4 ms·

If you have a plan that relies on everyone in a nation of 300 million behaving ethically and honestly when there is a big incentive not to, you have a bad plan.

If you have a plan that relies on everyone in a nation of 300 million behaving ethically and honestly when there is a big incentive not to, you have a bad plan. The moral failing is on the clinics, sure, but if you want to fix the problem, you have to look at the government.

ggrrhh_ta 6y ago
I think you are implying the following when you say "you have to look at the government": "if you want to fix the problem of people/clinics/etc. abusing (dodging/fraudulently take advantage of) government programs/policies you have to ..." ----- And the "..." is not filled in. I guess I could fill it in with: "stop implementing policies/programs if you are not at the same time investing as much as it is necessary to guarantee nobody gets around the law" - that is, do not trust, add more inefficiency (clinics already need to attest the procedure is necessary) and cost.
jmcqk6 6y ago
Isn't the answer to this better accountability? Incentives without accountability usually lead to this type of outcome.
- kaiju0 6y ago
  Define accountability. Now you have a cost benefit ratio. If there is personal liability who can be blamed so you get the benefit and they get the detriment.
  - jmcqk6 6y ago
    In this specific case, it would be an independent audit of the procedures to determine whether they were actually necessary or not. it's not rocket science. Poor people don't have the money required to go to the dentist and properly take care of your teeth. Since having a healthy populace is a good thing, we say "okay, we're all going to pitch in so everyone can be as healthy as possible." If people start to take advantage of that for personal gain (which we know there are always people who are going to do that), we need to have a plan in place for dealing with those assholes. The presence of assholes in society shouldn't mean we don't even try to take care of each other. It should mean that we have plans for recognizing when someone is an asshole and taking measures to change that behavior.
    - Consultant32452 6y ago
      Now you've created a new problem of bureaucrats that are just as susceptible to incompetence, incentives, and malfeasance as the dentists. This is going to be the problem with every system of mandatory funding. Doesn't matter if it's housing, dentistry, food stamps, etc. People were abusing the disability program, so we made a bunch of hurdles to get funding. Now there's companies who train you how to get over those hurdles: what to write on the forms, what to say to your doctor, etc. And guess what? The companies that train you what to say to get disability then get to bill the government for this new service they provided you. I'm sure it's easy to imagine their incentives.
      - jmcqk6 6y ago
        And yet there are ways we can address those issues too. I don't get why we gotta stop trying to take care of each other simply because there are assholes who try to take advantage of things.
        Consultant32452 6y ago
        >I don't get why we gotta stop trying to take care of each other How would ending food stamps stop you from taking care of other people?
        jmcqk6 6y ago
        Removing a massive mechanism for being able to address a need that most people feel shame for and explicitly try to hide due to social pressure? If I'm acting on my own, my reach is very limited. By using the government, we have the potential to make a much larger impact, and in this case, create the expectation that no one should go hungry in this country. We're not there yet, mainly because there are many people around here who don't believe that expectation is valid. I'll fight them for the rest of my life.
AnHonestComment 6y ago
You still haven’t said — why can’t you look at the clinics?
CrazyPyroLinux 6y ago
There is a specific term relevant to this, which is applicable to many problems of misaligned risk/incentive, governmental and otherwise: "Moral Hazard"
akiselev 6y ago
Dentists take the Hippocratic Oath just like doctors. First and foremost, this wasn't just a moral failing, this was a major professional violation, regardless of any government incentives. They put patients in unnecessary risk of complications and likely caused harm in some cases, in direct violation of the one of the most important oaths in any profession. It is the job of healthcare professionals to cater to the health of their patients, not their billing departments. You can't write all laws like we're living in a Mad Max dystopia - some laws will need to assume that other laws are functioning correctly in order to be practically implementable as a law - just like software has dependencies that must uphold some invariants for the interface to work. The issue isn't subsidizing healthcare, it's unethical professionals abusing our trust.
- inglor_cz 6y ago
  "Dentists take the Hippocratic Oath just like doctors. First and foremost, this wasn't just a moral failing, this was a major professional violation, regardless of any government incentives. They put patients in unnecessary risk of complications and likely caused harm in some cases, in direct violation of the one of the most important oaths in any profession." Generally true, but the judgment call on "is this patient better off by being left alone" vs. "is this patient better off by having a surgery" is not easy, especially in our culture which worships heroic medicine. Patients often demand that something be done because they are primed so from the popular media they consume. This can be even seen in the end-of-life care. Too many families demand that their dying grandma is given expensive and invasive care to live three weeks longer, even though its not just pointless, but outright cruel.
  - akiselev 6y ago
    > Generally true, but the judgment call on "is this patient better off by being left alone" vs. "is this patient better off by having a surgery" is not easy, especially in our culture which worships heroic medicine. Patients often demand that something be done because they are primed so from the popular media they consume. That's why it's a problem with professional ethics in healthcare first and foremost. Nobody in the bureaucratic chain is qualified to make or judge medical decisions and them trying would only be a monumental disaster because they don't even meet the patient and they're probably not medical professionals themselves. Hell, the patients and their family are rarely qualified to make the decisions - just look at what doctors chose for end of life care versus what their patients end up doing. The system doesn't work if we don't police the professionals making the decisions at the point of care. The trick is not overdoing it like we did with opiates, scaring doctors from prescribing them even for patients genuinely in need.
nkingsy 6y ago
Seems like existing whistle blower incentives could be beefed up and better publicized. A new "moral heroes" national holiday celebrating those who uncover fraud. More resources dedicated to investigating claims, more leeway to fine corporations for bad faith activity in order to increase the incentive to blow the whistle.

