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Comment by kmonsen | Hacker News Reader

Why should we convince them on altruism and not by paying them more? I thought USA was all about the market deciding where resources should go?

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That would be if we didn't let them successfully lobby to restrict residencies and therefore doctors. Americans with the skill and will exist but we will shut them out because we want to maintain price floors.

This is false, or at least no longer true.

Since you didn't provide evidence, I don't feel the need to do so either. But debunkings can be found on this site, as well as elsewhere

Edit: OK, here's one from me https://news.ycombinator.com/item?id=21127853

1986, 1997, 2005, 2018. Not only is there a hysteresis effect here but the AMA didn't stop being evil villains in 1900. https://news.ycombinator.com/item?id=22940320

Doctors are protectionist evil people.

Your 2018 link is the same opinion piece that I rejected in the comment I linked.

Your 2005 link includes the following quotes:

> Congress controls the supply of physicians by how much federal funding it provides for medical residencies — the graduate training required of all doctors.

and

> Even the American Medical Association (AMA), the influential lobbying group for physicians, has abandoned its long-standing position that an "oversupply exists or is immediately expected."

That second quote precludes me from having to respond to the 1986 or 1995 links since my original comment said "no longer true"

It's the usual hysteresis that results in what they did. The Nazis haven't gassed anyone in fifty years. They're still evil.

Ultimately, the AMA blocked residencies through lobbying and now maintains the position through small expense of effort because the status quo is a strong position. Change needs justification and you only have to block at the point of change. Things are the way they are because they put in the effort at the crucial moment.

And they certainly haven't undone their crimes. Just stopped being criminal. It's like a bank robber who stopped robbing banks and invested in the S&P500.

Because when people don't have money to "pay doctors more", if there's no altruism then there's death.

Because rural life is fundamentally economically inefficient, so they can't pay more. Transportation and overhead is too expensive. It only works if its subsidized by altruism of the urban economy, or a huge portion of locals learn the skills for themselves.

The way I see it is, a rural economy has to be propped up by at least one "export" of some kind. This usually isn't informational; the information economy gravitates toward urban centers. Whether or not the information economy has to stay in urban centers is unclear, but it seems to be the case right now.

Traditionally that export has been mining, manufacturing, and/or farming. Things that require lots of cheap space and labor and not much else. The first two have taken deep dives in the past few decades. This makes rural life, in many places, simply uneconomical. Without something bringing money into the town, people don't have money to spend on local services. Healthcare is an expensive local service. If we leave it up to the market, the answer is often simply "don't live in a rural area". I'm not saying we should just leave it up to the market, though many would, but I think these are the base facts.

Edit: I hadn't actually read the article yet and I hope the above doesn't come off as insensitive in relation to the OP's tone. But I still think it's the truth. Rural America right now is the most broken part of our country's broken system. Something fundamental has to change.

The crux of the rural decay problem is that we've left it up to the global free market, and China/India/other developing countries have sucked up all the manufacturing jobs (national labor cannot realistically compete with Chinese labor).

Sure, but that's still the free market. Free-market purists (many of whom live in rural areas) have to realize that this is what comes from taking a hardline stance against government action when it comes to the economy. Stuff just shifts to maximize efficiency, with no regard to the lives that break in the process. This is the unregulated force that they so blindly worship.

Many conservative people in rural areas are not pure free market people. Hence the wide support for Trump. He's a populist and nationalist. Ask anyone in rural America and I guarantee you will be hard-pressed to find anyone that thinks the US should do nothing to stop jobs and production from moving overseas because they believe in the free market.

I'm more pointing out that when they talk about that sort of thing, they're often being hypocritical after using "small government" and "free market" arguments five minutes before to denounce everything from social services, to capital gains taxes, to environmental regulation. There's a deep-cutting double-standard. I'd have more respect for it if they just admitted to self-interest, instead of preaching against deregulation except when it negatively impacts them.

"The country" means rural for anyone curious.

Edited for clarity. Didn't think about the ambiguity.

I can get on board with the urban centers being altruistic and subsidizing rural America as long as there is some return value unlike the current times where they turn around and gives us Mitch McConnell.

Also let’s pay nurses and doctors well even if someone has to bring healthcare to rural America.

Or if we bring the inflated costs of medical school down.

Sounds like the modern day definition of socialism, which is largely rejected by rural populations, as evidenced by voting patterns.

It seems logical to allow people who reject a the system that provides them care to endure the consequences of that decision.

Actually it’s unclear how the people in the article would vote as that section of Georgia was subject to de facto voting restrictions in the last two elections.

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