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> Markets serve the person with bargaining power. If doctors and drug companies have all the bargaining power -- and in the most important health care situation

> Markets serve the person with bargaining power. If doctors and drug companies have all the bargaining power -- and in the most important health care situations, they do -- why do you think a free-er market will give you a better deal? Contrary to popular opinion, doctors have close to zero bargaining power in the US. That's why private practices have been rapidly shutting their doors over the last 10-15 years - they've been losing money, so they've had to sell their practices to large provider networks. But even those hospital networks don't have much bargaining power, which is why many of those have been going out of business and either shutting their doors or consolidating in the last 5-10 years.

randysavage 8y ago
Anecdotal, but I worked for a specialty EMR and consolidation was the big trend at the time (~2010). Lots of one-offs and small chains getting acquired and folded into larger networks. Many of these smaller providers were either not or barely profitable and we saw plenty of others go under. Long term strategy for the EMR was focusing on the hospital networks because the trend seemed clear at the time.
jjoonathan 8y ago
My point: the consumers are powerless. Whether doctors are individually powerful or only powerful as a member of an organization is entirely tangential, except in that the consumer is even less powerful in the second case. EDIT: I now have two people providing evidence that actually reinforces my core point in order to argue with me about a synechdoche. I don't know whether to laugh or cry.
- chimeracoder 8y ago
  > My point: the consumers are powerless. Yes, but that's a far cry from saying the doctors are powerful. They're not. They're powerless too. > Whether doctors are individually powerful or only powerful as a member of an organization is entirely tangential. Doctors are neither powerful as individuals nor as members of any organization. Despite common misconception, they have almost as little power as patients do.
  - jjoonathan 8y ago
    s/Doctors/Health Care Providers then. The more you insist on precision, the less accessible this debate becomes. I hope you have a good reason. The salaries say that doctors are more powerful than patients -- but we both agree that they are powerless compared to the organizations that employ them. What of it?
    - chimeracoder 8y ago
      > s/Doctors/Health Care Providers then. The more you insist on precision, the less accessible this debate becomes. I hope you have a good reason. Yes, because there's a big difference between doctors and provider networks, and as I've already explained above, neither has the level of power that people generally believe they do. > The salaries say that doctors are more powerful than patients I have no idea what this is even supposed to mean. You're not comparing like quantities. > we both agree that they are powerless compared to the organizations that employ them. No, we don't, because I've already said that the hospital networks (which employ the majority of doctors these days) don't really have much power either.

randysavage 8y ago

Anecdotal, but I worked for a specialty EMR and consolidation was the big trend at the time (~2010). Lots of one-offs and small chains getting acquired and folded into larger networks. Many of these smaller providers were either not or barely profitable and we saw plenty of others go under. Long term strategy for the EMR was focusing on the hospital networks because the trend seemed clear at the time.

jjoonathan 8y ago

My point: the consumers are powerless. Whether doctors are individually powerful or only powerful as a member of an organization is entirely tangential, except in that the consumer is even less powerful in the second case. EDIT: I now have two people providing evidence that actually reinforces my core point in order to argue with me about a synechdoche. I don't know whether to laugh or cry.

chimeracoder 8y ago
> My point: the consumers are powerless. Yes, but that's a far cry from saying the doctors are powerful. They're not. They're powerless too. > Whether doctors are individually powerful or only powerful as a member of an organization is entirely tangential. Doctors are neither powerful as individuals nor as members of any organization. Despite common misconception, they have almost as little power as patients do.
- jjoonathan 8y ago
  s/Doctors/Health Care Providers then. The more you insist on precision, the less accessible this debate becomes. I hope you have a good reason. The salaries say that doctors are more powerful than patients -- but we both agree that they are powerless compared to the organizations that employ them. What of it?
  - chimeracoder 8y ago
    > s/Doctors/Health Care Providers then. The more you insist on precision, the less accessible this debate becomes. I hope you have a good reason. Yes, because there's a big difference between doctors and provider networks, and as I've already explained above, neither has the level of power that people generally believe they do. > The salaries say that doctors are more powerful than patients I have no idea what this is even supposed to mean. You're not comparing like quantities. > we both agree that they are powerless compared to the organizations that employ them. No, we don't, because I've already said that the hospital networks (which employ the majority of doctors these days) don't really have much power either.