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Comment by danblick | Hacker News Reader

Restricting access to medical education (certification) is only one way to restrict supply.

Another way is to require certification for more kinds of activities in the first place.

If Americans want access to less expensive healthcare, why not make it so that some kinds of medical treatment are available from people with ~2 years of education instead of 10? (Yes, the treatment would be inferior, but also much less expensive.)

Also, when IBM's Watson becomes the world's best diagnostician (Any Day Now), what will its legal status be? Probably IBM would be happy with a special exception to the law that makes it hard for other computer companies to enter the market?

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> If Americans want access to less expensive healthcare, why not make it so that some kinds of medical treatment are available from people with ~2 years of education instead of 10? (Yes, the treatment would be inferior, but also much less expensive.)

We already have. It turns out that patients generally don't want this. When given the choice, they generally opt for the practitioner with more training (the physician) over the one with less (an NP or PA).

Sure, we can (and do) pass these costs on to the patient, or (in some cases) force them to use the cheaper option, but at that point, you're literally talking about either:

(A) forcing patients to assume the costs of their care directly, either entirely or in proportion; or

(B) forcing patients to use the lower-cost, lower-quality option

Politically, people don't like (A) because it means patients' access to quality medicine is restricted by their ability to pay. And people don't like (B) because nobody likes to be told that they can't have access to the top level of quality (whether or not they're expected to pay for it themselves).

Man, pro tip- always go with a PA over an actual doctor for most general purpose visits. Doctors are waaaaaaaaay harried and checked out of the process. PA all the way. Honestly, even for hard problems I'm half inclined to go with a PA first, just because getting through to a doctor is so difficult, and there's always an easier solution they're going to try to make you prove won't work (to save themselves a little trouble).

> We already have. It turns out that patients generally don't want this. When given the choice, they generally opt for the practitioner with more training (the physician) over the one with less (an NP or PA).

That's because there's no price consequence for the majority of people in that circumstance. If the doctor costs $500 to see, the 2 year example costs $50, and the person actually has to feel that cost, it's very obvious which one they will choose.

Most working Americans get heavily subsidized insurance from their employer; most of the rest get almost entirely subsidized coverage from the government. Accordingly, very few Americans ever directly touch the cost of care. The majority of all Americans never get anywhere near that in fact. That's one of the big reasons why we're spending a trillion dollars per year beyond what we should be.

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