3 ms·

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

by 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.
- ethbro 8y ago
  There are three possibilities. 1) Extreme cases are pervasive 2) Extreme cases occur but are rare 3) Extreme cases never happen Aside from the absurdity of abusing statistically-defined adjectives, I'll assume you know what I mean. The health care industry is BIG. Things happen a lot, even if they're only 0.01% of the time. I haven't seen any proof that indicate (1) is true, previous shock post included. And if it's not, it's not the most important problem to focus on. In contrast to, say, the incentives you note.
  - wu-ikkyu 8y ago
    The perverse incentives are what create the extreme cases. It's plainly obvious that the US healthcare system as a whole is an extreme case when compared to the rest of the world.

by ethbro 8y ago

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.

ethbro 8y ago
There are three possibilities. 1) Extreme cases are pervasive 2) Extreme cases occur but are rare 3) Extreme cases never happen Aside from the absurdity of abusing statistically-defined adjectives, I'll assume you know what I mean. The health care industry is BIG. Things happen a lot, even if they're only 0.01% of the time. I haven't seen any proof that indicate (1) is true, previous shock post included. And if it's not, it's not the most important problem to focus on. In contrast to, say, the incentives you note.
- wu-ikkyu 8y ago
  The perverse incentives are what create the extreme cases. It's plainly obvious that the US healthcare system as a whole is an extreme case when compared to the rest of the world.