“Look, when we shop for healthcare, no one is pulling licenses, certifications or degrees—we ask our friends, and/or we trust the institutional brand. We’d keep doing that. “
You know it takes months to switch jobs as a physician because that’s how long it takes the new employer to vet whether someone is safe to employ despite there being a national clearing house of strikes against physicians and states issuing and maintaining licenses for physicians.
This cultural change to happy go lucky health care will be a big one!
I mean, it takes 2 seconds, but it takes them months to do 2 seconds worth of work, because the whole industry is rife with pointless procedures to do pointless procedures to make sure you completed all your pointless procedures. healthcare is the closest thing to experiencing communism that we have in america.
The US for some reason insists that you can only study to be a doctor, dentist, veterinarian, or lawyer after you complete 4 years of undergraduate college. Most of the rest of the world does not require this. That requirement burns years of time and huge amounts of money. It also shortens the length of time these professionals have to practice before retirement by 4 years reducing the overall work force. Really dumb.
I agree that we should make it easier to become a "skilled" health care worker. This has been going on for a while as nurse practitioners and physicians assistants become more common. But I don't think the AMA is likely to let things get much easier.
The bigger problem is that we mostly need UNskilled workers for nursing home care, hospital maintenance, and things like that. Many of these jobs are unpleasant to say the least, and many are physically demanding. As foreign workers disappear, I doubt that there will be nearly enough Americans to fill the void, and certainly not at the wages the former workers were paid. If they are willing, they will need to be bid away from other jobs. There aren't all that many people who want a job who are not now working. Does this make sense?
We need to unclog the entire system. There is so much sand-in-the-gears, so much rigidity, and so much sclerosis. Healthcare is broken because we break it by depriving it of every known mechanism for the efficient allocation of goods and services. We built a clown-car and then we act puzzled why it finishes deadlast in the Daytona 500.
My niece is leaving being a scientist to become a nurse, because being a nurse provides a solid and secure middle class living and will allow her to leave California for a state with a cheaper COL.
It seems to me that everyone wants there to be some “solid middle class pathway with little risk that you can just autopilot on” out there. Once upon a time it was manufacturing. Now it’s Eds and Meds.
I accept all of your criticisms of this. Anything that is “guaranteed” becomes a bloated mess. We need that good old creative destruction, and creative destruction means some middle class people getting their lives blown up by change. But just as people are NIMBY about housing they are nimby about their job and their industry.
I don’t know the political economy solution here. It kind of seems like maximum economic efficiency would mean a lot of uncertainty and churn that voters just don’t want. They prefer bullshit jobs they can rely on, even if it’s a Ponzi scheme in the long run. Manufacturing jobs went away because they were subject to capitalism, not voters.
But job satisfaction for nurses is really low and burnout is high! But yes, tradeoffs to dynamism is stability, but I actually think we'd get more nurses if it wasn't such a daunting commitment.
The political economy is basically impossible. Most viable path would be some kind of free trade zone that would exist as a parallel economy
There’s also the cliquey/catty social element to nursing… I debated transitioning to some kind of medical; but in the end, the idea of wearing scrubs is too close to “nurse,” and I don’t want to be perceived as one.
As an Australian I don’t understand how you let healthcare and drug regulation get as bad an entrenched to private interests and regulatory capture as it has. If I may.
well, "private" interests are what make the productive world go round--it's not by the generosity of the baker that we get our bread, etc. The reason they get "captured" is because the short-term allure of socializing those benefits is very high, but it's a longer-run deal with the devil.
Ironically, a lot of home health workers are also senior citizens… caring for seniorer senior citizens. There’s a lot of them doing it part time, a huge increase makes sense
Back in the mid 90's (I think) the Cato Institute put out a pamphlet/small book called, "Patient Power". It outlined how by taking the government and insurance companies out of the Patient, Doctor relationship, we could make healthcare of higher quality and lower cost.
Obviously, there would need to be some sort of voucher system for the folks who cannot provide for themselves. But NOT a government agency or bureacracy.
If you look at the areas of medical care that are generally not covered by insurance, think LASIK, Radial Keratotomy, cosmetic, etc. they are all MUCH cheaper than they were 30 years ago and they are all incredibly technologically advanced.
Government NEVER makes things better. The fact that there are folks who have to deal with the DMV, or contractors who have to deal with building inspectors, or any of a huge number of worthless government bureaucracies, but then say that they want government run healthcare boggles the mind. That is some SERIOUS cognitive dissonance.
i mean, the same people who will lecture you about ABUNDANCE and YIMBYism are very sure that we should have nationalized healthcare (more so than we already do).
re. the first point, the only quibble that I have is that doctors are just as much a part of the problem, as anyone else. they like their cartels and they want unfettered judgment to make "care" decisions, damn the cost (which they prefer not to think about). but healthcare is a good and service. I want walmart running healthcare, not "doctors."