ggrrhh_ta 6y ago

I think you are implying the following when you say "you have to look at the government": "if you want to fix the problem of people/clinics/etc. abusing (dodging/fraudulently take advantage of) government programs/policies you have to ..." ----- And the "..." is not filled in. I guess I could fill it in with: "stop implementing policies/programs if you are not at the same time investing as much as it is necessary to guarantee nobody gets around the law" - that is, do not trust, add more inefficiency (clinics already need to attest the procedure is necessary) and cost.

jmcqk6 6y ago

Isn't the answer to this better accountability? Incentives without accountability usually lead to this type of outcome.

kaiju0 6y ago
Define accountability. Now you have a cost benefit ratio. If there is personal liability who can be blamed so you get the benefit and they get the detriment.
- jmcqk6 6y ago
  In this specific case, it would be an independent audit of the procedures to determine whether they were actually necessary or not. it's not rocket science. Poor people don't have the money required to go to the dentist and properly take care of your teeth. Since having a healthy populace is a good thing, we say "okay, we're all going to pitch in so everyone can be as healthy as possible." If people start to take advantage of that for personal gain (which we know there are always people who are going to do that), we need to have a plan in place for dealing with those assholes. The presence of assholes in society shouldn't mean we don't even try to take care of each other. It should mean that we have plans for recognizing when someone is an asshole and taking measures to change that behavior.
  - Consultant32452 6y ago
    Now you've created a new problem of bureaucrats that are just as susceptible to incompetence, incentives, and malfeasance as the dentists. This is going to be the problem with every system of mandatory funding. Doesn't matter if it's housing, dentistry, food stamps, etc. People were abusing the disability program, so we made a bunch of hurdles to get funding. Now there's companies who train you how to get over those hurdles: what to write on the forms, what to say to your doctor, etc. And guess what? The companies that train you what to say to get disability then get to bill the government for this new service they provided you. I'm sure it's easy to imagine their incentives.
    - jmcqk6 6y ago
      And yet there are ways we can address those issues too. I don't get why we gotta stop trying to take care of each other simply because there are assholes who try to take advantage of things.
      - Consultant32452 6y ago
        >I don't get why we gotta stop trying to take care of each other How would ending food stamps stop you from taking care of other people?
        jmcqk6 6y ago
        Removing a massive mechanism for being able to address a need that most people feel shame for and explicitly try to hide due to social pressure? If I'm acting on my own, my reach is very limited. By using the government, we have the potential to make a much larger impact, and in this case, create the expectation that no one should go hungry in this country. We're not there yet, mainly because there are many people around here who don't believe that expectation is valid. I'll fight them for the rest of my life.

AnHonestComment 6y ago

You still haven’t said — why can’t you look at the clinics?

CrazyPyroLinux 6y ago

There is a specific term relevant to this, which is applicable to many problems of misaligned risk/incentive, governmental and otherwise: "Moral Hazard"

akiselev 6y ago

Dentists take the Hippocratic Oath just like doctors. First and foremost, this wasn't just a moral failing, this was a major professional violation, regardless of any government incentives. They put patients in unnecessary risk of complications and likely caused harm in some cases, in direct violation of the one of the most important oaths in any profession. It is the job of healthcare professionals to cater to the health of their patients, not their billing departments. You can't write all laws like we're living in a Mad Max dystopia - some laws will need to assume that other laws are functioning correctly in order to be practically implementable as a law - just like software has dependencies that must uphold some invariants for the interface to work. The issue isn't subsidizing healthcare, it's unethical professionals abusing our trust.

inglor_cz 6y ago
"Dentists take the Hippocratic Oath just like doctors. First and foremost, this wasn't just a moral failing, this was a major professional violation, regardless of any government incentives. They put patients in unnecessary risk of complications and likely caused harm in some cases, in direct violation of the one of the most important oaths in any profession." Generally true, but the judgment call on "is this patient better off by being left alone" vs. "is this patient better off by having a surgery" is not easy, especially in our culture which worships heroic medicine. Patients often demand that something be done because they are primed so from the popular media they consume. This can be even seen in the end-of-life care. Too many families demand that their dying grandma is given expensive and invasive care to live three weeks longer, even though its not just pointless, but outright cruel.
- akiselev 6y ago
  > Generally true, but the judgment call on "is this patient better off by being left alone" vs. "is this patient better off by having a surgery" is not easy, especially in our culture which worships heroic medicine. Patients often demand that something be done because they are primed so from the popular media they consume. That's why it's a problem with professional ethics in healthcare first and foremost. Nobody in the bureaucratic chain is qualified to make or judge medical decisions and them trying would only be a monumental disaster because they don't even meet the patient and they're probably not medical professionals themselves. Hell, the patients and their family are rarely qualified to make the decisions - just look at what doctors chose for end of life care versus what their patients end up doing. The system doesn't work if we don't police the professionals making the decisions at the point of care. The trick is not overdoing it like we did with opiates, scaring doctors from prescribing them even for patients genuinely in need.

nkingsy 6y ago

Seems like existing whistle blower incentives could be beefed up and better publicized. A new "moral heroes" national holiday celebrating those who uncover fraud. More resources dedicated to investigating claims, more leeway to fine corporations for bad faith activity in order to increase the incentive to blow the whistle.