WBUR.org, Bosto
n's National Public Radio news station, is conducting a report titled Are the Kids All Right? regarding the impact of the pediatric mental health provider shortage in Massachusetts. A shortage which the publishers state without question is getting worse. This is substantiated by a large number of studies made by the industry illustrating that the demand for such services are increasing while, particularly in Massachusetts, the supply of physicians is decreasing.
When considering the scarcity of resources in any paradigm, it is necessary to look at both the supply and demand side of the equation. With even the most elementary understanding of economics, one recognizes that when the demand for a service or product increases, the market expands, and the incentive for more suppliers to enter the market increases as well.
There are times, of course, in which the cost to supply a product or service is not in line with what is affordable to those who demand it. In such cases, the profit motive is by far the greatest conduit to bridging such a gap. In other words, the only rational way to make a profit is to identify a demand that is not being satisfied, and supply it in such a way that one can both make a profit and gain market share (in other word, supply it to the most people by increasing access).
So why is this not the case in Massachusetts? Why, in accordance with WBUR's report and others, are indications showing the supply of pediatric mental health practitioners will continue to go down while demand will go up?
The reason is due to the fact that the government, not the market, is in control.
As stated in the report:
Dr. Eugene Beresin, director of Child and Adolescent Psychiatry Residency Training at Massachusetts General Hospital, knows that he and the doctors he trains are in great demand. He says there are several reasons why: Demand for kids (sic) services has skyrocketed since the 1990s while the number of certified training programs has remained stagnant. Beresin also says a big reason people stay away from the field is that child psychiatrists aren't compensated for all of their time which is usually triple the amount of time that other medical professionals spend with a patient.
In child psychiatry, you need to see the child for a longer period of time, Beresin said. You need to make contact with parents, teachers, court officials. You have to write reports. The amount of ancillary work you have to do is pretty big.
It is evident that child and adolescent psychiatry is a demanding profession. The key element of this report is in its subsequent statement citing a recent Blue Cross Blue Shield of Massachusetts study which concludes, because of the lower compensation and an aging workforce, it's likely that more than half of the pediatric mental health care workers in Massachusetts will leave in the next five years.
What the report neglects to cite is that lower compensation is due to the fact that government, not market forces, is what is driving down such compensation making the benefits to entering into the field minimal. Without a profit motive, no person or company is compelled to enter into the field to supply a demand. Even if there was a possibility to satisfy the demand at a lesser cost and in turn a lesser price, why risk the time and effort to do so when such compensation is capped by the government?
Without proper incentive, there is no motivation; and without motivation the gap in supply and demand is not closed. Access to care is minimized.
This article is a compliment to a another analysis of nationalized health care published by this author titled, Health care employment opportunity costs and the inevitable rationing of care.
© 2011 Objective Nation
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Comments: 56
Yeah, like 30 minutes, as opposed to 10 minutes. I was just talking to someone tonite who was saying she feels rushed every time she visits her Dr. (we're from MA). Plus 1-hour shrink sessions are long gone~they've been cut to 45, even 30-minute sessions. Despite the praises of the MA Health Care model, it's still all about $$, and as long as these professionals keep playing the "who-makes-more-than-who" game, they put at risk not only peoples' health, but peoples' lives.
Perhaps the right answer is some kind of additional tax incentive for pursuing medicine, some way to defray the cost of getting a license. Educational expenses are the reason doctors of my acquaintance cite as the reason why they have to charge so much, personally, for their time. Find a way to take that initial outlay down a step, and perhaps we can make all of medicine more affordable.
If the free market will mean only the rich get health care, how is that poor people eat, have TVs, cars, and places to live in the US? Does 100% of everyone have everything they need? No. But your statement that the free market does not provide this is so obviously wrong . . . all you have to do is look around. There is a gas station on every corner. A grocery store accessible jut about anywhere. You REALLY think if the government got control that somehow politicians will make food and gas more accessible to the poor?
Ajatasutra, you simply want to believe what you have been told. You claim that the free market doesn't work, but you show no evidence of it. The Soviets didn't have free markets, look at them now. Look at every command economy in the world, their societies are in despair all of the time. Then look at other markets. The more free, the more accessible are goods and services to EVERYONE.