Before I reply, I have to admit I can't tell if your comment about "ABUNDANCE" was satire or what. But, assuming you are a reader, and you must be since you have a Jewish name 😍🤣, get a copy of "Super Abundance:..." by Gale Pooley and another guy. Great explanation of why every single commodity in the world is cheaper today than it was 50 years ago. And there is more of them. Humans do consume but we create and innovate at much higher rates. Well, those of us not living in Africa, the ME and much of Asia. Anyway, not why I wrote.
Yes, the doctors do have and love their cartel. However, many of the good ones were forced into said cartel by Obama Care. Still, by removing the insurance companies, except for everyone having access to some type of catastrophic insurance policy, AND the "gubmint" (that's how rednecks say government) from the equation, doctors would become subject to competition, reputational comparison shopping by patients, etc. and this would put the patient in charge of the relationship.
Hence, the name of the book, "Patient Power".
Two additional things. Just realized that your "name" is probably not your real one and what is YIMBY? I know what NIMBY is. Thanks,
Abundance is a reference to Ezra Klein's book, which offers a framework for a competing platform for the democratic party. It's all about making government more effective, often by getting it out of the way. A major boogeymen is housing regulations, like zoning, that cause a "housing shortage/affordability crisis" by reducing supply. Y = Yes, as in the opposite of Not [in my backyard].
There are many decent doctors and insurance company executives and hospital admins and regulators. Decency plays second to incentives. The doctor cartel is the whole credentialing and licensing regime. That predates Obamacare by nearly a century.
In re: "many decent...". Totally agree. The system swallows good folks. And indeed, incentives matter. In fact, in most cases, incentives are all that matter. Not all, but most.
Had the good fortune to interview Gale Pooley once before he wrote the book. He had co-written a long form essay, which became the book, with his co-author of the book, and I must say, brilliant thinker.
I think there is a bit of conflation of education and training in this article. The US (or the ECFMG) has a list of foreign med schools that it recognizes, but all of those graduates still need to take the USMLE and go through residency training to become licensed in any state. In essence the US gets foreign educated residency applicants for free.
“Look, when we shop for healthcare, no one is pulling licenses, certifications or degrees—we ask our friends, and/or we trust the institutional brand. We’d keep doing that. “
You know it takes months to switch jobs as a physician because that’s how long it takes the new employer to vet whether someone is safe to employ despite there being a national clearing house of strikes against physicians and states issuing and maintaining licenses for physicians.
This cultural change to happy go lucky health care will be a big one!
I mean, it takes 2 seconds, but it takes them months to do 2 seconds worth of work, because the whole industry is rife with pointless procedures to do pointless procedures to make sure you completed all your pointless procedures. healthcare is the closest thing to experiencing communism that we have in america.
I am not sure "surfeit" means what the sentence thinks it does: "Little wonder we have a surfeit of 'qualified' healthcare workers."
I think I flipped it..originally had “no surfeit” and that sounded stupid, but forgot to flip back to shortage
The US for some reason insists that you can only study to be a doctor, dentist, veterinarian, or lawyer after you complete 4 years of undergraduate college. Most of the rest of the world does not require this. That requirement burns years of time and huge amounts of money. It also shortens the length of time these professionals have to practice before retirement by 4 years reducing the overall work force. Really dumb.
I agree that we should make it easier to become a "skilled" health care worker. This has been going on for a while as nurse practitioners and physicians assistants become more common. But I don't think the AMA is likely to let things get much easier.
The bigger problem is that we mostly need UNskilled workers for nursing home care, hospital maintenance, and things like that. Many of these jobs are unpleasant to say the least, and many are physically demanding. As foreign workers disappear, I doubt that there will be nearly enough Americans to fill the void, and certainly not at the wages the former workers were paid. If they are willing, they will need to be bid away from other jobs. There aren't all that many people who want a job who are not now working. Does this make sense?
We need to unclog the entire system. There is so much sand-in-the-gears, so much rigidity, and so much sclerosis. Healthcare is broken because we break it by depriving it of every known mechanism for the efficient allocation of goods and services. We built a clown-car and then we act puzzled why it finishes deadlast in the Daytona 500.
My niece is leaving being a scientist to become a nurse, because being a nurse provides a solid and secure middle class living and will allow her to leave California for a state with a cheaper COL.
It seems to me that everyone wants there to be some “solid middle class pathway with little risk that you can just autopilot on” out there. Once upon a time it was manufacturing. Now it’s Eds and Meds.
I accept all of your criticisms of this. Anything that is “guaranteed” becomes a bloated mess. We need that good old creative destruction, and creative destruction means some middle class people getting their lives blown up by change. But just as people are NIMBY about housing they are nimby about their job and their industry.
