Yale Basketball gym repositioned as field hospital. Caption Hospital beds in the Gym. Libraries closed. Classes online facing Down Covid-19. The 1790s epidemics that shut down Yale. Yale Alumni Magazine Cover May June 2020.

Here is an alternative to medical subsidies. Vast enough for the 50 states, scalable, and does not require federal legislation. In February 2020,  Congressman Gosar filed a bill to respond to the King vs Burwell law suit of 2015  which extended tax credits – subsidy – to all persons. There are other responses, besides more subsidies. Open a thousand medical schools, instead of extending subsidies.  Since 1975, from time to time proposeals have been made for opening more medical schools. This may now be the time for real consideration. We know that health care is eating the resources for national security like a pac man eating yellow dots (whoa, back in the day).   Health care has eaten up all resources otherwise available to the space program, academia, defense, and air force.

   Health care’s costs increased at a rate three times inflation for decades with limited or no access for rural and poor portions of the population. Thi is a problem a century in the making.   The proposal is to return to a free market in health education, and then the health industry.  If a grand enough alternative is not proposed, after the decision on subsidies, the pressure will be enormous to continue subsidies anyway. 

             America has fewer medical schools now than a century ago, because of the Abraham Flexner’s  report which closed all women’s schools and dozens of medical schools, including all but three of the ‘black’ schools. – Ron Paul criticized Flexner in 2009.  The Flexner Report put a  Stranglehold on medical schools and caused a national Doctor shortage.  The shortage is  a regular topic, wringing hands, but nothing was done.   The Medicare business model estimates the years to Equilibrium for the cost for expanding medical physician training,    which eventually cures the shortage of health professionals with minimum legislation.

The only legislation needed is for each state to authorize license from a state approved medical school (removing the Department of Education which granted AMA authority to accredit and limit medical schools by withholding AMA approval). If a state already licenses its doctors, irrespective of the AMA, this is not an item of legislation.  Although the AMA denies this, the AMA has carefully, methodically, gone state by state to get the limitations written into state law.

Many  more seats will restore market based incentives in health care.

Expanding medical school seats can be presented as the renewal of an earlier proposal, not just responding to loss of subsidies, as it was proposed in Connecticut in 2002. (and Congress in 2009)

             Scalable – new medical school seats can be opened state by state, any and all. No new federal legislation is required.   Funding sources are already in place without legislation – i.e. student loans have no cap and can be used for full costs, and repayment is available at very favorable rates by paying interest only and working for a government or NGO, or non profit for 10 years and the loanl is satisfied. Students are immediately available from the MCAT pool, which has tested twice the number of test takers, as compared to available seats, for decades.  The extra help at each hospital can shoulder some of the burden on uninsured, or former subsidy patients. New seats relieves pressure on B-1 Visas, side steps issues of immigration, and federal red tape.

These are relatively short papers to introduce the problem.

A suggestion for the  Republican Platform on Health Care in Connecticut, May 23, 2002 called for opening 100 new medical schools in Connecticut, each with 100 seats, to train 10,000 health care providers a year, at a cost of $1.3 Billion

Utah and Nevada, with three medical schools, but hundreds of insurance companies, would benefit  from a plan to open hundreds of medical schools. 

The Flexner Report’s Stranglehold on Health Care

Congressman Ron Paul recently gave a speech on the House floor covering the topic of health care. In it he brought up the Flexner Report, an item that few individuals have even heard about that is worthy of much more attention than it currently receives.

A lot of problems were created in 20th century as a consequence the Flexner Report (1910), which was financed by the Carnegie Foundation and strongly supported by the AMA. Many medical schools were closed and the number of doctors was drastically reduced.  The motivation was to close down medical schools that catered to women, minorities, and especially homeopathy. We continue to suffer from these changes, which were designed to protect physicians’ income” — Ron Paul; September 24, 2009 MORE GOVERNMENT WON’T HELP — (House of Representatives – September 23, 2009) [Page: H9873]

The seeds of the Flexner Report were planted in 1908 when the Carnegie Foundation for the Advancement of Teaching commissioned Abraham Flexner, a high school principle, to research and report on medical schools in the U.S. Flexner himself was not involved in the medical industry, but after being asked to take on the report he researched and grew fond of the medical systems in England, France, and Germany.

