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Comment by ertian | Hacker News Reader

People have built a frustrating system for themselves with a century of complicated and messy political decisions (and resulting regulations). They don't have the will or attention span required to solve the various problems via the slow moving & gridlocked political system. So, they take out their frustration on the highest profile participants in the system.

Solutions? I'm worried that there aren't solutions. There are only bandaids.

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There is really basic stuff that we're going to have to do no matter what that doesn't involve restructuring the system, like drastically increasing the number of practicing physicians, which is capped by (you guessed) Medicare, which sponsors residencies. But all we can talk about is payer structure because of a complete fixation on insurance companies as singular villains.

This could be an opportunity for me to learn something new...

I thought the American Medical Association were the ones who artificially constrain the supply of physicians. Is that not true, or is the AMA constraint transitively related to the Medicare caps in some manner?

The AMA is just a lobbying group. The actual cap on the number of new physicians is residency slots, which are funded by Medicare.

Which I think itself is a bit of a red herring. Medicare subsidized residency slots are not the only way training doctors could be funded, and largely an artifact of our billing procedures and criteria.

It is just one aspect of how incredibly constrained the supply of healthcare is in the US. Medications that are over the counter in many countries requires someone with 12 years of training.

It's not the only way they could be funded, but it is the only way they are funded.

Sure, and my point is that the entire bottleneck is based on a a completely arbitrary artifact of how we handle billing in the US. It is a policy choice.

Residents provide healthcare to patients with real value. This healthcare either gets attributed to the attending physician or goes unbilled. The market value of care provided exceeds what it actually costs to employ and train a resident.

https://pubmed.ncbi.nlm.nih.gov/21217491/

The "arbitrary artifact" here is literally Medicare!

Yes, largely the fact that Medicare forbids billing for resident services. Im sure there is also an objection on the insurance reimbursement side as well, but I see no reason why a successful procedure of adequate quality performed by a resident should not be billable at the same rate.

Heyyy, we're starting to talk solutions after all. Good stuff. What do you think is UHG's and its executives' role in supporting or opposing the policies and politicians who could enact these fixes? I didn't verify this, but I'm going to go out on a tiny limb and guess that UHG and its execs pay for legislative seats to be filled by Republicans. Republicans famously want to reduce Medicare funding. Do you think lowered Medicare funding would result in more or fewer Medicare-funded residency positions? Certainly there's more at play in elections than UHG itself, but I'm wondering which side of the solution they're on.

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