose. Why would government workers be any more likely to hold purity of purpose than a private industry worker? Still, I agree the threat of force can be useful in imposing integrity where pure profit motives might become unclear. A well run fraud is often more profitable than an honestly run business so long as they avoid getting caught or held personally responsible.
The basic idea is that if people were paid for their organs, more organs would be made available. Wherever the money comes from, it would be POSSIBLE to save someone if enough were spent. Currently, we have a huge shortage of organs. This model might allow that shortage to be reduced because someone who otherwise might not bother to sign an organ donor contract might do so if you gave them (or their dependents) money for the donation. One doesn’t have to agree with Colin’s anarchist position to see the logic in this.
good discussions.
anarcho-capitalist, very cool. Government workers pretty much have only bribery (which happens all too often) as an incentive to cheat. Self regulated industries have very much a built in conflict of interest (and of course good old fashioned bribery works too, a union shop steward once suggested to me that $5,000 cash would be very, very helpful to expedite my credentialing).
I don’t agree or disagree with Colins position. The logic in paying for organ donation to increase availability fine. As from “My Cousin Vinny” he makes a lucid well reasoned argument. What I keep asking repeatedly is some type of defense to or explanation of (just one example of several in the same vein):
“In essence, the doctor is not your friend here. He wants to maintain his extra special privileges and profits - and he doesn’t want to complete for it. He wants it by using the guns of government enforcement - all in the name of protecting your health.”
If donors were paid and organs made more available then docs would perform more operations and make more money. Why does Colin keep repeatedly saying docs not only oppose paid organ donation for financial reasons, but are somehow making “tons of money” by opposing it? I just can’t figure that part out.
Yeah, I can’t figure that part out either. It seems like more organ transplants = more money, even if some of the money goes to the donor. I think doctors really truly do want to protect life. They’re afraid that the buying and selling of organs might lead to a cheapening of life and might allow a donor to cause himself harm. A doctor who is ethically bound to do no wrong cannot allow a person to cause himself harm, and so a doctor cannot support the buying and selling of organs because it might lead to such harm.
It’s not a profit motive. It’s a case of a doctor (and in broader terms, the whole medical industry) think that he knows better than the donor. The donor wishes to sell her kidney, for example, but the doctor thinks he knows better. The doctor thinks that his decision is better than the donor’s own self-interest.
That’s at odds with the libertarian belief that the individual is best qualified to determine his own needs and interests. Who knows me better than me? Nobody, not even my doctor.
The medical industry is misguided in opposing the buying and selling of organs because the industry has decided it is better qualified to determine the needs and interests of the common people. The industry is wrong. A person’s rational self-interest–not his doctor or the medical industry or Congress–is better at determining needs and interests.
I’m a minarchist libertarian, by the way, in case anybody cares.
My apologies bob. I have been giving what I would deem a satisfactory answer to this. Let me try a different explanation.
First of all, I do not think it is the individual doctor that thinks this way (and I should have clarified that) but the bodies who protect the employment benefits of doctors. Consider any worker in a regulated system: school teachers for example. Many teachers favor merit pay, especially hardworking, young ones. However the Union has to protect all teachers and many less qualified or even plain bad teachers. Thus the union takes a position against merit pay. Many of the teachers who believe (rather acknowledge, because it is a fact) their salaries and benefits come from privilege - will not favor the “instability” of merit pay.
When I worked in the health care industry, it was painfully obvious to me that many doctors liked the status quo. They did not want to modernize, they did not want to improve their technology, they were skeptical of newer methods, they liked the stable money coming in from government contracts, etc… Legalizing a brand new organ market would radically affect the health care industry. While I think many doctors can see the aggregate benefit - they are going to look after the stability their own practices first. Doctors are not immune to the entrenchment mentality of any other profession - regardless of the possible benefits in opening up a risky scenario such as an organ market.
I don’t think I agree with this. The doctor probably does know better. But ethically, he has no right to impose his knowledge on you for your own good. The individual is not qualified as self-steward by knowledge, but by the ethics of nature.
Ok, I buy that more or less. I do think you are somewhat guilty of mushing two related but not directly supporting subjects (or rants) into one general general discussion. So you are saying that not paying for organs is bad (i agree by the way, but realistically it would be problematic), the process of licensing doctors is bad but neither is the causation of the other.
I hated doing software systems for doctors offices. Worst job I ever took. However I found it really wasn’t a status quo thing. Most docs are total science geeks who have spent so many years focusing on becoming docs (a necessary evil, it really does take a lot of knowledge and training) that they have very little breadth of life experience. They tend have almost zero knowledge of business practices or frequently even day to day social situations. That doesn’t mean it didn’t drive me crazy.
Germain to the discussion and like many other subjects (legalized drugs comes to mind) the question would be do your contentions hold up in other situations. In other words how do things work in other countries. I have already pointed out the open enrollment model in parts of europe. I would be glad to discuss the Australia and New Zealand model, since we are in New Zealand. Why are we in NZ? Because working as a doctor in the states sucks these days. My wife will never practice medicine in the states again. Many, many other docs feel the same way and are bailing out any way they can. The baby boomers may be really shocked when they need to find medical care after retirement.
