5 ms·

If you're so apathetic as to be actively harmful that's still malicious. Also, as they are actively looking to increase profits, I can't possibly see how this

If you're so apathetic as to be actively harmful that's still malicious. Also, as they are actively looking to increase profits, I can't possibly see how this is "apathetic". Quit making excuses for garbage people.

ethbro 8y ago
You know what's easy? Blaming people. "How could they be so evil / greedy / stupid / mean / etc? Don't worry. We'll fire them and bring in new people. Everything fixed." You know what's harder but more productive? Admitting there are systemic, structural issues. And having enough compassion for people trying to do their jobs. Because suddenly there's no easy scapegoat. And the only response is to actually change the system. -- The issue with the US health system isn't some malevolent Oz pulling strings behind the scenes, but that none of the legally defined and empowered players have their interests fully aligned with the patient.
- AnimalMuppet 8y ago
  Worse: Some of the players have their interests exactly the opposite of other players. In particular, the doctors want to get paid, and the insurance company makes money partly by finding ways to not pay doctors. So the insurance companies pay people to find ways to not pay doctors, and the doctors pay people to find ways to get the insurance companies to pay. (Almost?) all of those people, on both sides, are a net lost to society as a whole.
  - ethbro 8y ago
    And that's partly my point. Does the doctor want to kill you? No, he or she wants to heal you and be paid well. Does the claims analyst at the insurance company want customers to die? No, he or she wants to pay as little as possible while keeping you healthy. And yet when both of these players are placed in the system we've constructed, the strictly dominating, logical strategies for both are sociopathic. And so they adjust their behavior in that direction. I'm hopeful that pushing outcome-driven analytics onto the medical field will drive a lot of productive change. The whole reason we abstracted care choices from payment is that we couldn't answer the question, "How much is this procedure / test / consult worth to you?" And without that, we're waving our hands in the air as to whether or not it makes sense to skip an MRI scan.
    - dredmorbius 8y ago
      Bad assumption: "Indiana cardiologists sued for alleged unnecessary surgeries" (October 28, 2014) MUNSTER, Ind. (WLS) -- Dozens of people are joining a lawsuit filed against three Northwest Indiana cardiologists as well as Munster Community Hospital for allegedly performing unnecessary procedures. After two patients announced legal action six months ago, dozens more have come forward accusing three Indiana doctors of medical malpractice and, in some cases, wrongful death. Lawyers say their investigation has revealed that 75 percent of heart procedures were performed unnecessarily.... http://abc7chicago.com/health/indiana-cardiologists-sued-for-alleged-unnecessary-surgeries/370155/ http://abc7chicago.com/health/indiana-cardiologists-sued-for... More: https://scholar.google.com/scholar?q=unnecessary%20surgery&btnG=Search&as_sdt=800000000001&as_sdtp=on https://scholar.google.com/scholar?q=unnecessary%20surgery&b... (550,000 results) https://duckduckgo.com/?q="unnecessary+surgery"+fraud https://duckduckgo.com/?q="unnecessary+surgery"+fraud
      - ethbro 8y ago
        The example does not disprove the point. Somewhere around 50M surgeries / year. Some of those are going to be bad. If you want to talk about defensive medicine and financial and legal malincentives that pressure doctors into anti-patient choices, I'm all ears. Freakonomics had a great mini-series on that. But pointing to horrific botched or fraudulent surgeries and acting outraged? Meh. I accepted some humans were immoral a long time ago. If it's most surgeons or many surgeons, or they aren't getting sued and/or charged with malpractice, then it's an issue. Otherwise, I leave it to the local nightly news.
        dredmorbius 8y ago
        The extreme cases both refute your blanket allegations of fundamental goodwill and strongly suggest there might be a substantially larger set of less-nefarrious and malevolent, but still corrupt practices: Insurance and workers comp fraud, overprescriptions, unnecessary labs and imaging, pharma kickbacks, the opioids crisis and Perdue pharma specifically, device and equipment practices, and far, farr, far more. The fundamental problem is that in the US, most providers are paid to render services, drugs, and equipment, but not for making or keeping patients and populations healthy. Payors (insurance companies and administrators) are similaly incentivised on profits, not outcomes.
- tedajax 8y ago
  Suggesting there aren't malicious forces actively pushing for their bottom line over say, structural changes that would improve healthcare for everyone is really really dumb. Sometimes there really are just evil greedy people being bad.
  - ethbro 8y ago
    Are there greedy people out there? Of course. Do I spend time focusing on them? Not a minute. That's what the justice system is for, and it's not terrible at punishing people who break the law. Th difference is in outcome. If you focus on people, you get to feel righteous, targeted anger, and nothing ever changes. If you focus on the system, you're left viscerally unsatisfied ("The US healthcare system is dysfunctional? I can't yell at that..."), but might effect real change.
  - beaconstudios 8y ago
    often, the malicious force actively pushing for increasing profits is systemic itself - the responsibility of public company executives to maximise shareholder value. also, most of the time I think "evil greedy people" is just people who are far enough abstracted away from the impact of their deeds that they have no connection to the impact. If you're looking at departmental budgets all day, you probably don't see the patient who gets refused treatment.

ethbro 8y ago

You know what's easy? Blaming people. "How could they be so evil / greedy / stupid / mean / etc? Don't worry. We'll fire them and bring in new people. Everything fixed." You know what's harder but more productive? Admitting there are systemic, structural issues. And having enough compassion for people trying to do their jobs. Because suddenly there's no easy scapegoat. And the only response is to actually change the system. -- The issue with the US health system isn't some malevolent Oz pulling strings behind the scenes, but that none of the legally defined and empowered players have their interests fully aligned with the patient.

