This is an uninformed take. A relatively small fraction of our healthcare dollars (~7%) are going to ‘providers’ i.e. doctors and nurse practitioners. I don’t have a source handy but this is easily searchable.

Most of the spiraling healthcare costs are attributable to administrative bloat, hospital profits, insurance companies and pharmaceutical profits. What you’re suggesting would just result in lower quality care in general and has effectively already been implemented with the rise of ‘supervised’ and unsupervised mid-level providers. I.e. NPs, PAs, CRNAs etc. It hasn’t resulted in any decrease in healthcare costs for the patient.

Let me give you some context for insight. If I see a patient in clinic for an intravitreal injection my fee will be $150-250 before overhead, the pharmaceutical company will be paid by medicare or private insurance around ~ $2000 for the drug that I inject. Double that for a bilateral injection.

If I operate at a hospital, my fee is $5-600. The hospital bills medicare a $4000 facilities fee plus additional fees for anesthesia, consumables etc. to the tune of over $10000 per eye.

If you want to lower healthcare costs a good start would be negotiating drug prices, repealing the clause in the ACA that bans physicians from owning hospitals, banning non-competes for healthcare professionals and getting rid of certificates of need that make it unnecessarily difficult to build outpatient surgery centers. In short, ideas that require a more nuanced understanding of our healthcare system.

Thank you for the reply. As in all things, I'm prepared to be wrong, if that 7% is indeed even ballpark accurate.

btw I appreciate being called uninformed (which I dont dispute and find no offence in) rather than stupid or pigheaded or whatever. The point of talking about things is to share and increase our understanding.

For what its worth I did check this today and it seems to be more like 20% of healthcare is going to providers, not 7%.

However in the grand scheme of things this still isnt that bad, and I do think doctors/nurses deserve a good compensation, so given the problems associated, maybe we dont go with removing medical licences as a solution to healthcare costs

Hey, good attitude to have. I've been seeing this type of exchange less and less on HN, but agree completely that it's (reassessing their positions) something more people should be doing / willing to do.

Look, the plausible version of this is spelled: "force the AMA to allow and the USG to fund more residency slots, so the supply of MDs can meaningfully grow, and the premium they demand be reduced. Also maybe let NPs and CRNAs and the like practice more independent".

But throwing medicine to the whims of the market is absurd. We're going to pick surgeons by reading reviews on Google?

Are medical licenses actually the cause of expensive healthcare?

No it's largely just the magical "a market will fix this" thinking that's been ruining policy for decades. It's silly and doesn't work because the assumptions that go into the underpinnings of the economics theory about the functioning of free markets don't exist in many potential markets they want to apply the logic to. Health care isn't the same as shopping for a pair of shoes and it's mind numbingly stupid to me to try to treat them the same.

I’d probably ask this question on a website for nurses, doctors, or maybe healthcare public policy folks. Instead of a website for programmers.

i.m.o. a different, significant factor is excessive testing for protection against malpractice lawsuits

Also doctors can be compelled to sign enforceable, legally binding noncompetes. Unlike most of us, they have to move far away to change employers, thereby making competition in the health care space very difficult.

I wanna say yes but to be fair, I cant prove it. I think without licencing we would get reduced length degrees & more people like nurses transitioning into primary care physicians - and I think that would be fine for a lot of conditions

I don't think licensure is really that much of a barrier, though. One of the huge trends going on is that nurses are increasingly replacing doctors in primary care. In my market it's unusual to have an actual doctor as a primary care provider. These nurses just go through some additional training for a PA or NP license and it's still a great deal cheaper than medical school.

This happens to me (my PCM is a nurse) but funnily enough my costs haven't gone down. Those nurses still work under a qualified doc, who will never look at your file until youre nearly dead, but theyre still getting a cut believe you me.

They’re not ‘getting a cut’ unless they directly own the clinic. What you’re seeing is a cost-cutting measure increasing the bottom line for whoever owns the clinic. Physicians are forced to agree to ‘supervise’ midlevels as a condition of their employment these days.

I replied to your other comment but wanted to reply here to say that this is also probably a fair point. I guess I dont really see doctors as employees taking orders (dont doctors mostly own their own practice?) since theyre so highly paid, but probably thats how being a software dev looks to others aswell.

Im curious if you think malpractice insurance is also a significant, unnecessary cost? What if we made it harder to sue doctors? On the flip side, malpractice is still a real problem - probably not one that will be fixed by removing medical licences :D just hoping you see this comment since I am genuinely interested in your answer

In the last decade, private practice rates for doctors has dropped from ~60% to ~45%.

By me in FL, it's hard to find a doctor that actually has a private practice now. Most are corporate owned clinics where doctors are just employees.

The US only allows a specific number of people to enter medical training each year to be doctors. This is the reason we pay so much.

The financial incentives a specialist headache doc has whos spent the time and money to get to where they are would never tell a patient to eat less and radically adjust your diet for your ailment to go away, they wouldn't have patients coming back to them and they would go broke (that education was super long and expensive). I like the uncanny idea of getting rid of training requirements and let the free market handle it.

That kind of change though would leave someone with the bag and tends to never get voted or happen so we stay stuck in the over priced pharma, insurance, beating around the bush health game were in. Everyone is incentivezed to keep the bandaids rolling. Don't tell people their drug habits (I mean eating habits) are killing them.

Ohh wait, we got a new pgp blocker for you!

How about just skip breakfast.....

Letting the free market handle it equals letting quacks handle it. I really doubt quacks will be any more incentivized (or qualified) to do right by their patients.