I do agree with you that there is an element of protectionism in the training process. I totally disagree about the amount of protectionism. It is much smaller and much much less of a grand collusion than you imply. If what you say is true then why have docs wages been falling since the early 90’s? According to the last research I read physician wages dropped something like 7-8% between 1998 and 2006 . Why would that happen in a totally controlled market that you describe? Almost no one else’s wages dropped in that time frame.
Bob, humbly, I think that is a mostly fair assessment. There really are two separate issues here.
I think we agree on opening up the organ market.
I will, however, maintain a firm disagreement regarding protectionism. I do not argue that it is a collusive element, but the combination of many smaller elements. The training and costs required by law (and that is the key part) is a massive, massive barrier to entry. The requirements for specialist referrals and protections, rooted all the way back to the hippocratic oath, is a massive protection and competition prevention. The lack of rights for non-doctors to perform certain procedures. Etc, etc, etc… The amount of protections is staggering and I think it is a great disservice to the industry overall.
This will inevitably lead to the stagnations that you are referring to. Look at the American auto industry, for example. All the beneficial trade policies and bailouts can’t save them from their own labor protections.
Huh? You lost me around the curve. You have argued for 30 posts that the training of docs is a racket to create a shortage of docs and keep salaries high. Then you are saying this same shortage has created the fall in physician salaries. Say what? There are very few instances where an increasing demand (america is rapidly growing older which means sicker and has an increasing population) and a decreasing supply (there has been literally a wave of physician retirements and medical schools have not even come close to increasing the number of graduates to match the increase in population) results in lower prices. Maybe other factors are involved.
At this point I have to ask, are you a malpractice lawyer or medical insurance company executive or something? Physician salaries are falling because insurance companies and medicare have been continually cutting reimbursements, while expenses have skyrocketed. Especially medical malpractice insurance, but also including staff salaries, rents, utilities, etc. Maybe you aren’t aware that almost all physicians offices are basically independent small businesses. There is no monolithic “medical industry”. Physicians see patients, bill the insurance company, and hopefully get paid something (if you dot all the i’s cross all the t’s and sing a gregorian chant under the harvest moon). If a physician wants to see patients from a particular insurance company then first the physician must sign up and be approved to see the companies planholders. Then whatever the insurance company pays the physician for visits or procedures is it. Take or leave it, period. If expenses go up then tough titty. Either work longer hours or make do with less money.
You may also be of the impression that doctors are making your medical care decisions. Silly, silly boy. Very frequently it is actually some $8.00 per hour insurance company clerk in podunk iowa that decides what medical care you receive or don’t receive. The good news to this is these people are rapidly being replaced by $1.00 per hour clerks in podunk india. If you think getting your phone bill corrected by someone who barely speaks english is fun, wait until they are handling the approval of your heart transplant.
The medical industry isn’t in a bubble. But even if it were, artificial restrictions on supply are only going to be destructive in the long run. While on a chalkboard, what you are saying is true. However, were are ultimately talking about changing, unpredictable and dynamic market forces and a managed, stagnant and controlled industry. It’s like an oil cartel being shocked when its initial profits from collusion are affected by the wider implications of the market, and they begin to see things crumble. Protectionism is not sustainable. Artificial barriers and subsidies in the market don’t pay out forever.
Really, I think that explains your other points - at least broadly. You cite the effects, and I don’t dispute them, but I am talking about the systemic causes.
Wow!! Way way too ivy covered tower esoteric for me. Atanamis is incorrect. You are not a anarcho-capitalist, you are a utopianist. Good for you. I live in a much more gritty Damon Runyonesq world.
No the “medical industry” is not in a bubble. The renumeration for medical services is controlled by the insurance companies. They dictate what is allowed and how much the payment will be. It is irrelevant how many doctors there are (ok not 100% but if you can be utopian and anecdotal so can I). If the number of doctors were to magically triple tomorrow then each doctor would make 1/3 as much. The total renumeration to doctors will not change one cent. The number procedures and office visits will remain the same. The payments for these visits and procedures will remain the same. People don’t go to doctors because they have nothing else to do. I don’t know anyone who says “hey there’s a sale on kidney transplants, lets go”. Energy can be conserved in many ways as opec found out in the late 80’s (too bad we blew it). You can’t cut back on your chemotherapy or dialysis.
Anyway this is my last ditch effort to make this point. Restrictions on the number of doctors simply means each doctor gets a bigger piece of the pie. Along with a bigger piece of the workload. I always agreed to this point. However the size of the pie doesn’t change at all. People will need the exact same amount of medical care no matter how many doctors there are.
bob wrote: No the “medical industry” is not in a bubble. The renumeration for medical services is controlled by the insurance companies.
Yes, but if the legal barriers were removed, the insurance companies wouldn’t control the payment to doctors. Doctors could set their own prices if they wanted to. There’s no reason why doctors should be at the mercy of insurance companies except that the law tends to enforce that relationship.
Thanks, bob. I agree that we should probably agree to disagree. Although I don’t think we actually have too much disagreement. In fact, I do believe that we are making fundamentally different points, but speaking past each other a little bit.
good deal. fun discussion.