Just think Ajatasutra. You seem like an intelligent person.
What I have been told since childhood is that the free market is the only way. My father is a Randist. I've read virtually all of her (Ayn Rand) books. I grew up listening to Rush Limbaugh. After much soul searching and historical study, I discovered that they... and I, were wrong. History does not bear up the assertion that free markets alone can create a stable and powerful middle class. It takes shrewd economic policy, progressive taxation, and incredible investments in emerging technologies and infrastructure.
There are other countries whose markets are less free that are doing better than we are. China is a great example there. And there are places where markets are more free where the economy is worse (there are many countries that don't have the body of economic law we have that struggle... like Sierra Leon for example).
Think about moderation, John. It's been the only successful model since Aristotle.
So you are saying that the way in which the poor in America have access to TVs, cars, food, satellite TV, and so on is through the government, eh? How exactly does this happen? Is there a commission on TVs and cars that doles them out? Just curious.
No. There's no direct program. That's my point. Investment in the future is what created the middle class. The Montgomery GI Bill allowed veterans of World War II (and there were many) to stay out of the work force for four more years and become professionals (as opposed to laborers which is what they would have been without government subsidized education). The professionals that were the result went on to be our 'Greatest Generation'. They built companies and created wealth. But none of that would have been possible without a government funded education. Government funded.
The industry created in World War II allowed the US to produce vehicles at very low prices. This was possible because the factories that would produce them were built, in part, on the understanding of huge government contracts funded by war monies. Those war funds were all deficit spending. Now, I don't normally like the idea of deficit spending. I think that a government should spend within their means and should have deficit spending available only as a last resort (which, I believe, World War II was a good time for).
Both of these examples are where the government invested in the future by guiding the free market. They put government funds into changing the free market. No, they weren't making business leaders slaves. They were influencing the free market in such a way as to create wealth. Not all government intervention in the free market is wrong.
You stated that, "If we allow the market to set their value (keeping in mind the relative scarcity of the necessary skill sets) then we price much of our community out of access to those resources." I replied by stating that if this was true, how is it that the poor and less educated have TVs, cars, satellite television and so on. Your response is about the GI bill and what not which has nothing to do with the the fact that today the poor and less educated possess these items via the free market. If what you said was true, they'd barely have enough to eat let alone all these other non-necessities. Yet that is not the case. Because of the free market most less educated people and the poor have access and in fact possess many luxuries without ANY government assistance. How is that possible Ajatasutra without the government taking it from those who have it and handing it to them?
BTW - are you going to respond to my comments in the other thread? Your last response was simply a reiteration of my point regarding regulations and why they do not work. I'd like to see my words have helped someone who cares, like you, hold a better and more righteous position if that is in fact that case. If it is not, you should tell me why.
During the Gilded Age, American poor were lucky to have a roof and edible food and potable water. Anything else was unlikely. During the inter-war period, the downward pressure on pricing resulting from the gluts of production still did not drive prices down far enough so that factory workers could buy the things they made (cars being a perfect example).
After World War II, with the impacts of the programs I mentioned as well as the institution of the welfare state, the poor began to be able to afford these things. For two major reasons, really, 1. prices were low due to increased production capability and 2. (really the more important) wages were high because of the combination of labor shortages, increased education levels, and increased union strength. Higher wages for the poor means having the capability to buy what you make. This only became true after the government intervention during the war.
And which thread are you referring to?
The fact is, and it is evident by your lack of interest in regard to addressing the point directly, is that the poor and under educated have access to and enjoy so many luxuries today because, and only because, of the free market. The government did not redistribute TVs, DVD players, cars, and satellites to them. How is this possible if the free market would "price much of our community out of access to those resources" then why is it not true about things much less essential as the stated luxuries?
I am referring to the regulation discussion (http://www.gather.com/viewArticle.action?articleId=281474979599433), in the bottom of the thread.
Looking forward to your responses in both discussions! Thank you for sticking in there Ajatasutra, I appreciate your thoughts.
The working poor in America can afford luxuries today because of the economic pressures created by the development of a strong middle class. Why did the middle class develop in America after World War Two? Because of improved availability of education, the efficiencies created by US infrastructure, and e ability to pursue to application the technological results of war research. All of the roots of these lay in federal spending.
