7 ms·

The consolidation of the medical industry has been one of the most terrible things I've witnessed during my lifetime. What is the end state for all this?

delfinom 3y ago
One company owning everything? To be fair, some of the consolidation is purely because the costs of business have been raised so far that both doctors and pharmacists can't operate independently. From mountains of school debt, to requirements for IT services and compliances, to the insane cost of real estate everywhere. This country is heading towards one of those cyberpunk endings where corporations own people.
- jimbob45 3y ago
  HIPAA was a stupid mistake by the Clinton administration. I really don’t care who has my medical history and the field of medical study would be infinitely better off if it was public.
  - deleted 3y ago
    [deleted]
  - jhloa2 3y ago
    Now that's a take I've never heard before. It'd be interesting to have an opt-in for sharing your medical history with entities, but there is no way in hell I'd be sharing information that is so easily weaponized against me.
    - late2part 3y ago
      But do you use pharmacies?
      - ceejayoz 3y ago
        "Yet you participate in society. Curious!" https://knowyourmeme.com/memes/we-should-improve-society-somewhat https://knowyourmeme.com/memes/we-should-improve-society-som...
    - chimeracoder 3y ago
      > It'd be interesting to have an opt-in for sharing your medical history with entities That already exists. It's baked into HIPAA (if you're talking about medical history collected by Covered Entities). All "medical" data collected by direct-to-consumer products that aren't providing clinical care (think 23AndMe, or third-party services that allow you to book appointments with doctors in a Yelp-style interface) are not subject to HIPAA, so they already can legally collect (and sell) that data without additional consent.
  - tenebrisalietum 3y ago
    Would you like employers to be able to pull medical history (using "background check" type firms) and able to deny employment based on your medical condition? Some employers may prefer not to hire anyone who has ever been on antidepressants, for example.
    - tiahura 3y ago
      Don’t I have a right to avoid crazy or lepers? Freedom of association shouldn't end just because I want to hire an assistant.
      - tenebrisalietum 3y ago
        Individual rights vs. societal responsibilities. Jobs are touted as necessary as being part of modern society. Judges, legislators, and commmunity leaders expect you to have a job and consider whether or not you have one as judgement of your character. The health of society and a community are measured by the percentage of adults that have jobs. As long as this is true, then strict freedom of association should have lower priority than making sure everyone is employed. An alternative is UBI.
    - jimbob45 3y ago
      No, but health is already a protected class in employment laws. Any employer pulling or seeking that information in any way would open themselves up to a class action lawsuit by everyone who had ever been rejected from that company.
      - kevin_thibedeau 3y ago
        The US government does that for security clearances.
  - claytongulick 3y ago
    So, treatment for an STD, for example, should be public information? What if that treatment occurred while the spouse was on a six month military deployment? Mental health records should be freely available? Would you enjoy having potential employers review all of your conversations with a counselor before deciding whether to hire you? There's a very good reason why society has placed a high value on the privacy of health care information above almost all else, including financial.
    - thwarted 3y ago
      So, treatment for an STD, for example, should be public information? What if that treatment occurred while the spouse was on a six month military deployment? There has to be a better example of why privacy is important than keeping infidelity and having an STD secret from your military deployed spouse.
      - claytongulick 3y ago
        Marital infidelity rate is about 50% - and that's just for self-admitted [1]. Actual rates are likely much higher. A large majority of people of both sexes admit that they would have an extra-marital affair if they believed they wouldn't get caught. Anecdotally, when I was I the military I saw much, much higher than 50% when spouses were deployed. This seems to be a pervasive issue [2]. Seems like a culturally relevant health issue to use as an example. [1] https://worldpopulationreview.com/country-rankings/infidelity-rates-by-country https://worldpopulationreview.com/country-rankings/infidelit... [2] https://pubmed.ncbi.nlm.nih.gov/28054799/ https://pubmed.ncbi.nlm.nih.gov/28054799/
        thwarted 3y ago
        While divorce may be culturally relevant, I read the phrasing > What if that treatment occurred while the spouse was on a six month military deployment? as indicating that the STD treatment would be kept from the spouse. While each individual has a right to privacy, cheating on an away spouse, getting an STD and treatment, and then keeping it secret from the spouse is pretty shitty, and is especially bad under the guise of "right to privacy". "I'm not going to tell my spouse I had an STD, they have no right to know" is not what medical information privacy is about. We can talk about the value of someone's medical information not being public without evoking a spousal relationship as some kind of reason for privacy. And when we're talking about keeping medical information private, we're trying to avoid harm to the person the information is about. Someone who is cheating and/or getting STDs without telling their spouse is harming the spouse.
