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My anecdotal data (which is primarily second-hand from friends who work closely with doctors in a hospital setting) agrees with your anecdotal data, for whateve

My anecdotal data (which is primarily second-hand from friends who work closely with doctors in a hospital setting) agrees with your anecdotal data, for whatever that is worth. There are some spectacularly bad doctors out there which the medical system provides cover for, mainly, as far as I can tell, because they generate revenue. It is important to understand that in the American private healthcare system, the doctor is the true “customer” of the hospital, in that, with the exception of services provided by hospital-employed physicians, the things the hospital itself can actually bill for have to be ordered by physicians in private practice who have patients admitted to the hospital. There is a tremendous power imbalance between physicians and non-physician clinicians and a powerful incentive to cover up bad acts by bad doctors who perform a large number of profitable procedures.

temp0826 4y ago
I believe this is a big part of it. Anecdotal as well, but my grandmother had a new leadless pacemaker installed for dubious reasons by a doctor that specialized in this particular type of leadless pacemaker. The pacemaker migrated at one point and it resulted in her chest filling with fluid, the removal procedure was very tough on her (leading to other complications on an already frail body) and marked the beginning of the end for her.
- spaetzleesser 4y ago
  "installed for dubious reasons by a doctor that specialized in this particular type of leadless pacemaker" That's the problem with a fragmented health system. A lot of doctors are specialists in a certain procedure and want to repeat their pet procedure on every patient they see. I saw this with my ex who had chronic leg pain. Most of the doctors we met just wanted to repeat what they do every day (and makes them good money). There are only a few doctors who have a wide knowledge of the area and can recommend a treatment that actually fits.
  - sangnoir 4y ago
    It's a double-edged sword. For surgeons, specialization improves outcomes as practice makes perfect. Since this is HN, I'll liken it to using the same programming language daily, versus being asked to fix a bug in a language you last used years ago, within a fixed time window. The only missing peace is the a doctor on the care team who chooses which type of surgery is best, becasue once one is referred to a specialist: they are going to get that specific specialized care.
    - spaetzleesser 4y ago
      That doctor on the care team is usually missing. Actually I would guess that most people don’t have a “care team”. They are referred to a surgeon or other specialist that then does their pet procedure.
VancouverMan 4y ago
I don't think that any profession or system with extensive state-imposed restrictions and regulations (education requirements, medical boards, licensing, exams, continuing education requirements, and so on) should be considered "private". Perhaps such a system incorporates some aspects of private enterprise, but ultimately it should still be seen as a non-private system. A truly private healthcare system would allow anybody to practice any kind of medicine at any time, without specific requirements and restrictions being imposed by the state. It would be up to each patient to decide whether or not he or she will deal with a particular practitioner or provider of services. (Of course, this can be complicated in the case of an incapacitated patient, without prior planning.) As is typical with non-private/socialist/communist systems of any sort, where natural free market balancing forces such as consumer choice, competition, and reputation are limited or absent, we should expect to see the inefficiencies you described, including significant quality variation, bureaucratic games, and misaligned incentives. Healthcare in America seems very non-private in nature to me. It may not be as overtly non-private as the healthcare systems in Canada or many European nations, but it certainly does not seem to be private, either.
- rscho 4y ago
  With private healthcare as you describe, poor people are left with subpar care, and you've got a revolution on your hands. At least I would be very prone to violent action in such a system.
  - nradov 4y ago
    I support affordable universal access to basic healthcare regardless of ability to pay, but you're overestimating the impact of the healthcare system. Up until a few generations ago there was no real "system" at all, and treatments frequently caused more harm than benefit. This wasn't a significant cause of violent revolutions. Even today, organized healthcare beyond vaccines and antibiotics has only a marginal impact on lifespan and healthspan. It's way behind sanitation (clean drinking water, sewage systems, waste disposal) and lifestyle issues (substance abuse, obesity, lack of exercise).

temp0826 4y ago

I believe this is a big part of it. Anecdotal as well, but my grandmother had a new leadless pacemaker installed for dubious reasons by a doctor that specialized in this particular type of leadless pacemaker. The pacemaker migrated at one point and it resulted in her chest filling with fluid, the removal procedure was very tough on her (leading to other complications on an already frail body) and marked the beginning of the end for her.

spaetzleesser 4y ago
"installed for dubious reasons by a doctor that specialized in this particular type of leadless pacemaker" That's the problem with a fragmented health system. A lot of doctors are specialists in a certain procedure and want to repeat their pet procedure on every patient they see. I saw this with my ex who had chronic leg pain. Most of the doctors we met just wanted to repeat what they do every day (and makes them good money). There are only a few doctors who have a wide knowledge of the area and can recommend a treatment that actually fits.
- sangnoir 4y ago
  It's a double-edged sword. For surgeons, specialization improves outcomes as practice makes perfect. Since this is HN, I'll liken it to using the same programming language daily, versus being asked to fix a bug in a language you last used years ago, within a fixed time window. The only missing peace is the a doctor on the care team who chooses which type of surgery is best, becasue once one is referred to a specialist: they are going to get that specific specialized care.
  - spaetzleesser 4y ago
    That doctor on the care team is usually missing. Actually I would guess that most people don’t have a “care team”. They are referred to a surgeon or other specialist that then does their pet procedure.

VancouverMan 4y ago

I don't think that any profession or system with extensive state-imposed restrictions and regulations (education requirements, medical boards, licensing, exams, continuing education requirements, and so on) should be considered "private". Perhaps such a system incorporates some aspects of private enterprise, but ultimately it should still be seen as a non-private system. A truly private healthcare system would allow anybody to practice any kind of medicine at any time, without specific requirements and restrictions being imposed by the state. It would be up to each patient to decide whether or not he or she will deal with a particular practitioner or provider of services. (Of course, this can be complicated in the case of an incapacitated patient, without prior planning.) As is typical with non-private/socialist/communist systems of any sort, where natural free market balancing forces such as consumer choice, competition, and reputation are limited or absent, we should expect to see the inefficiencies you described, including significant quality variation, bureaucratic games, and misaligned incentives. Healthcare in America seems very non-private in nature to me. It may not be as overtly non-private as the healthcare systems in Canada or many European nations, but it certainly does not seem to be private, either.

rscho 4y ago
With private healthcare as you describe, poor people are left with subpar care, and you've got a revolution on your hands. At least I would be very prone to violent action in such a system.
- nradov 4y ago
  I support affordable universal access to basic healthcare regardless of ability to pay, but you're overestimating the impact of the healthcare system. Up until a few generations ago there was no real "system" at all, and treatments frequently caused more harm than benefit. This wasn't a significant cause of violent revolutions. Even today, organized healthcare beyond vaccines and antibiotics has only a marginal impact on lifespan and healthspan. It's way behind sanitation (clean drinking water, sewage systems, waste disposal) and lifestyle issues (substance abuse, obesity, lack of exercise).