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I think the credentialing in medical practice has more to do with the stakes involved than in some salary-padding or labor-control scheme. Patients want to be a
by pixelmonkey 9y ago
I think the credentialing in medical practice has more to do with the stakes involved than in some salary-padding or labor-control scheme. Patients want to be able to enter a hospital and have confidence that, when push comes to shove, even the worst MD on call is a better option than a "no-op" treatment.
Also, exorbinant salaries and good hours are not to be found in the hospital system. Yes, specialist doctors get paid "well", but not exorbinantly, when adjusted for required training, education, experience, and opportunity cost. In private practice, the hours are better, yes -- but only in certain subspecialties. But this is like saying major airline commercial pilots should just fly private charters for a better lifestyle, or that software engineers should just work at hedge funds as quants for better compensation.
It's the hospital system, not private practice, that shows us a healthcare system where doctors are being put to their unique purpose of advanced clinical treatment. And that's where the market is failing.
Healthcare requires the hospital system to provide the most advanced and emergent forms of care, and that is where doctors are overworked and undervalued.
As for the free market, I wish you were right that it could fix the US healthcare system. But patient health is, unfortunately, not valued correctly by the market. The market rewards chronic treatment, whereas society prefers one-time cures. The market tries to monetize patient-doctor interactions, whereas society would prefer fewer doctor visits with fewer hospitalizations. The market treats doctors as a cost center whose hours needs to be billed out at a profit, and society would prefer doctors as a value center who are given the professional leeway to use clinical judgment in assigning time to cases and patients.
I love market systems, but only when they work.
- pdonis 9y agoYou are blaming the failings of the US healthcare system on "the market", but the market in health care in the US is not anywhere close to a free market. Some key reasons why not: (1) The supply of doctors (and other health professionals) is restricted by licensing, not driven by the demand for their services. (2) The price of health care is not determined by supply and demand, but by various regulatory arrangements and bulk agreements which often do not involve either the producers (doctors, hospitals, etc.) or the consumers (patients) of the services. So the parties who are determining the prices are the ones with the least possible stake in the outcome. (3) The consumers of health care, patients, are almost always unaware of the cost of the services they are getting, so they have no way of knowing whether those services are worth more than they cost, and hence no way of signaling where health care is being inefficiently provided. (4) What the US healthcare system calls "health insurance" is actually a combination of insurance and prepaid health care. Insurance is supposed to be for unforeseen costly events, but most health care does not consist of unforeseen costly events but of predictable expenses (annual physicals, shots) and unforeseen not very costly events (you go to the doctor with the flu, get an exam, and are told to rest and drink lots of fluids). (5) Prescription drugs are regulated by a regime (the FDA) that is heavily penalized if an approved drug has any bad effects whatsoever, but suffers no penalty whatsoever for keeping helpful drugs off the market for years while they undergo "testing" and hence depriving large numbers of people of their benefits. I'm sure there are more, but those are just the ones I came up with off the top of my head.
- stale2002 9y agoWhy would you as a consumer reward cronic care, vs a one time cure? I myself would prefer the one time cure, and would be willing to pay for it. In a perfectly free market, my demand for the one time cure would be represented by market forces. Now ask yourself, what is it about the healthcare market, that PREVENTS my market demand for a one time cure, as a consumer, from effecting the market?