  - gosub100 3y ago
    I sort of agree with you on the surface (who cares if some rando knows I take thyroid meds?), but the ways medical data can be used against you are very insidious. Even now that preexisting conditions are history (AFAIK), if your data were public, people could target you (or the elderly) for snake oil cure scams, financial scams (especially if they knew you were dying of cancer), identity theft scams (send you fake bills and steal your money). Anything sexual or psychiatric could be used to blackmail you, all sorts of cruel things could be done, it just takes some imagination.
  - renewedrebecca 3y ago
    Imagine being a woman with a miscarriage or a trans kid in Texas. Healthcare info being public invites all sorts of abuse by people going for political or "culture war" gains.
  - conductr 3y ago
    One of the catalyst for that were that insurance companies were kicking people off coverage as they knew about increased risk. I have a female family member who never got a genetic cancer lab test because a positive result came with risks of her getting kicked off private insurance. Even though her sister had cancer at 30 and her paternal line had tons of history of women dying young for “woman issues” as it was called back then. Anyway she assumed she had the genetic mutation but never could get the preventative surgery she should have because insurance wouldn’t approve it without the positive lab results confirming she was at high risk for cancer. It’s dystopian.
    - FireBeyond 3y ago
      And beyond the most obvious stuff too. I worked for a company that ran claims benefits management systems. We had regular inquiries from our customers (insurers) saying that they had genealogy databases and wanted to be able to mine not just their own systems for "increased familial risk" based on claims history, but wanted to be able to get this information from "partner" (not actual partners, just "our other customers") databases similarly. We would not, thankfully. But many of them asked. Some, repeatedly.
  - HumblyTossed 3y ago
    A rather naive take. That information will be taken and used against you in some way. But, hey, you do you...
  - sowbug 3y ago
    Lots of downvotes for this comment. Yet it represents the prevailing public opinion on privacy (even if the polarizing point about a particular US president is removed).* How will the privacy landscape change if the vast majority of people don't care? *Apologies for the excessive alliteration. Didn't see until I submitted.
- gruez 3y ago
  >costs of business have been raised so far that both doctors and pharmacists can't operate independently. From mountains of school debt, to requirements for IT services and compliances, to the insane cost of real estate everywhere. It's worth noting that the costs you listed, only "requirements for IT services and compliances" seems to favor large corporations. Everything else you listed don't offer economies of scale (eg. 100 pharmacists = 100 "mountains of school debt"), so unclear how they're contributing towards consolidation. >This country is heading towards one of those cyberpunk endings where corporations own people. I don't get it. Does a future where you have to work for corporations mean "corporations own people"?
  - jsbisviewtiful 3y ago
    > I don't get it. Does a future where you have to work for corporations mean "corporations own people"? These kinds of responses are always so frustrating to see. The average person clearly is not paying attention to how much of a stranglehold corporations now have over the populous and how often they just buy themselves power - or even worse, the average populous just doesn’t care or is willfully ignorant. In the US especially - folks always screaming about gov power but not caring about corporations and billionaires owning governments.
    - llbeansandrice 3y ago
      It’s not a problem unless they do something I don’t like like Apple /s
    - gruez 3y ago
      >The average person clearly is not paying attention to how much of a stranglehold corporations now have over the populous and how often they just buy themselves power Sounds like the actual issue is "corporation control over government". Why not say that directly instead of making a tenuous point about how "corporations own people"? >the average populous just doesn’t care or is willfully ignorant Have you been living under a rock? "big corporations bad" is a bipartisan issue. The only difference between the parties is the reasoning for why they're bad. eg. "big tech is bad because they're hoarding wealth" vs "big tech is bad because they're pushing woke agenda".