You assume that because the government isn't hand delivering things directly to the people, it somehow isn't socialism and/or that these events aren't tied together causally. It is and they are. It doesn't have to be a short term effect to be socialism. You have been talking as if the only way government can help the poor is by handouts direct to individuals. My point is that the systemic efforts to put upwards pressure on educational levels and on the reliability and efficiency of infrastructure is still federal spending, still socialist in nature, and is beneficial to the poor and lower middle class and results in higher standards of living for the lower income brackets.
Remember, this is supposed to somehow be a defense of your statement that if it wasn't for government intervention into our lives, only the rich would have such things as health care and education and the poor would not. Now you are saying that it is economic pressures that do it coming from the middle class instead of the government?
Quite frankly, it sounds like you are just swinging aimlessly in hopes of either changing the discussion so that you do not have defend your beliefs that you know are not correct or some other rather strange reason. One this is for sure, you are not proving that without the government the rich will have all the necessities and the poor and undereducated will not, wouldn’t you agree?
You are choosing not to see. The growth of the middle class creates jobs. The middle class would not have grown (and especially would not have become more prosperous) without government intervention in the economy. These interventions include the MGIB and government war spending in particular, but there are many others that played roles.
We're not talking about all of a sudden processes. I'm not rambling aimlessly. I've selected two government interventions in the economy that have demonstrably resulted in a growth of the middle class who, in turn, helped to create jobs and increase standards of living (ie the economic pressures mentioned earlier). Your continued insistence that I'm not saying anything coherent is simply false. My arguments follow a simple A+B=C scenario. If before World War II (specifically prior to 1929) there were less government controls on the economy and general intervention in the economy by government than there is now (I don't think anyone can logically assert to the contrary)- ie A, and if government intervention in the economy occurred in the period of World War II- ie B, and if the middle class grew dramatically after all of this government intervention in the economy when, in the preceding century the economy had been dealt with in a hands-off approach, then it stands to reason that one of the contributing causes to the growth of the middle class included the government intervention in the economy. Now, were there other factors involved? Undoubtedly. But the free market - on its own - did not result in the post war boom.
No, I would not agree. In the 19th Century in America, during a period of Laissez Faire capitalism, the rich had all the necessities and the poor and undereducated did not. Since World War II the government has had a hand at the rudder and the poor and middle classes have gotten access to a lifestyle unheard of in most parts of the world. Government intervention, therefore, established conditions necessary for this economic change.
We BOTH agree that today luxuries are prevalent among the poor and undereducated (not trying to put words in your mouth, you did agree to this). You also agree that this is true without government intervention. So I have proven my point simply by virtue of the fact that you agree with all of them. Your assumptions that somehow despite these facts the poor would have nothing and the rich would have everything (of value or of necessity, I think we both would agree that people would have at least something) does not hold water.
Still waiting on you response in the regulation discussion!!
I do not agree that the poor and undereducated have what they have without government intervention. You are putting words in my mouth. You haven't proven anything. I've done all the proving here. During the Gilded Age, the rich had everything they needed and most of what they wanted while the poor had (usually) neither and the middle class barely had what they needed. The Gilded Age is, arguably, the closest we've ever come to Laissez Faire Capitalism. What makes you think that if that was the impact of Laissez Faire in the Gilded Age, that Laissez Faire now would be any different?
So now you are saying that the government does subsidize these things for people who are uneducated and poor? Please cite proof of this. Where is the transfer of money from the rich to the poor so that they can afford cars, cable TV, and cell phones please.
I don't agree with you. Government intervention created the middle class as we know it today. It doesn't hand out things like you're suggesting. But that doesn't make government intervention any less significant in terms of how they can afford those things now.
You claim that market forces alone created the wealthy American middle class that could afford the things you talk about. That's simply untrue. Without the MGIB and government war spending, among other things, that wealth would not have been possible.
Come on man, you can do better than this. You're a very intelligent person, so please, address my question not the question you want to address.