AnimalMuppet 8y ago
Worse: Some of the players have their interests exactly the opposite of other players. In particular, the doctors want to get paid, and the insurance company makes money partly by finding ways to not pay doctors. So the insurance companies pay people to find ways to not pay doctors, and the doctors pay people to find ways to get the insurance companies to pay. (Almost?) all of those people, on both sides, are a net lost to society as a whole.
- ethbro 8y ago
  And that's partly my point. Does the doctor want to kill you? No, he or she wants to heal you and be paid well. Does the claims analyst at the insurance company want customers to die? No, he or she wants to pay as little as possible while keeping you healthy. And yet when both of these players are placed in the system we've constructed, the strictly dominating, logical strategies for both are sociopathic. And so they adjust their behavior in that direction. I'm hopeful that pushing outcome-driven analytics onto the medical field will drive a lot of productive change. The whole reason we abstracted care choices from payment is that we couldn't answer the question, "How much is this procedure / test / consult worth to you?" And without that, we're waving our hands in the air as to whether or not it makes sense to skip an MRI scan.
  - dredmorbius 8y ago
    Bad assumption: "Indiana cardiologists sued for alleged unnecessary surgeries" (October 28, 2014) MUNSTER, Ind. (WLS) -- Dozens of people are joining a lawsuit filed against three Northwest Indiana cardiologists as well as Munster Community Hospital for allegedly performing unnecessary procedures. After two patients announced legal action six months ago, dozens more have come forward accusing three Indiana doctors of medical malpractice and, in some cases, wrongful death. Lawyers say their investigation has revealed that 75 percent of heart procedures were performed unnecessarily.... http://abc7chicago.com/health/indiana-cardiologists-sued-for-alleged-unnecessary-surgeries/370155/ http://abc7chicago.com/health/indiana-cardiologists-sued-for... More: https://scholar.google.com/scholar?q=unnecessary%20surgery&btnG=Search&as_sdt=800000000001&as_sdtp=on https://scholar.google.com/scholar?q=unnecessary%20surgery&b... (550,000 results) https://duckduckgo.com/?q="unnecessary+surgery"+fraud https://duckduckgo.com/?q="unnecessary+surgery"+fraud
    - ethbro 8y ago
      The example does not disprove the point. Somewhere around 50M surgeries / year. Some of those are going to be bad. If you want to talk about defensive medicine and financial and legal malincentives that pressure doctors into anti-patient choices, I'm all ears. Freakonomics had a great mini-series on that. But pointing to horrific botched or fraudulent surgeries and acting outraged? Meh. I accepted some humans were immoral a long time ago. If it's most surgeons or many surgeons, or they aren't getting sued and/or charged with malpractice, then it's an issue. Otherwise, I leave it to the local nightly news.
      - dredmorbius 8y ago
        The extreme cases both refute your blanket allegations of fundamental goodwill and strongly suggest there might be a substantially larger set of less-nefarrious and malevolent, but still corrupt practices: Insurance and workers comp fraud, overprescriptions, unnecessary labs and imaging, pharma kickbacks, the opioids crisis and Perdue pharma specifically, device and equipment practices, and far, farr, far more. The fundamental problem is that in the US, most providers are paid to render services, drugs, and equipment, but not for making or keeping patients and populations healthy. Payors (insurance companies and administrators) are similaly incentivised on profits, not outcomes.
tedajax 8y ago
Suggesting there aren't malicious forces actively pushing for their bottom line over say, structural changes that would improve healthcare for everyone is really really dumb. Sometimes there really are just evil greedy people being bad.
- ethbro 8y ago
  Are there greedy people out there? Of course. Do I spend time focusing on them? Not a minute. That's what the justice system is for, and it's not terrible at punishing people who break the law. Th difference is in outcome. If you focus on people, you get to feel righteous, targeted anger, and nothing ever changes. If you focus on the system, you're left viscerally unsatisfied ("The US healthcare system is dysfunctional? I can't yell at that..."), but might effect real change.
- beaconstudios 8y ago
  often, the malicious force actively pushing for increasing profits is systemic itself - the responsibility of public company executives to maximise shareholder value. also, most of the time I think "evil greedy people" is just people who are far enough abstracted away from the impact of their deeds that they have no connection to the impact. If you're looking at departmental budgets all day, you probably don't see the patient who gets refused treatment.