- Geisterde 3y ago
  >This country is heading towards one of those cyberpunk endings where corporations own people. That was settled in 1971, when money itself ceased to exist as humans have generally known it for thousands of years, and was instead replaced with fuduciary credit. So long as this stands, anything, you can only buy something if you or someone else has gone into debt to aquire the money for it, and those dollars will eventually be removed from circulation when they make their way back to a private banking cartel, the federal reserve.
  - gruez 3y ago
    For all intents and purposes, working for federal reserve notes and working for yellow lumps of metal (via federal reserve notes) is the same. Yellow lumps of metal can't provide you with food or shelter, so you'd have to exchange it with someone else that has those things. There's no difference between the two aside from the fact that federal reserve notes can be printed at will in response to economic conditions, and yellow lumps of metal are extracted from the ground at haphazard rates.
    - claytongulick 3y ago
      > aside from the fact that federal reserve notes can be printed at will in response to economic conditions, and yellow lumps of metal are extracted from the ground at haphazard rates. That's a pretty key difference. The value is based on scarcity. When there's no scarcity constraint, we can all just collectively vote ourselves to be billionaires. What could go wrong?
      - renewedrebecca 3y ago
        And yet, after all this time, we haven't voted ourselves to be billionaires.
      - gruez 3y ago
        >What could go wrong? I could say the same for basing your money supply on the production of a yellow metal. What happens when there's a massive discovery of gold? Or there's a (trade) war between the top producers (eg. china, australia, and russia)? Or when there's a worldwide pandemic and you need to provide stimulus so the economy doesn't collapse?
- deelowe 3y ago
  These "costs" you speak of are purely fabricated through a complex system of insurance, pharmacy consolidation, medical practice consolidation, and intermediaries who structure the pricing.
  - ClumsyPilot 3y ago
    Consolidation drives consolidation. It’s a closed loop. We’ve gotten to the point where ‘communist’ China has more competition than most of the west does.
- logicchains 3y ago
  [flagged]
  - renewedrebecca 3y ago
    Please get therapy.
    - logicchains 3y ago
      What an intellectual response. If you disagree with me, please tell me why you think that people who support mandating an mRNA vaccine would not support mandating a nanobot vaccine? Especially if the latter was genuinely effective at preventing transmission. And if you don't disagree that they'd support that, then you're essentially acknowledging that we're being streamrolled into a cyberpunk future, because there's nothing more cyberpunk than people being forced to augment their body with nanotech or lose their job.
      - renewedrebecca 3y ago
        I’m not joking…. You’re sounding really paranoid. Please get help.
- teeray 3y ago
  > mountains of school debt Is this, plus the liability insurance aspect, the root of the problem? I wonder if prospective doctors could “enlist” where the government pays for all this training and shields them on the condition that they follow orders for some period of time like “be a primary care doctor in this underserved community and treat everyone.” You can’t go be a Malibu plastic surgeon until after your mandatory service period.
  - MattGaiser 3y ago
    Isn’t this just the military? Canadian military is perpetually short of medical staff even with this.
    - teeray 3y ago
      Not exactly my thoughts, but similar. The military trains doctors for troops and veterans. This would be for the benefit of civilians. One provides for the common defense, this would promote the general welfare.
  - giantg2 3y ago
    "Is this, plus the liability insurance aspect, the root of the problem?" Maybe for some, but not all. I know of more than a few older doctors that decided to retire because they didn't want to deal with increased regulation. So it's not always a money issue. "I wonder if prospective doctors could “enlist” where the government pays for all this training and shields them" They have these programs for military doctors. Doctors working for the VA (and maybe other federal things like prisons) can usually avoid a lot of state related costs, which I believe includes malpractice insurance (or maybe the federal version of malpractice is cheaper).
  - logicchains 3y ago
    Medical school is so expensive because it's a cartel; the government limits new entrants, so the schools can charge whatever they want because they know they're not going to get any competition. And it doesn't allow people to practice medicine unless they attended one of those privileged schools.
Centigonal 3y ago
Perhaps we'll get single-payer... but the single payer will have a profit motive.
