Nobody in politics wants to talk about reforming the American health care system after the Affordable Care Act debate, but the Commonwealth Fund’s latest report is a reminder that the inadequacy of the current system remains our number one long term problem.
America’s PPP-adjusted per capita GDP continues to be extremely high, but a lot of this extra product is extra health care:
Now that’s fine. Extra GDP by definition means extra spending on something and health care is something. But what are we buying with this extra spending? Well, it’s not more visits to the doctor:
Instead, it’s largely better-paid doctors:
And it’s not just doctors. If you look at the price of health care inputs, you’ll see that we pay more per pill and per MRI as well. But the doctors thing is crucial. How is it that US physicians are earning higher incomes even while American patients see them less frequently? Well, our doctors are scarce:
It seems like common sense that if America is going to devote an above-average share of output to medical care while having close to the highest per capita output, we should have an above average number of doctors. Instead, we’re way below average. The upshot seems pretty clear to me. We need more doctors and we need more ways to get by without doctors. That means expanding what nurses are allowed to do without a doctor’s supervision, it means expanding the number of slots in American medical schools, and it means establishing clear paths for foreign-trained doctors to immigrate to the United States. I’m reasonably optimistic that improved technology will ameliorate this problem in the near future, but the fact that we’re using existing doctor-producing technology so poorly right now means there’s no guarantee that future policy will unleash future technology in the best possible ways.