Subsidizing costs while restricting supply drives America’s fiscal imbalance | Hacker News Reader

Subsidizing costs while restricting supply drives America’s fiscal imbalance

niskanencenter.org

23 pointsjseliger15 comments

"The Center is named after William (Bill) Niskanen. Bill was a long-time friend whom we knew as chairman of the Cato Institute"

https://www.niskanencenter.org/about/

I’ve become a true believer that our society is artificially poor through supply constraints, particularly in the areas that are most discussed, housing, education and medicine. The majority of the supply restrictions are due to totally artificial constraints that we could chose to destroy, which would make our society all the wealthier. Things like a $15 min wage will do little to alleviate supply driven privation, but abundance can being a material quality of life to everyone regardless of income level.

The residency system needs to go. This is the major bottleneck. Too much innovation is held back because the supply of doctors is just too constrained via education through apprenticeship. If the only profitable job in life science is medicine (the physician track), then all those equally talented people who lose the rat race for one reason or other would be forced to seek other careers.

We are already increasing supply of healthcare providers, via price discrimination. You want the most highly qualified? Pay for concierge healthcare. You want mostly MDs? Pay for more expensive health insurance that compensates healthcare providers more. You need to save money? Pay for less expensive health insurance that reimburses healthcare providers less, and you get to see a nurse practitioner/physician assistant.

Probably 80% of my healthcare professional needs can be met by a nurse practitioner or PA. (When I was younger, this was probably more like 95%. As I get older or sicker, that percentage will fall.)

Maybe. The difference is more in the probability of getting someone who is less capable or otherwise undesirable since the barrier to entry to NP/PA is so much lower.

We don’t even need to eliminate residency. Just eliminate the requirement that the residency must be in the US. There’s a mountain of highly qualified Turkish, Russian, Korean, and Mexican doctors who are ready and willing to practice in the US.

Opening picture is a reference to memetic soviet motivator: https://stihi.ru/pics/2016/05/16/8685.jpg

Our society makes more sense when you realize that politicians don't actually care about whether policies work or not.

Not just politicians. People don't care whether policies work, they care whether they think the policies are "fair" or "the right thing to do" or "compassionate", etc. They will slide into hell as long as they thought they were doing the right thing, and evidence that their policies aren't working just means that they must double down and do even more.

US has one of the highest medical costs, while being one of the most private ones.

Medical costs being so high is much better explained by Baumoll’s cost disease: https://en.wikipedia.org/wiki/Baumol%27s_cost_disease

> The traditional socialist call to “seize the means of production” has thus been updated to something closer to “subsidize my cost of living” — a less revolutionary ambition, perhaps, but one that is no less myopic.

If the core messaging indicates a complete change in policy/action directives, maybe the faux-cyrillic and "socialist" moniker don't fit.

It's just a funny motif when compared to a quote found in their financial report:

> In a hyper-polarized time, the Niskanen Center has shown intellectual independence, respect for empirical data and a devotion to reason. May their tribe increase!

(1) If there is an insufficient number of doctors then it must be that they're insufficiently compensated (factoring in cost of education) - if there's money to be made, people will do it. Education will (and does) grow to support demand, and America has no shortage of educatable young adults.

If doctors aren't being compensated well enough while health care costs are high (controlled for confounders e.g. population disease prevalence) it's hard to blame anything other than the industries drawing profit off those interactions (insurance/hospitals).

(2) Stop using "socialism" to define any form of government intervention you do not like.

>If there is an insufficient number of doctors then

perhaps there is a "union" limiting the number of new doctors allowed to practice every year?

I understand the argument that medical associations intentionally limit supply to prop up their own salaries. I don't think there's sufficient evidence to demonstrate that's a critical factor. Any form of licensing "friction" introduced could be countered by a compensation increase - unless there's evidence that they're imposing a specific cap on licensing numbers then it seems implausible.

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