- deleted 3y ago
  [deleted]
deleted 3y ago
[deleted]
droopyEyelids 3y ago
A move towards "Value Based Pricing" for medical services, where pricing corresponds to the value of our lives.

delfinom 3y ago

One company owning everything? To be fair, some of the consolidation is purely because the costs of business have been raised so far that both doctors and pharmacists can't operate independently. From mountains of school debt, to requirements for IT services and compliances, to the insane cost of real estate everywhere. This country is heading towards one of those cyberpunk endings where corporations own people.

jimbob45 3y ago
HIPAA was a stupid mistake by the Clinton administration. I really don’t care who has my medical history and the field of medical study would be infinitely better off if it was public.
- deleted 3y ago
  [deleted]
- jhloa2 3y ago
  Now that's a take I've never heard before. It'd be interesting to have an opt-in for sharing your medical history with entities, but there is no way in hell I'd be sharing information that is so easily weaponized against me.
  - late2part 3y ago
    But do you use pharmacies?
    - ceejayoz 3y ago
      "Yet you participate in society. Curious!" https://knowyourmeme.com/memes/we-should-improve-society-somewhat https://knowyourmeme.com/memes/we-should-improve-society-som...
  - chimeracoder 3y ago
    > It'd be interesting to have an opt-in for sharing your medical history with entities That already exists. It's baked into HIPAA (if you're talking about medical history collected by Covered Entities). All "medical" data collected by direct-to-consumer products that aren't providing clinical care (think 23AndMe, or third-party services that allow you to book appointments with doctors in a Yelp-style interface) are not subject to HIPAA, so they already can legally collect (and sell) that data without additional consent.
- tenebrisalietum 3y ago
  Would you like employers to be able to pull medical history (using "background check" type firms) and able to deny employment based on your medical condition? Some employers may prefer not to hire anyone who has ever been on antidepressants, for example.
  - tiahura 3y ago
    Don’t I have a right to avoid crazy or lepers? Freedom of association shouldn't end just because I want to hire an assistant.
    - tenebrisalietum 3y ago
      Individual rights vs. societal responsibilities. Jobs are touted as necessary as being part of modern society. Judges, legislators, and commmunity leaders expect you to have a job and consider whether or not you have one as judgement of your character. The health of society and a community are measured by the percentage of adults that have jobs. As long as this is true, then strict freedom of association should have lower priority than making sure everyone is employed. An alternative is UBI.
  - jimbob45 3y ago
    No, but health is already a protected class in employment laws. Any employer pulling or seeking that information in any way would open themselves up to a class action lawsuit by everyone who had ever been rejected from that company.
    - kevin_thibedeau 3y ago
      The US government does that for security clearances.
- claytongulick 3y ago
  So, treatment for an STD, for example, should be public information? What if that treatment occurred while the spouse was on a six month military deployment? Mental health records should be freely available? Would you enjoy having potential employers review all of your conversations with a counselor before deciding whether to hire you? There's a very good reason why society has placed a high value on the privacy of health care information above almost all else, including financial.
  - thwarted 3y ago
    So, treatment for an STD, for example, should be public information? What if that treatment occurred while the spouse was on a six month military deployment? There has to be a better example of why privacy is important than keeping infidelity and having an STD secret from your military deployed spouse.
    - claytongulick 3y ago
      Marital infidelity rate is about 50% - and that's just for self-admitted [1]. Actual rates are likely much higher. A large majority of people of both sexes admit that they would have an extra-marital affair if they believed they wouldn't get caught. Anecdotally, when I was I the military I saw much, much higher than 50% when spouses were deployed. This seems to be a pervasive issue [2]. Seems like a culturally relevant health issue to use as an example. [1] https://worldpopulationreview.com/country-rankings/infidelity-rates-by-country https://worldpopulationreview.com/country-rankings/infidelit... [2] https://pubmed.ncbi.nlm.nih.gov/28054799/ https://pubmed.ncbi.nlm.nih.gov/28054799/
      - thwarted 3y ago
        While divorce may be culturally relevant, I read the phrasing > What if that treatment occurred while the spouse was on a six month military deployment? as indicating that the STD treatment would be kept from the spouse. While each individual has a right to privacy, cheating on an away spouse, getting an STD and treatment, and then keeping it secret from the spouse is pretty shitty, and is especially bad under the guise of "right to privacy". "I'm not going to tell my spouse I had an STD, they have no right to know" is not what medical information privacy is about. We can talk about the value of someone's medical information not being public without evoking a spousal relationship as some kind of reason for privacy. And when we're talking about keeping medical information private, we're trying to avoid harm to the person the information is about. Someone who is cheating and/or getting STDs without telling their spouse is harming the spouse.
