"It is no exaggeration to say that the success of the health-care law rests on young doctors choosing to do something that is not in their economic self-interest."

Any economist knows altruism is a myth by definition, since it's rational to sacrifice money for the feel-good outcomes gained when helping others to live a more productive life.

This also explains why Baker's accusation of protectionism is deeply marred by a misundertanding of the trade-off between leisure time and work time preferred by good samaritan doctors. They'd rather work for nothing to save or extend an additional life at the margin than play golf or have more sex.

Shame on WaPo and Baker for disparaging this dwindling circle of heroes who have sacrificed the present value of their income to the future value of others.

Abide by the Hippocritic Oath - Do no harm unto others that one would not want done to one's self. Protect protectionism.

Stupid liberals.

Ok enough of blaming all the problems of high health care costs on doctors. First of all, in terms of primary care access this problem could be addressed TODAY by expanding nurse practicers practice. There are enough of them to fill the primary care gap and of course they are paid less. Midwifes, nurse or otherwise, could be given expanded access which would require less OBs who are always complaining about malpractice anyway. And physical therapists could be given "direct access"--that is allowed to see patients without a doctor referral which would also bring costs down and lead to more efficient care (allowed in a few states. In many states midwifes are illegal unless they are nurses). These professions are paid less--in part because they have less training and therefore have had less to pay for their education. Something that I have NEVER seen you mention is that in this country doctors are in training much longer and have MUCH higher costs then their counterparts in other countries. One of the many ways to bring MD costs down is to seriously exam medical schools costs, and the cost of training in general. It doesn't seem that all of this training is necessary, and there is no question if you don't start your life until around 30, and when you do start it is with $150,000+ in debt, that this will strongly effect your career choices. You also seem to assume that if foreign MDs were allowed to come to the US and immediately start work, this would suddenly push wages down. I think this is highly questionable due to several factors. It is true that wages for MDs are lower in just about every other country (helped by low education costs) but what makes you think they are all going to come here and work for less? Costs of living are higher here too, and the kind of people who leave home are the kind of people who want to make that extra money. There is the ethical issue of MDs and other health professional from non-Western countries leaving their home countries to work in Western countries--this has come up in the UK--therefore leaving a "brain drain". Home countries would, if they were smart, quickly impose restrictions--in the form of post-graduate commitments, etc. I would think. There are genuine culture issues as well, outside of just racism, that may restrict usage of such MDs (and this could be true of lawyers).You could argue that low costs would trump all, but of course in most cases people are not actually paying MDs themselves, it's a third party and if people don't want to go that would be an issue. Look, I agree that low-skilled workers have gotten screwed in this country and I am all for an intelligent industrial policy. And there is no question that health care costs are THE problem, and MD salaries are a part of that but they are a PART, and even if you waved a magic wand with VISAs this would not solve it. The health care system is a multi-headed beast, and many sectors aside from MD salaries and drug costs need to be addressed and if you are going to go on and on about it you should make an effort to say a little about the complex nature of the problem.

Not only is there a lack of foreign competition akin to what traditional blue collar workers have faced, but the AMA works to control the supply of practicing physicians in the country as well. They make sure the supply is just right to get their wages to a good place. I suspect there are a lot of talented Americans who are denied a desired place in medical school because they just weren't admitted.

Jennifer Reft and Larry both make good points.

(1) Medical education takes too long and too restrictive. One solution is to eliminate baccalaureate requirements and allow American high school graduates to go directly to med school. Other countries do this, and their populaces are often healthier than ours. I also suspect med school can also be shortened by a year or two without a serious loss in practitioner quality, at least for primary care doctors.

(2) Med school tuition is growing out of control, and the WSJ (much less Dean Baker) should've pointed that out. According to the Department of Education's Digest of Educational Statistics and in 2010 dollars, in 1988 public med school cost $10,500 per year and private schools $28,800 per year. Twenty years later they grew to $23,200 and $41,800, respectively. Four years of this on top of undergraduate debt, and there's little hope these doctors will go into general practice. Fortunately, doctors can now borrow the full cost of attendance from ED, go onto Income-Based Repayment to work in primary care, and leave the American taxpayer with the bloated tuition bill.

I would like to see Dean Baker show more interest in fixing the American higher education system's parasitic cost structure than creating a new, cumbersome tax repatriation program for foreigners.

The issue of a tax repatriation system is separable from free trade in physicians services. I think it is a very good idea and is far simpler than things like copyright and patent enforcement that even bozos in DC seem to manage reasonably well. But, I can see no reason whatsoever why doctors need more protection than autoworkers and dishwashers. After all, they claim to be smart -- let them compete in the world economy like less educated workers.

The United States is the third most populous country on the planet and also its wealthiest. Its physician shortage isn't due to barriers that insulate them from foreign competition. Rather it's due to barriers that insulate physicians from domestic competition.

If I were press-beating the Post, I'd show more interest in why medical school in the U.S. must take ~10 years and require $250k+ in student loan debt. It very likely requires neither, and the onerous licensing requirements and unlimited federal Grad PLUS loans to professional students do more to explain the physician shortage than our unwillingness to subsidize training English-illiterate foreign workers.

Yes, we should fix medical education in the U.S., but that will be much easier once we destroy the current system by exposing it to foreign competition. This one should be simple. The Washington Post and all the other establishment types hold free trade as absolutely sacred. Let's hold them to their word.

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