4 ms·

This is basically the Kaiser model. Kaiser's doctors are salaried, rather than getting paid per procedure. Works pretty well! (I think the actual answer to the

This is basically the Kaiser model. Kaiser's doctors are salaried, rather than getting paid per procedure. Works pretty well! (I think the actual answer to the question in the OP is, at least in part, to license more doctors. Then the cartel doesn't have as much pricing power and medical care is less of a luxury good. The rich person should really hire a lobbyist.)

infecto 5y ago
I had Kaiser for a year and I actually enjoyed it. I saw a couple specialist but I never had any major work done so perhaps I am biased. It is funny to say it since I believe Kaiser originally was one of the opponents of a single payer system but using Kaiser kind of felt like what a government health care system should be. Very low friction. Oh I need blood work or whatever done, walk down the hall. Everything felt more convenient.
- hellbannedguy 5y ago
  It is so much better than driving office to office while not feeling well. Dealing with ego. Dealing with huge bills even when having good insurance. I sometimes hear people talk about doctors like they are going to cure you when you need them. The older I get, the more I see the profession as an art. I remember Lance Armstrong commenting on his cancer treatment. He basically said he knew he had the best medical care because of his wealth. He said driving from doctor to doctor was just depressing/agonizing, and he felt it was unnessary.
- spaetzleesser 5y ago
  Same here. I enjoyed knowing there is one place where I can go and have everything done. They also sent reminders about vaccinations and checkups. I have moved away from CA so I don't have Kaiser anymore. I generally rarely go to a doctor and if I ever get sick I don't even know where to go :-(
lotsofpulp 5y ago
The golden days of the doctor “cartel” (and people in the healthcare chain in general) are over. https://www.beckersasc.com/asc-news/9-cms-pay-cut-for-physicians-in-2022-practice-costs-on-the-rise.html https://www.beckersasc.com/asc-news/9-cms-pay-cut-for-physic... The 80s/90s/00s were probably the golden years for them, but they got in the political spotlight, and combined with the decreasing proportion of young to old people, the government is going to push down cuts to whoever lacks political power to push back. Such as smaller businesses like independent doctor offices and pharmacies. The government has already increased supply by letting Nurse Practitioners and Physician Assistants do stuff that doctors used to do, and I suspect a lot more price discrimination is on the way. Expect the average quality of care to fall (may not be a bad thing if overqualified people were treating pink eye), and paying more will result in being seen by someone more qualified.
- Robotbeat 5y ago
  Increasing the supply doesn't mean the average quality of care will fall. If I pay doctors $400,000 a year to work 80 hours a week and then double the number of doctors and pay them $200,000 a year to work 40 hours per week, the quality of care would almost certainly improve but costs would be constant. And actually, do we pay doctors a premium for those overtime hours where they're actually probably less effective? If so, our costs would go down as quality of care improves.
  - ProjectArcturis 5y ago
    In theory, if you want to train twice as many doctors, you have to relax admissions criteria to let in twice as many people, and the new admitees wouldn't have qualified under the previous system.
    - GloriousKoji 5y ago
      But what if the limiting factor of admission criteria isn't scoring well but things like crippling amount of debt, archaic culture of hazing and adversity to stupid hours?

infecto 5y ago

I had Kaiser for a year and I actually enjoyed it. I saw a couple specialist but I never had any major work done so perhaps I am biased. It is funny to say it since I believe Kaiser originally was one of the opponents of a single payer system but using Kaiser kind of felt like what a government health care system should be. Very low friction. Oh I need blood work or whatever done, walk down the hall. Everything felt more convenient.

hellbannedguy 5y ago
It is so much better than driving office to office while not feeling well. Dealing with ego. Dealing with huge bills even when having good insurance. I sometimes hear people talk about doctors like they are going to cure you when you need them. The older I get, the more I see the profession as an art. I remember Lance Armstrong commenting on his cancer treatment. He basically said he knew he had the best medical care because of his wealth. He said driving from doctor to doctor was just depressing/agonizing, and he felt it was unnessary.
spaetzleesser 5y ago
Same here. I enjoyed knowing there is one place where I can go and have everything done. They also sent reminders about vaccinations and checkups. I have moved away from CA so I don't have Kaiser anymore. I generally rarely go to a doctor and if I ever get sick I don't even know where to go :-(

lotsofpulp 5y ago

The golden days of the doctor “cartel” (and people in the healthcare chain in general) are over. https://www.beckersasc.com/asc-news/9-cms-pay-cut-for-physicians-in-2022-practice-costs-on-the-rise.html https://www.beckersasc.com/asc-news/9-cms-pay-cut-for-physic... The 80s/90s/00s were probably the golden years for them, but they got in the political spotlight, and combined with the decreasing proportion of young to old people, the government is going to push down cuts to whoever lacks political power to push back. Such as smaller businesses like independent doctor offices and pharmacies. The government has already increased supply by letting Nurse Practitioners and Physician Assistants do stuff that doctors used to do, and I suspect a lot more price discrimination is on the way. Expect the average quality of care to fall (may not be a bad thing if overqualified people were treating pink eye), and paying more will result in being seen by someone more qualified.

Robotbeat 5y ago
Increasing the supply doesn't mean the average quality of care will fall. If I pay doctors $400,000 a year to work 80 hours a week and then double the number of doctors and pay them $200,000 a year to work 40 hours per week, the quality of care would almost certainly improve but costs would be constant. And actually, do we pay doctors a premium for those overtime hours where they're actually probably less effective? If so, our costs would go down as quality of care improves.
- ProjectArcturis 5y ago
  In theory, if you want to train twice as many doctors, you have to relax admissions criteria to let in twice as many people, and the new admitees wouldn't have qualified under the previous system.
  - GloriousKoji 5y ago
    But what if the limiting factor of admission criteria isn't scoring well but things like crippling amount of debt, archaic culture of hazing and adversity to stupid hours?