- gosub100 3y ago
  I sort of agree with you on the surface (who cares if some rando knows I take thyroid meds?), but the ways medical data can be used against you are very insidious. Even now that preexisting conditions are history (AFAIK), if your data were public, people could target you (or the elderly) for snake oil cure scams, financial scams (especially if they knew you were dying of cancer), identity theft scams (send you fake bills and steal your money). Anything sexual or psychiatric could be used to blackmail you, all sorts of cruel things could be done, it just takes some imagination.
- renewedrebecca 3y ago
  Imagine being a woman with a miscarriage or a trans kid in Texas. Healthcare info being public invites all sorts of abuse by people going for political or "culture war" gains.
- conductr 3y ago
  One of the catalyst for that were that insurance companies were kicking people off coverage as they knew about increased risk. I have a female family member who never got a genetic cancer lab test because a positive result came with risks of her getting kicked off private insurance. Even though her sister had cancer at 30 and her paternal line had tons of history of women dying young for “woman issues” as it was called back then. Anyway she assumed she had the genetic mutation but never could get the preventative surgery she should have because insurance wouldn’t approve it without the positive lab results confirming she was at high risk for cancer. It’s dystopian.
  - FireBeyond 3y ago
    And beyond the most obvious stuff too. I worked for a company that ran claims benefits management systems. We had regular inquiries from our customers (insurers) saying that they had genealogy databases and wanted to be able to mine not just their own systems for "increased familial risk" based on claims history, but wanted to be able to get this information from "partner" (not actual partners, just "our other customers") databases similarly. We would not, thankfully. But many of them asked. Some, repeatedly.
- HumblyTossed 3y ago
  A rather naive take. That information will be taken and used against you in some way. But, hey, you do you...
- sowbug 3y ago
  Lots of downvotes for this comment. Yet it represents the prevailing public opinion on privacy (even if the polarizing point about a particular US president is removed).* How will the privacy landscape change if the vast majority of people don't care? *Apologies for the excessive alliteration. Didn't see until I submitted.
gruez 3y ago
>costs of business have been raised so far that both doctors and pharmacists can't operate independently. From mountains of school debt, to requirements for IT services and compliances, to the insane cost of real estate everywhere. It's worth noting that the costs you listed, only "requirements for IT services and compliances" seems to favor large corporations. Everything else you listed don't offer economies of scale (eg. 100 pharmacists = 100 "mountains of school debt"), so unclear how they're contributing towards consolidation. >This country is heading towards one of those cyberpunk endings where corporations own people. I don't get it. Does a future where you have to work for corporations mean "corporations own people"?
- jsbisviewtiful 3y ago
  > I don't get it. Does a future where you have to work for corporations mean "corporations own people"? These kinds of responses are always so frustrating to see. The average person clearly is not paying attention to how much of a stranglehold corporations now have over the populous and how often they just buy themselves power - or even worse, the average populous just doesn’t care or is willfully ignorant. In the US especially - folks always screaming about gov power but not caring about corporations and billionaires owning governments.
  - llbeansandrice 3y ago
    It’s not a problem unless they do something I don’t like like Apple /s
  - gruez 3y ago
    >The average person clearly is not paying attention to how much of a stranglehold corporations now have over the populous and how often they just buy themselves power Sounds like the actual issue is "corporation control over government". Why not say that directly instead of making a tenuous point about how "corporations own people"? >the average populous just doesn’t care or is willfully ignorant Have you been living under a rock? "big corporations bad" is a bipartisan issue. The only difference between the parties is the reasoning for why they're bad. eg. "big tech is bad because they're hoarding wealth" vs "big tech is bad because they're pushing woke agenda".
