Please allow me to express a certain amount of frustration over the idea that it is somehow our responsibility to pay for the schooling of doctors. Why should a coffee shop barista who earns an entry-level wage and can’t afford college be told to surrender her money in order to subsidize post-secondary training for doctors who may one day earn as much as $200,000 a year?
“But Wayne, DOCTORS SAVE LIVES! WE NEED THEM!”
We need doctors only if we’re sick, injured, or dying. But whether we are sick or not, we all need food, clothing, and shelter, yet there is far less demand at state legislatures for taxpayers to pay for the ongoing education of farmers, tailors, and construction workers.
The medical industrial complex uses fear of dying — you might be hit by a bus or have a heart attack and there won’t be any doctors to save you! — in order to convince politicians to pay for the education of the people who will earn more money than the rest of us.
Moreover, asking politicians to come up with ways to make it so there is not a shortage of doctors is like forming a committee of burglars to figure out how to stop burglaries.
Lawmakers, since the late 1800s, have walked hand-in-hand with the medical profession to create the doctor shortages that exist today. And now they’re all sitting around a table trying to figure out how to bilk taxpayers for more money in order to solve the problem they created. And we sit around and nod politely as if this is perfectly normal.
First, let’s understand that, there is zero doubt that it was politicians and the Medical Industrial Complex created the problem of doctor shortages. This is well documented.
The very design of the medical system in the U.S. is to keep doctors in short supply. The lack of doctors is not some kind of unfortunate accident that fell upon Americans over time. It was always planned this way. There are many, many research reports that go into this in detail, but I’ll summarize it here by saying that since the 19th and early 20th century, the American Medical Association was obsessed with increasing the prestige and pay of doctors by reducing the supply of practitioners. This continued well into the so--called modern era.
Among the actions taken by both politicians and medical association lobbyists was:
reducing the number of U.S. medical schools.
making taxpayers instead of the medical profession itself responsible for the cost of training new doctors.
capping the number of would-be physicians that could be trained in a single year.
getting passed strict state-based licensure schemes, and segmenting the medical profession into specialties instead of general practice.
making it difficult or even illegal for non-profit associations and for-profit businesses to retain their own doctors.
lobbying for the expansion of healthcare services to people who are largely healthy, even as the number of medical professionals stagnated.
Furthermore, the discussion about doctor shortages is not new, nor is it unique to Idaho. Every state in the country has a doctor shortage, for the reasons cited above, and this includes states that have robust taxpayer-funded programs, scholarships, and medical schools to pay for the education of doctors.
So what is to be done about this? (And btw, to keep this short, I’m offering my studied synopsis, but if you’re a policymaker and want more information, feel free to email me.)
End programs that drive up demand for medical care for people who don’t need it. The Affordable Care Act made “free” annual checkups a thing, thus taking time for doctors to consult with people who have no medical emergency whatsoever. So states have the option of ending any program that encourages the overuse of the medical system, e.g., expanded access to medical welfare programs and mandated healthcare screenings via insurance programs.
Clarify that it is permissible for companies, associations, and nonprofits to hire a doctor to serve its employees and/or customers and members. For years, the Idaho Board of Medicine maintained that having a doctor on the payroll was against the law, even though state statute made no such statement. The board quietly reversed this policy in 2016 but no one has gone out of their way to make this fact widely known.
Stop funding medical training programs. Idaho got into the business of paying for medical education in the 1970s, and doing so was aimed at {drumroll please} getting a handle of doctor shortages. It didn’t work. By absolving the medical profession of the job of training its own, there is, unsurprisingly, an unnatural limit on the number of practitioners that can enter the profession every year. This naturally means a shortage of doctors, and this is what is happening now.
End the policies that give a preference to western medicine over other modalities. It might be shocking to some readers, but there are a lot of ways to treating certain medical conditions — recurring pain, immobility, diabetes, depression, anxiety, etc. — that do not require a physician in a white coat. Yet almost the entirety of the government superstructure is built in support exclusively to the benefit of western medicine.
Reduce the time it takes to become a practicing doctor. It can take between 11-16 years of education to become fully authorized to practice medicine. For obvious reasons, this creates a large bottleneck on the availability of medical practitioners. Really, the state should play no role at all in deciding how and when a person becomes a doctor.
Now, for paid subscribers, one action that the government should not take:
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