I have addressed your question. You are choosing not to see it. I am a reasonably intelligent person, smarter than some but not as smart as others. That's not really the point. At issue here is whether government intervention increased the wealth of the poor sufficiently to enable them access to the frivolous things they can buy now in America. My contention is, and always has been, yes. So far you have not offered any countervailing evidence.
Like so many others, you do not want "health care accessible to everyone" you want a free lunch. And if that means flushing American principles down the toilet, so be it. If it means "some are more equal than others" and therefor are granted the unearned from those who may or may not be willing to give it, so be it. Just as long as you get what you want, so what, right?
This is an immoral and (obviously) un-American position, wouldn't you agree?
This is addressed in the article, "There are times, of course, in which the cost to supply a product or service is not in line with what is affordable to those who demand it. In such cases, the profit motive is by far the greatest conduit to bridging such a gap. In other words, the only rational way to make a profit is to identify a demand that is not being satisfied, and supply it in such a way that one can both make a profit and gain market share (in other word, supply it to the most people by increasing access)."
The use of the word "demand" is different in the quote. That isn't demand in the economics sense. That's demand in the "I want" sense. (Not a criticism, just a note.)
The rest of the quote is mostly magic. That is, it in no way explains how it is possible for the out of line demand to be met in such a way that a profit can be made. It merely implies that it will somehow (as if by magic) happen.
Thus I find it to be quite unsatisfying. It answers none of my questions above and tells me nothing at all about the world as we know it. :-(
@Larry - it most certainly does if you read the entire article and the citing article. Of course it is demand in the economic sense. I am not saying that the profit motive is perfect, nothing is perfect unless you live in a fantasy land. What I am saying it is the best means of getting the most for everyone and the greatest access. What alternative to you suggest?
My solution does use the free market. But our current money prevents free markets. The only way to get a free market is to change the basic and fundamental nature of our money.
If you have the time please read my novel which explains the problem and the solution in a fun way.
Have you gotten to chapters 27 and 28 as yet? I am told that it gets better about there. :-)
I'm not reiterating what I've been told. I'm saying what I've found to be true through personal research having grown up a firm Rand-loving capitalist. Neither end of the polarity is 100% correct in terms of greatest benefit. If it were true that you could only have one or the other, then I would agree with you. But it's not true. Programs like the Federal highway system prove that. Massive government spending in infrastructure made our economy incredibly more productive per laborer than our competitors. Was that increase in capability a government monopoly? No. Simply the infrastructure to make industry better. Ports and highways and educational levels and health standards all make a nation more economically stable and productive. They are also areas of investment too broad, long reaching, and complicated for corporate investors to be interested in making them happen. So they will never be adequately actioned by the private sector. It takes the government investing in these fields, intelligently, to create an environment wherein the economy can act.
Just like the legal framework necessary to ensure good business. Unfair business practices have crushed many more start-ups in history than have regulations. Monopolies (like US Steel and Standard Oil - those who built their monopolies themselves), sucked up, crushed with undervaluation, and what-have-you an insane number of business rivals. And they did so in world in which there weren't any laws prohibiting it. Those monopolies then proceeded to do what all monopolies do - they raised prices and offered worse service.
It is in the natural state of any competitive system for someone to win. Laissez faire capitalism would allow that to happen. Obviously, this isn't in anyone's best interests.
I've offered both theoretical models and concrete examples of situations in which Laissez Faire capitalism cannot achieve what you think it can. The only solution is capitalism tempered by limited government intervention.
But economies are too unstable for the balance between private wealth and government regulation to be maintained. As we know, big money interests soon gain control of government for the advantages that can be so gained. Those advantages are used to gain still more advantages until either government swallows all or a few "capitalists" swallow all. (Capitalists don't control government in theory so the label doesn't really fit what exists in real life.)
Do you believe, Ajatasutra, that one has a right to their own life? Do you believe we should all be equal under the law? Do you believe that if a person has not committed a crime or used force or fraud against another individual they should be free to live as they see fit? If you do, you are a laissez faire capitalist.
Any compromise of these values means they are not a value at all. There is a middle of the road, "well it is okay to violate this person's right to equality under the law because he or she has more money and this person needs it so therefore we can make an exception." Immediately at that point equality under the law is NOT a value said person holds. Even if they advocate for it once, it is over. That is the nature of a value system and principles, they are not subjective.
