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Related: ProPublica investigation on doctors performing unnecessary amputations on poor black diabetes patients, because they don't pay enough attention to the

Related: ProPublica investigation on doctors performing unnecessary amputations on poor black diabetes patients, because they don't pay enough attention to the patients and also get paid more to amputate. https://features.propublica.org/diabetes-amputations/black-american-amputation-epidemic/ https://features.propublica.org/diabetes-amputations/black-a... Another link if you are skeptical there is a racial issue: page 12 of https://data.dartmouthatlas.org/downloads/reports/Diabetes_report_10_14_14.pdf https://data.dartmouthatlas.org/downloads/reports/Diabetes_r.... Among Medicare beneficiaries with diabetes, black people are still way more likely to have a leg amputated.

w1nst0nsm1th 3y ago
Man.. It's Nazi Germany level of evil.
- mrguyorama 3y ago
  Hitler claimed to have taken inspiration from how America treats its undesireables. A doctor who grew up in the heyday of eugenics could still be practicing medicine into the 70s. We literally gave black people syphilis behind their backs, and now we wonder why they are vaccine shy. We spent over two centuries with at least half the country openly espousing as policy that black people were a lesser race and the south screamed from the hills that it was God's intention that white people control black people. The children of these people were still politically relevant recently.
  - dumbotron 3y ago
    We also set up concentration camps for Japanese-Americans.
WalterBright 3y ago
Frontline did an episode a while back were dentists were performing unnecessary major dental work on poor people when the government had a program to pay the dentists for such work. Frontline was outraged at the dentists, but did not seem to recognize that this is the inevitable result of incentives the government set up.
- 2devnull 3y ago
  And such incentives get amplified when healthcare is the only game in town in terms of economic activity.
- SilasX 3y ago
  Whoa whoa whoa, I'm the first one to call out perverse incentives in government programs, but even I would assume that dentists had meaningful ethics codes and enforcement that would largely mitigate this kind of abuse. OTOH, if the "unnecessary" there just means "not satisfying the platonically correct cost/benefit analysis", and there's still some net benefit to the patient, and the government program didn't ask the dentists to use such CBA, then I wouldn't consider that abusive. (I can imagine Frontline being equally outraged at dentists denying government-subsidized dental care on grounds of failing the platonic CBA too...)
  - nradov 3y ago
    Dentists do have an ethical code, government payers do look for patterns of abuse, and state licensing boards do investigate complaints of unnecessary procedures (to some extent). But many of these cases really fall into gray areas. Dentistry is still more an art than a science, and different dentists treating the same patient in good faith will often come up with completely different treatment plans. It's tough to really prove abuse. Financial incentives absolutely do encourage healthcare providers to err on the side of doing more procedures.
    - WalterBright 3y ago
      Medicare pays based on how many tests are performed. Hence, medicare patients get lots and lots and lots of tests done.
  - WalterBright 3y ago
    When the government provides a vending machine that dispenses gold coins at the push of a button, how many of us could resist pushing that button as much as possible? A society cannot be run on expecting people to resist the powerful incentives set up for them. You can see this effect in every aspect of government operations.

w1nst0nsm1th 3y ago

Man.. It's Nazi Germany level of evil.

mrguyorama 3y ago
Hitler claimed to have taken inspiration from how America treats its undesireables. A doctor who grew up in the heyday of eugenics could still be practicing medicine into the 70s. We literally gave black people syphilis behind their backs, and now we wonder why they are vaccine shy. We spent over two centuries with at least half the country openly espousing as policy that black people were a lesser race and the south screamed from the hills that it was God's intention that white people control black people. The children of these people were still politically relevant recently.
- dumbotron 3y ago
  We also set up concentration camps for Japanese-Americans.

WalterBright 3y ago

Frontline did an episode a while back were dentists were performing unnecessary major dental work on poor people when the government had a program to pay the dentists for such work. Frontline was outraged at the dentists, but did not seem to recognize that this is the inevitable result of incentives the government set up.

2devnull 3y ago
And such incentives get amplified when healthcare is the only game in town in terms of economic activity.
SilasX 3y ago
Whoa whoa whoa, I'm the first one to call out perverse incentives in government programs, but even I would assume that dentists had meaningful ethics codes and enforcement that would largely mitigate this kind of abuse. OTOH, if the "unnecessary" there just means "not satisfying the platonically correct cost/benefit analysis", and there's still some net benefit to the patient, and the government program didn't ask the dentists to use such CBA, then I wouldn't consider that abusive. (I can imagine Frontline being equally outraged at dentists denying government-subsidized dental care on grounds of failing the platonic CBA too...)
- nradov 3y ago
  Dentists do have an ethical code, government payers do look for patterns of abuse, and state licensing boards do investigate complaints of unnecessary procedures (to some extent). But many of these cases really fall into gray areas. Dentistry is still more an art than a science, and different dentists treating the same patient in good faith will often come up with completely different treatment plans. It's tough to really prove abuse. Financial incentives absolutely do encourage healthcare providers to err on the side of doing more procedures.
  - WalterBright 3y ago
    Medicare pays based on how many tests are performed. Hence, medicare patients get lots and lots and lots of tests done.
- WalterBright 3y ago
  When the government provides a vending machine that dispenses gold coins at the push of a button, how many of us could resist pushing that button as much as possible? A society cannot be run on expecting people to resist the powerful incentives set up for them. You can see this effect in every aspect of government operations.