> In the US, medicine is a racket where the supply is intentionally constrained.
The correct solution in that case would be to increase CMS funding for US residency and fellowship spots (which was frozen for ~25 years).
You should see this for what it is, salary suppression by importing foreign labor, in a similar vein to what the tech industry did with abusing the H1B system until fairly recently. It's easy to lower costs by cutting corners on quality, but that is not a pro patient move.
You sure about that? Seems to me that being able to see a “90%” doctor today instead of a “100%” doctor 6 months from now is beneficial to patients. Especially for things like oncology, where that 6 month wait could be the difference between life and death.
If you have confirmed cancer you should never wait six months to see an oncologist. If there's a bureaucratic block, your primary care doctor can pick up the phone, call the oncologist, and get you booked within one to two weeks. If you suspected cancer but not confirmed, it's your primary care doctor's job to get the appropriate testing completed within a reasonable timeframe. Not only is it the right thing to do ethically, but they face legal responsibility if they don't get you the medically indicated testing and follow up within a reasonable time frame.
On the other hand waiting six months for something like a knee replacement is not fun, but it's also not detrimental to your health. Would you rather see an orthopedic surgeon in six months and be 99% confident that they have the expertise to replace your knee without botching the job, or would you rather see a surgeon in two weeks and have 90% confidence that they're not going to botch the job?
Of course. But the right to practice medicine is not considered a innate human right, it's a privilege that has to be earned by completing specific training and demonstrating specific competencies.
Your profile mentions that you live in Singapore. You may not realize that Singapore is very picky about which foreign medical credentials it accepts [1]. This is a safeguard that they provide to you as a (potential) patient.
> But the right to practice medicine is not considered a innate human right, [...]
Sorry, no opinion on medicine implied. My comment was meant to highlight the casual xenophobia of this sentence:
> You should see this for what it is, salary suppression by importing foreign labor, [...]
At the risk of making a comment on medicine:
> Your profile mentions that you live in Singapore. You may not realize that Singapore is very picky about which foreign medical credentials it accepts [1]. This is a safeguard that they provide to you as a (potential) patient.
No, it's not a safeguard. Just like it ain't in the US. The only thing necessary for a safeguard would be something like a rule that you need to sign tedious paperwork of acknowledgement before you can be treated by someone without the proper credentials. Not a ban.
If Singapore cared about proper safeguards, they probably wouldn't allow all kinds of 'alternative' medicine. See eg https://www.healthprofessionals.gov.sg/tcmpb/en/registration... for 'Traditional Chinese Medicine'. (See also https://en.wikipedia.org/wiki/Traditional_Chinese_medicine for how TCM isn't even all that traditional, it's a fairly recent invention. Though that article is mostly focussed on the PRC. It would be interesting to see how that contrasts with practices in Taiwan, Hong Kong and Singapore: places where Chinese culture escaped the Cultural Revolution.)
(Of course, government policy, even of a generally competent place like Singapore, isn't really a coherent thing. So some people in the Gahmen and in interest groups care about safeguards, some care about protecting the 'guild', some care about other things like cultural heritage, etc and in the end you get some messy compromise.)
Twisting anti-outsourcing into xenophobia is quite frankly corporate doublespeak.
If you're following my argument I'm not taking issue with "foreign person" but "salary suppression" and "foreign credential"
The US addressed the doctor shortage in the late 70s and early 80s by offering foreign doctors top dollar and an expedited visa process to come here, complete US training, and then join the workforce. This was a good thing. But today's solution is waive the US training years so you can lowball them on the salary.
If employers recruited foreign workers at the payscale as domestic workers (and held them to the same credentialing standards), it wouldn't be salary suppression and I wouldn't have a problem with it.
> No, it's not a safeguard. Just like it ain't in the US. The only thing necessary for a safeguard would be something like a rule that you need to sign tedious paperwork of acknowledgement before you can be treated by someone without the proper credentials. Not a ban.
A libertarian approach doesn't work here. Healthcare isn't a free market.
In the best case, you often don't get to choose any doctor you want - you are limited to the pool of doctors that your insurance covers. And what your insurance covers is a function along the lines of (bare minimum required by the law) + (just enough extra to make the policy seem attractive).
In the worst case, if you show up to the emergency room unconscious or delirious or in critical condition, you aren't in a position to sign or make decision about anything. So anyone whose health will ever reach that stage better be comfortable with the lowest common denominator.
> Twisting anti-outsourcing into xenophobia is quite frankly corporate doublespeak.
Are we talking about guest workers or about outsourcing to other countries? Both can be good and commendable, but they are separate topics of discussions.
> If you're following my argument I'm not taking issue with "foreign person" but "salary suppression" and "foreign credential"
The foreigners earn a lot more than at home, that's why they put up with silly H1B nonsense. So you are the one arguing in favour of salary suppression.
The positive effect of migration on the migrant is large, well-documented and robust. Effects on the host country mostly positive too, but I guess you can find some weak evidence for some salary suppression for some natives? From what I can tell, that effect either doesn't exist, or at most it's weak and not robust.
> A libertarian approach doesn't work here. Healthcare isn't a free market.
Huh? Who said that it is?
> In the best case, you often don't get to choose any doctor you want - you are limited to the pool of doctors that your insurance covers. And what your insurance covers is a function along the lines of (bare minimum required by the law) + (just enough extra to make the policy seem attractive).
Are we still talking about Singapore?
As I said, we have all kinds of de-facto medical practitioners around here in the form of Traditional Chinese Medicine and Ayurveda etc. People already make the kinds of choices about their medical care you describe as the 'libertarian approach'. I know that many patients pay for these alternative options out of pocket, but there might also be some insurance coverage (I'm not completely sure).
(Similar, the US has eg chiropractors and homeopaths, too, I think? And people can visit them, too, and they decidedly do not offer medical care that is recognised as kosher by modern medicine.)
If you really wanted a safeguard, you would suppress these snake oil salesmen first. The law doesn't really do that in either country, and people haven't keeled over either, yet.
> In the worst case, if you show up to the emergency room unconscious or delirious or in critical condition, you aren't in a position to sign or make decision about anything. So anyone whose health will ever reach that stage better be comfortable with the lowest common denominator.
Before you ever even make it to the emergency room, some good Samaritan who just passes by might give you first aid. The lowest common denominator for random passersby usually doesn't include any credentials at all.
I'm not sure what point you are trying to make with your paragraph?
The correct solution in that case would be to increase CMS funding for US residency and fellowship spots (which was frozen for ~25 years).
You should see this for what it is, salary suppression by importing foreign labor, in a similar vein to what the tech industry did with abusing the H1B system until fairly recently. It's easy to lower costs by cutting corners on quality, but that is not a pro patient move.