While much (MUCH!) has been said about health care, and various suggestions for improving it have been put forward by both the right and left, no one, it seems to me, is addressing the real reason for escalating health care costs in the US. The chief cause of any price increase is an imbalance between supply and demand. In this case, the demand for physicians far outstrips the supply, and so the price of a even a simple visit to the doctor’s office is becoming prohibitively expensive to a growing number of people.

The reason for the imbalance in supply and demand is the mechanism we use to mint new physicians. In order to practice medicine in the US, one must attend an accredited medical school, generally after earning a bachelors degree. This is fine and well. The trouble arises out of the fact that the only body currently authorized to accredit medical schools is the Liaison Committee On Medical Education (LCME), which is intimately affiliated with the AMA. If one were to somehow attend a medical school accredited by some other agency, one would be ineligible to take the United States Medical Licensing Examination (USMLE) and therefore unable to practice medicine in the US.

As the sole body accrediting medical schools, the LCME dictates the number of medical schools in the country and the size of each class. For an already accredited medical school, increasing the size of their classes requires approval from the LCME. So the AMA exerts tremendous influence on how many new physicians are created per year.

The LCME asserts that they seek to insure that only the best educated people can practice medicine. They insure this, they would say, by only allowing the most qualified educational institutions to educate only the number of people they can do so optimally. And there is probably truth in this. What should be clear, though, to even the most casual observer, is that the AMA can in no way be objective about how many physicians the country needs. For every “extra” physician created, the supply is increased, and so health care costs and physician salaries could decrease. This fact can not be lost on the AMA.

Whatever their intentions, it seems unavoidably clear that as long as people already in a profession are allowed to control how many new people can join that profession, the costs of receiving professional services will remain high and even climb. No serious health care reform can take place until the issue of physician supply is corrected.

All the information about the LCME for this post was gathered from their website (lcme.org)’s FAQ.