Abundance

by Ezra Klein

Sometimes being a bottleneck detective is about removing restrictions that shouldn’t exist. The US has fewer primary-care physicians as a share of its population than almost any other rich country, despite having the world’s most expensive health-care system. This shortage is partly by design. In the early 1980s, a special committee established to review the state of American medicine reported to the US Department of Health and Human Services that the US was on the verge of a massive surplus of doctors. Physician groups backed up the finding. “The size of medical schools must be diminished,” Charles Evarts, the president of the American Orthopaedic Association, said in a 1985 speech. “Certain programs need to reduce their numbers, others must consolidate, and others need to terminate voluntarily or be terminated.”68 Starting in the 1980s, the government cut its support for medical schools and medical students, and many universities agreed to freeze the number of new studies and stop construction on medical programs. Between 1980 and 2005, the number of medical-school matriculants essentially flatlined69 as the US added 70 million people.