In the report, which was officially published in 1910, Flexner called homeopathic schools “a striking demonstration of the incompatibility of science and dogma.” What’s curious is that Flexner points out that between 1900 and 1909 homeopathic schools decreased from 22 to 15 and students within the schools decreased from 1,909 to 1,009. Flexner uses these figures to conclude that “the rise of legal standard must inevitably affect homeopathic practitioners.” In short, even with the marketplace whittling out the unproductive and unsustainable homeopathic colleges (or any colleges, for that matter) that Flexner clearly did not appreciate, he still advocated increased government intervention to further clear out homeopathic schools.

Flexner believed the problems in medicine were primarily because there were too many doctors and medical colleges. “The country needs fewer and better doctors; and…the way to get them better is to produce fewer.” The flaws of Flexner’s arguments and his general report is that he may indeed have made some noticeable observations, but he did not consider the economic consequences of increased government intervention, a centralized medical system in the hands of the American Medical Association (AMA), and the impact of fewer doctors and medical schools.

Basic economic common sense tells us that when you forcibly remove one product without subsequently lowering demand, you will increase the price of that product. Less supply without less demand means higher prices. The homeopathic schools that Flexner so strongly criticized may have lacked in some areas of educational standards compared to more traditional health schools, but they provided a key element of competition for allopathic medicine and an essential choice for individuals who needed health care.

Basic economics also tells us that weak products and services are bound to fail to the competition due to inefficiency and poor judgment. As I previously mentioned, Flexner’s own research displayed that homeopathic schools were struggling to stay open and maintain steady attendance. Their services had difficulty competing in some cases, and those schools (or services) disappeared or were in the process of failing.

The publishing of the Flexner Report in 1910 led to many educational reforms. Among Flexner’s final proposals included extending years spent in health education (two years in undergraduate collegiate studies and four years in medical school), increasing the caliber of medical schools to universities, expanding government involvement in medicine, decreasing total graduates to 3,500 from 4,500, and bringing the total amount of medical schools in the U.S. from 150 to roughly 31. In short, Flexner proposed a medical system driven not by the free market and individuals, but a manipulated system molded by some of the wealthiest men and foundations in the world. In fact, the Rockefeller Foundation donated large sums of money to schools who followed the model recommended by the Flexner Report.

One of the unfortunate impacts the Flexner Report had on medical education was the shut-down of many schools geared toward disadvantaged rural areas, African-Americans, and women. Because of mandated school time regulated by the AMA and state governments, only those wealthy enough to afford at least six years of college had a chance at becoming a licensed doctor. This essentially limited the market for prospective doctors to wealthy white males. (All but two African-American medical colleges were closed.)

The flaw with the Flexner Report is the same flaw that has brought us to today’s broken medical system. When a product is forcefully limited to be provided by a certain central group (in this case the AMA), it will reduce choice and competition. Choice and competition in a free marketplace are what drive businesses to become more efficient and productive, which provides the greatest possible benefits to individuals who are able to freely buy and sell in the market. A strong, sustainable system built for individuals cannot come from a manipulative central source, it must come from the demands and choices of the people whom it is intended to help.

Government regulatory standards do not necessarily serve the individual as many people believe. In the case of medical care, the Flexner Report recognized many flaws with education that the free market was already weeding out on its own. Rather than allow people and communities to make their own choices with doctors, medicine, and education, it was all placed in the hands of the AMA and state governments, thus limiting the supply. This resulted in less doctors, more expensive education, and decreased access to medical care.

A central system concentrates power into the hands of a select few individuals, groups, and organizations who have the means to control that respective market. A free market divides that power among individuals who have the ability to make their own decisions themselves and through their communities.

Concentrated control, as proposed and implemented in the Flexner Report, is the direct cause of the majority of problems with health care today. The solution does not lie with more government intervention and centralized power, but rather with increased individual freedom. The answer is not centralized power in government, but centralized power within ourselves.

Flexner Report –

According to its Wikipedia story, the 1910 Report by Abraham Flexner (1866-1959), called for controlling health care by controlling medical schools. Flexner was paid by the Carnegie Foundation. Flexner and Carnegie believed there were too many medical schools,  many  substandard, and that pre-requisites were needed for the study of medicine. In 1910, out of 155 Medical Schools in the United States and Canada, only sixteen required two or more years of college work for entrance (p 28).  So half of the schools were closed, including all women schools, all except 3 [traditionally black] schools.  

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