What you are suggesting is that they are, and that is simply wrong Ajatasutra.
You write like a libertarian. :-) I think you are really going to like the society / economy I describe in my novel.
I don't want laws and the government intervention that goes with it to prevent me from doing things any more than anyone else does. But I do like it when the government prevents someone else from doing something bad to me. That's the primary effect of laws. They get everyone's heads pointing the same direction when it comes to certain outcomes. If we all believe that theft is wrong, and there is a law against it, then there will be a large number of persons who, without the law against it, would have committed the crime, but choose not to either out of fear of punishment or social ostracism that occurs as a result of breaching the public trust.
Taxation is not a violation of someone's rights. It is a natural result of the desire for a structure to defend rights. That structure that defends rights takes many forms and some are more tangential to their enforcement than others. If we remove taxation then we remove government. A lack of government means no one to stop the thug from getting his friends together and stomping into your home or mine and doing things we don't want.
The poor simply do not have the wealth to support these structures. Additionally, due to the fact that their needs have been met so rarely in their lives, they are the most likely to act out. Tax the poorest and you get the French Revolution. It happened in Rome and Greece, the Papal States, and elsewhere before and since.
Progressive taxation is the only feasible way to support internal security, external security, and provide for social safety nets that ensure that the people (the poor and working poor) remain loyal to the regime. When a government forgets that it is through the support of the poor and the blue collar laborers that nations are forged and remain strong, it soon withers and disappears.
Values of the type you suggest are unsupportable. Life is complicated and gray and not clean or neat or pretty. We like to frame our lives in easy blacks and whites but the fact of the matter is that there are infinite possibilities that cannot be managed by such narrow ideas. Is homicide always wrong? No. Demonstrably. War, self defense, the defense of loved ones... I could go on. So you don't really have the right to life. You have the right to life until you abrogate it by threatening (note not taking) someone else's life. Do you have the right to be treated equally under the law? Well, am I as equal as someone who can afford millions of dollars in legal fees? No. And I never would be in a laissez faire capitalist society, regardless of what the document says. How do you define fraud? Were cigarettes marketed fraudulently? What about the Ford Pinto? The word fraud implies deceit, and marketing is, by its very nature, a deceitful process. You don't need the things that marketers try to sell to you. But they intend to make you feel like you need them. So is all marketing fraud? Probably not. But how do you sift through all of that bad for the good?
Life is subjective, John. We make the best choices we can based upon principles we are taught. I'm blatantly saying it. Values are subjective and must be. To think otherwise is to oversimplify a world full of nuance and complexity. We must be taught values in order to live moral lives. And those values must help a person build a framework for what right looks like. And any violation of those values results in a personal cost- emotionally, psychologically, and ultimately physically. But there are situations in the world that make us violate our values, whether we want to or not. One can, in the right circumstances, fall on ones' sword. But you have to keep in mind who else pays the price for that act. Sometimes, if it's better for loved ones or others that we compromise ourselves rather than take a noble stand, then we would be remiss to take a stand. Life is complex and messy. To say otherwise is folly.
If you read the novel you will see that my ideas are ready for execution within two years of the decision to adopt them. It really can be done very quickly.
2. I never said I was against taxation. "Taxation is not a violation of someone's rights. It is a natural result of the desire for a structure to defend rights is correct. Yet what you are advocating is not rights but privileged. If a rich person does not have the right to take form a poor person to fund his or her needs, neither does the poor person have that right. A right is not a right if it applied to people differently. In such case it is not a right at all but a privileged.
3. Many things in life are subjective and not black and white, but that is not true in relation to principles. As soon as they are not black in white, they cease to be a principles but a policy. What you advocate is a principle-less society Ajatasutra. A society that I do not want my children to experience.
Your advocacy for a society were people do not have a right not their own lives and are not equal under the law is an immoral society and un-American. Sorry, but that is a fact.
Outstanding point on 1. So few people understand that our "rights" are not possessions of individuals but are, rather, limitations on government. I like to see people make that point.
