Health Care Reform

Hello, everyone.

I’m Aaron, and I will be making occasional posts to matt.com.

The political issue that is dearest to me is the current state of health care in the United States.

While much (MUCH!) has been said about health care, and various suggestions for improving it have been put forward by both the right and left, no one, it seems to me, is addressing the real reason for escalating health care costs in the US.  The chief cause of any price increase is an imbalance between supply and demand.  In this case, the demand for physicians far outstrips the supply, and so the price of a even a simple visit to the doctor’s office is becoming prohibitively expensive to a growing number of people.

The reason for the imbalance in supply and demand is the mechanism we use to mint new physicians.  In order to practice medicine in the US, one must attend an accredited medical school, generally after earning a bachelors degree.  This is fine and well.  The trouble arises out of the fact that the only body currently authorized to accredit medical schools is the Liaison Committee On Medical Education (LCME), which is intimately affiliated with the AMA.  If one were to somehow attend a medical school accredited by some other agency, one would be ineligible to take the United States Medical Licensing Examination (USMLE) and therefore unable to practice medicine in the US.

As the sole body accrediting medical schools, the LCME dictates the number of medical schools in the country and the size of each class.  For an already accredited medical school, increasing the size of their classes requires approval from the LCME.  So the AMA exerts tremendous influence on how many new physicians are created per year.

The LCME asserts that they seek to insure that only the best educated people can practice medicine.  They insure this, they would say, by only allowing the most qualified educational institutions to educate only the number of people they can do so optimally.   And there is probably truth in this.  What should be clear, though, to even the most casual observer, is that the AMA can in no way be objective about how many physicians the country needs.  For every “extra” physician created, the supply is increased, and so health care costs and physician salaries could decrease.  This fact can not be lost on the AMA.

Whatever their intentions, it seems unavoidably clear that as long as people already in a profession are allowed to control how many new people can join that profession, the costs of receiving professional services will remain high and even climb.  No serious health care reform can take place until the issue of physician supply is corrected.

All the information about the LCME for this post was gathered from their website (lcme.org)’s FAQ.

What can we do about The Federal Reserve?

Thanks so much to everyone who has taken the time to read the slides and spread the word.  I sincerely believe, as I mention on one of the slides, that this is the most important issue that we face today.  People disagree on so many issues.  What should people be allowed to do?  Who should be taxed and how much?  How should that money be spent?  When is force justified to protect rights?  A significant consideration with all of these questions is the expenditure of money.  Before we can can even debate these issues, before we can consider the costs of political action, we have to stand on a foundation of money that is steady and not in a state of uncertain flux.  Money has to be something constant.  Something we all understand and trust.  It is like language.  We can’t have a conversation unless we agree on the definition of words, and we trust those definitions to remain basically constant.

Today we don’t really know what a dollar, a peso, a franc, a pound, or a euro is.  Today, debates on the expenditure of money are like debating the appropriate length of a highway in terms of miles when the definition of a “mile” changes from day to day.

I have convinced many of you that this is, in fact, the most important issue we face today.  This leads to the inevitable question: what do we do about it?  If you live in the United States, we have an unprecedented opportunity.

Since its inception in 1910, the Federal Reserve has operated under a veil of secrecy.  Even though an act of Congress created it, Congress is largely kept in the dark when it comes to its day-to-day workings.  We don’t know the specifics of the assets it purchases (with newly created money), or from whom it purchases them.  We don’t know the specifics of the loans made by the Fed.  While the jury is still out on the need for, and even the essential legitimacy of, the Fed, it seems reasonable that we ought to at least be allowed to know the details of its behavior.

This notion that we ought to at least be able to know what they do is catching on.  A bill has been introduced that will subject to the Fed to an audit by the Government Accountability Office.  While there is significant opposition to the bill by mainstream economists and those close to the Fed, virtually everyone else supports an audit.  In fact, most of the House and the Senate have signed on as cosponsors already.  The support is bipartisan.  What can you do?  This website will educate you on the details of the bill, and even provides tools for contacting your representative and senator.  If yours don’t already sponsor the bill, make sure they do.  Let them know now.

Welcome

On October 19th of 2008 I made matt.com, and the lesson of government, money, and economics live to the world.  Since then, tens of thousands of people have visited the site, and hundreds have emailed me with questions and comments.  Moving forward, I plan to start replying to these questions via my blog so I can engage everyone in the discussion.

And while I believe the issue of money and economics is probably more important than any other issue, I don’t intend to limit the scope of this blog to that topic.  I have lots of musings and opinions on politics and people, and I hope to get a lot of people interested in and talking about a lot of different things.

We will see what happens!  Please check back soon!