I don’t know the political economy solution here. It kind of seems like maximum economic efficiency would mean a lot of uncertainty and churn that voters just don’t want. They prefer bullshit jobs they can rely on, even if it’s a Ponzi scheme in the long run. Manufacturing jobs went away because they were subject to capitalism, not voters.
But job satisfaction for nurses is really low and burnout is high! But yes, tradeoffs to dynamism is stability, but I actually think we'd get more nurses if it wasn't such a daunting commitment.
The political economy is basically impossible. Most viable path would be some kind of free trade zone that would exist as a parallel economy
There’s also the cliquey/catty social element to nursing… I debated transitioning to some kind of medical; but in the end, the idea of wearing scrubs is too close to “nurse,” and I don’t want to be perceived as one.
As an Australian I don’t understand how you let healthcare and drug regulation get as bad an entrenched to private interests and regulatory capture as it has. If I may.
well, "private" interests are what make the productive world go round--it's not by the generosity of the baker that we get our bread, etc. The reason they get "captured" is because the short-term allure of socializing those benefits is very high, but it's a longer-run deal with the devil.
Ironically, a lot of home health workers are also senior citizens… caring for seniorer senior citizens. There’s a lot of them doing it part time, a huge increase makes sense
This can be done, and it has to be done or we're all screwed.
Also it's funny that of all the states, Wisconsin is not majority "healthcare" but....
https://en.wikipedia.org/wiki/Epic_Systems
Back in the mid 90's (I think) the Cato Institute put out a pamphlet/small book called, "Patient Power". It outlined how by taking the government and insurance companies out of the Patient, Doctor relationship, we could make healthcare of higher quality and lower cost.
Obviously, there would need to be some sort of voucher system for the folks who cannot provide for themselves. But NOT a government agency or bureacracy.
If you look at the areas of medical care that are generally not covered by insurance, think LASIK, Radial Keratotomy, cosmetic, etc. they are all MUCH cheaper than they were 30 years ago and they are all incredibly technologically advanced.
Government NEVER makes things better. The fact that there are folks who have to deal with the DMV, or contractors who have to deal with building inspectors, or any of a huge number of worthless government bureaucracies, but then say that they want government run healthcare boggles the mind. That is some SERIOUS cognitive dissonance.
i mean, the same people who will lecture you about ABUNDANCE and YIMBYism are very sure that we should have nationalized healthcare (more so than we already do).
re. the first point, the only quibble that I have is that doctors are just as much a part of the problem, as anyone else. they like their cartels and they want unfettered judgment to make "care" decisions, damn the cost (which they prefer not to think about). but healthcare is a good and service. I want walmart running healthcare, not "doctors."
Before I reply, I have to admit I can't tell if your comment about "ABUNDANCE" was satire or what. But, assuming you are a reader, and you must be since you have a Jewish name 😍🤣, get a copy of "Super Abundance:..." by Gale Pooley and another guy. Great explanation of why every single commodity in the world is cheaper today than it was 50 years ago. And there is more of them. Humans do consume but we create and innovate at much higher rates. Well, those of us not living in Africa, the ME and much of Asia. Anyway, not why I wrote.
Yes, the doctors do have and love their cartel. However, many of the good ones were forced into said cartel by Obama Care. Still, by removing the insurance companies, except for everyone having access to some type of catastrophic insurance policy, AND the "gubmint" (that's how rednecks say government) from the equation, doctors would become subject to competition, reputational comparison shopping by patients, etc. and this would put the patient in charge of the relationship.
Hence, the name of the book, "Patient Power".
Two additional things. Just realized that your "name" is probably not your real one and what is YIMBY? I know what NIMBY is. Thanks,
I will check it out!
Abundance is a reference to Ezra Klein's book, which offers a framework for a competing platform for the democratic party. It's all about making government more effective, often by getting it out of the way. A major boogeymen is housing regulations, like zoning, that cause a "housing shortage/affordability crisis" by reducing supply. Y = Yes, as in the opposite of Not [in my backyard].
There are many decent doctors and insurance company executives and hospital admins and regulators. Decency plays second to incentives. The doctor cartel is the whole credentialing and licensing regime. That predates Obamacare by nearly a century.
In re: "many decent...". Totally agree. The system swallows good folks. And indeed, incentives matter. In fact, in most cases, incentives are all that matter. Not all, but most.
Had the good fortune to interview Gale Pooley once before he wrote the book. He had co-written a long form essay, which became the book, with his co-author of the book, and I must say, brilliant thinker.
I think there is a bit of conflation of education and training in this article. The US (or the ECFMG) has a list of foreign med schools that it recognizes, but all of those graduates still need to take the USMLE and go through residency training to become licensed in any state. In essence the US gets foreign educated residency applicants for free.