So are you arguing against the progressive tax system or against the social safety net? I've already pointed out how the social safety net is a system that protects our society from internal revolutions. So are you for internal populist revolts, or just against the progressive taxation system?
I don't advocate a principle-less society. I'm arguing that government must temper its zeal with respect to 'principles' in order to provide good government for everyone. Good government for everyone means finding policies that are good, not just for the rich or the poor, but for both. In order to be good for both, neither set of principles (populist or elitist) can be enacted (primarily because the principles of one are intended to bring the other low - or lower). In a world of pure principles, there is only the one or the other. So we can either be good for the people or we can be good for the elite. Our Constitution, while purporting to be 'for the people' really meant for the land-owning, slave holding, elite. Is that really what we want our government supporting?
You are advocating a society that supports the elite on the broken backs of indentured servants and slaves. That's not a society I want my children to experience. You are advocating an immoral society and an un-American one. Sorry, but that is a fact.
I have hopes that when John finishes reading my novel he will become an advocate for my solution which benefits rich and poor alike (though in different ways) and makes it impossible for the government to oppress. It makes obvious that one part of the society cannot suffer without all parts suffering. Rather than the deceptions of our current money which lead people to believe that we are in a zero-sum game situation, my solution makes obvious or mutual interdependence.
I'll state it again and I would like you to either prove it wrong or accept it - a principle has to be applied the same way to everyone or it is not a principle, it is a policy. If I say that on principle I do not eat meat because I think it is wrong (this is just an example, I eat meat), and I have a cheese burger a week later and then made the same statement after, is that a principle? Of course not, by definition.
"So we can either be good for the people or we can be good for the elite." This simply is not true. If everyone is equal under the law and free to pursue their own self interests as long as they respect the equal rights of everyone else, everyone is equal. As long as the initiation of force and fraud is punished severely, adults should be allowed to enter freely into contracts and relationships through their own free will. Regardless of what you think, I think, or even the president.
The society you advocate results in one group taking advantage of another group by granting them special rights. No one is equal under the law, and only those who can curry favor from politicians come up on top. This view is wrong, immoral, and un-American.
A good example - is it a principle by which one should live one's life to throw away trash and recycle as best as you can? If so, then every time you see a fragment of trash on the ground you must, always stop to pick up said trash, otherwise it's not a principle.
I'm not advocating for the poor to take advantage of the rich any more than you are advocating the inverse. If the wealthy are not contributing back into society, then that is exactly what is happening. The wealthy, to this day, get away with things that the poor cannot. They take advantage of the poor every day and in every way. The mistaken belief that all of the people on welfare put together could possibly hope to compete with the degree of thievery that the wealthy have perpetrated on the American people is simply foolish. They take advantage of Americans much more than the poor, regardless of whether there's a welfare state or not. Why, then, are you targeting the small thieves when the big thieves steal so much more?
There were many small revolts prior to the progressive tax system. Union thugs, the violence around Hoovervilles, the Civil War, etc etc. All of these were fundamentally about the relationship between the wealthy and the labor they employed. The country was chaotic with labor violence from its inception to the institution of the progressive tax system. Even after there've been tensions, but significantly less actual violence.
I would like you to prove that a Laissez Faire, despite all historical evidence to the contrary, can provide stable growth that does not result in the wealthy taking advantage of the poor. 100 hour work weeks, child labor, monopolies, tainted food, snake oil, and unsafe business practices are the norm in an unregulated economy. Is that really what you want?
Proof that capitalism works? Sure, America at its onset was more capitalist than any country in history and in a about a couple of hundred years, a blink of an eye history-wise, went from not even being a country to the greatest super power that has every existed. Surpassing hundreds of statist countries that had been around much much longer than she in no time.
I am sure you are so stuck on extorting something from other people so you can get something for nothing, Ajatasutra, that you will continue to deny this fact, but it is the truth.
You pointed out above how many of the poor or less educated have fantastic "toys" - cell phones, CDs, DVDs and the players to go with, etc. What I've never understood is how any parent can choose these luxuries over taking care if his/her child (ie adequate food and medical care).
I so often say a right is not a right unless it applies to everyone in the exact same way. So many people (on both the left and the right) look at me like I have five heads when I say it . . .