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The Health Wonk Review features a post in which Matthew Holt, after seemingly interminable throat-clearing, stumbles across one of the most serious problems facing American health care:
We have a huge over-preponderance of specialists who both earn way more than primary care physicians, and use considerably more resources.
Unfortunately, Holt fails to comprehend the significance of his discovery. Like most “progressives,” he sees economics as a zero-sum game, and thus concludes that the way to build up the ranks of primary care is to prevent people from becoming specialists:
What’s the rational answer? Do what most other countries do and restrict the amount of specialty positions available. Instead insist that most physicians focus on primary care which is both cheaper to the system and more cost-effective.
The implementation of such an economically naïve policy would have virtually no effect on the shortage of PCPs. Its primary result would be the creation of an additional shortage—of specialists. Deprived of the specialist option, the best and brightest will not suddenly become willing to work for submarket wages.
We have more specialists than PCPs because the pay is better for the former than for the latter. Why is PCP reimbursement so anemic? Well, as Kevin Pho points out in a recent op-ed, it is the direct result of government meddling.
And, Holt’s fond illusions notwithstanding, in “most other countries” whose bureaucrats have attempted to “manage” physician supply, there are shortages of PCPs and specialists. In Canada, for example, such policies have backfired horribly.
One of these days, “progressives” will figure out that the halt cannot be cured by increasing the ranks of the lame. Unfortunately, they will probably do a lot of damage before they finally discover the free market.
+ May 2007
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