Supply: Another Ugly Side of Healthcare

Sixty years ago today President Truman signed the National Security Act, thereby creating the Department of Defense, Central Intelligence Agency, Joint Chiefs of Staff, and National Security Council. It seems that ever since, national security has ruled the debates and policy discussion. But isn't that to be expected? What could possibly be more interesting to watch on the nightly news than the scandals of outed CIA agents and hidden trips to Nigeria and debates on whether humans deserve more respect in the rest of the world than in the walls of Abu Ghraib?
Well, a lot of things, actually. The best tactic of anyone, be it a politician or a poacher, is diversion. With the extremity of events in the past 60 years, it seems one can't help but be diverted. The concept of living in the America where the President had fireside chats and JFK wasn't murdered is a little too far fetched for us. That is no excuse. The horror of realities abroad cannot divert us to the point of blindness at home. Sometimes, the events unfolding within our borders are much more disturbing because, well, they are in our borders.
Healthcare. Everyone has their eyes on healthcare, finally, but I find it to be a very one-sided stare. Yes, the wait is too long and the access too low. However, is having money available for everyone the answer to a system with other problems?
A discussion on health care recently took place the economics blog Marginal Revolution. Whereas the debate in the media focuses on demand, and the inability of our system to meet that demand — presumably because of prices — this discussion shifted to supply. With input ranging from medical students to ambulance drivers, the discussion became "Wouldn't more doctors make this whole thing easier?" The answer , quite simply, is yes.
The American Medical Association has what many consider a monopoly on medical care in the US. One can only be a doctor if one goes to an AMA certified school. The AMA keeps admissions down, supply low, and prices high. One of the commenters ventured to the theory that, out of the US's 302,441,741 people, we simply don't have enough with the brain power to be doctors. That was quickly shot down by another commenter:
Anyone who thinks there are not enough people willing to be doctors has never applied to medical school. The acceptance rates for U.S. med schools range from around 4% at the most prestigious schools down to maybe 15% for a less prestigious school. Plenty of intelligent and qualified people are turned away each year; some apply a second or third time and are successful, others leave the country or go on to some other field. Alejandro is right on that it's the American Medical Association controlling the supply of doctors overall, and that financial incentives lead to the imbalance of specialists over generalists.
It is impressive how much the AMA has avoided the spotlight being blasted over the healthcare system. One would almost think they were the most powerful lobby in Congress. Oh, wait, let's flashback 60 years to the the New York Times, June 15, 1952, we read:
Some rather expert observations of the art of lobbying as practiced in Washington assert that the A. M. A. is the only organization in the country that could marshal 140 votes in Congress between sundown Friday night and noon on Monday. Performances of this sort have led some to describe the A. M. A. lobby as the most powerful in the country.
And how are they standing now? Well, some things never change:
"The health care battle pits some of Washington's most powerful and well-heeled lobbies against each other ‐ the American Medical Association vs. the managed care industry on patients' rights, for example." WP
That quote was from '99. Where are the quotes now? Where has the AMA drifted to? Are they like the CIA created 60 years ago, lurking in dark corners and snatching senators into vans? Possibly, but as long as we spend all of our focus staring at diversions and snapping our heads everywhere they point their fingers, we will never solve any problems.
- Kristin Linder