Geisterde 3y ago
>This country is heading towards one of those cyberpunk endings where corporations own people. That was settled in 1971, when money itself ceased to exist as humans have generally known it for thousands of years, and was instead replaced with fuduciary credit. So long as this stands, anything, you can only buy something if you or someone else has gone into debt to aquire the money for it, and those dollars will eventually be removed from circulation when they make their way back to a private banking cartel, the federal reserve.
- gruez 3y ago
  For all intents and purposes, working for federal reserve notes and working for yellow lumps of metal (via federal reserve notes) is the same. Yellow lumps of metal can't provide you with food or shelter, so you'd have to exchange it with someone else that has those things. There's no difference between the two aside from the fact that federal reserve notes can be printed at will in response to economic conditions, and yellow lumps of metal are extracted from the ground at haphazard rates.
  - claytongulick 3y ago
    > aside from the fact that federal reserve notes can be printed at will in response to economic conditions, and yellow lumps of metal are extracted from the ground at haphazard rates. That's a pretty key difference. The value is based on scarcity. When there's no scarcity constraint, we can all just collectively vote ourselves to be billionaires. What could go wrong?
    - renewedrebecca 3y ago
      And yet, after all this time, we haven't voted ourselves to be billionaires.
    - gruez 3y ago
      >What could go wrong? I could say the same for basing your money supply on the production of a yellow metal. What happens when there's a massive discovery of gold? Or there's a (trade) war between the top producers (eg. china, australia, and russia)? Or when there's a worldwide pandemic and you need to provide stimulus so the economy doesn't collapse?
deelowe 3y ago
These "costs" you speak of are purely fabricated through a complex system of insurance, pharmacy consolidation, medical practice consolidation, and intermediaries who structure the pricing.
- ClumsyPilot 3y ago
  Consolidation drives consolidation. It’s a closed loop. We’ve gotten to the point where ‘communist’ China has more competition than most of the west does.
logicchains 3y ago
[flagged]
- renewedrebecca 3y ago
  Please get therapy.
  - logicchains 3y ago
    What an intellectual response. If you disagree with me, please tell me why you think that people who support mandating an mRNA vaccine would not support mandating a nanobot vaccine? Especially if the latter was genuinely effective at preventing transmission. And if you don't disagree that they'd support that, then you're essentially acknowledging that we're being streamrolled into a cyberpunk future, because there's nothing more cyberpunk than people being forced to augment their body with nanotech or lose their job.
    - renewedrebecca 3y ago
      I’m not joking…. You’re sounding really paranoid. Please get help.
teeray 3y ago
> mountains of school debt Is this, plus the liability insurance aspect, the root of the problem? I wonder if prospective doctors could “enlist” where the government pays for all this training and shields them on the condition that they follow orders for some period of time like “be a primary care doctor in this underserved community and treat everyone.” You can’t go be a Malibu plastic surgeon until after your mandatory service period.
- MattGaiser 3y ago
  Isn’t this just the military? Canadian military is perpetually short of medical staff even with this.
  - teeray 3y ago
    Not exactly my thoughts, but similar. The military trains doctors for troops and veterans. This would be for the benefit of civilians. One provides for the common defense, this would promote the general welfare.
- giantg2 3y ago
  "Is this, plus the liability insurance aspect, the root of the problem?" Maybe for some, but not all. I know of more than a few older doctors that decided to retire because they didn't want to deal with increased regulation. So it's not always a money issue. "I wonder if prospective doctors could “enlist” where the government pays for all this training and shields them" They have these programs for military doctors. Doctors working for the VA (and maybe other federal things like prisons) can usually avoid a lot of state related costs, which I believe includes malpractice insurance (or maybe the federal version of malpractice is cheaper).
- logicchains 3y ago
  Medical school is so expensive because it's a cartel; the government limits new entrants, so the schools can charge whatever they want because they know they're not going to get any competition. And it doesn't allow people to practice medicine unless they attended one of those privileged schools.

Centigonal 3y ago

Perhaps we'll get single-payer... but the single payer will have a profit motive.

deleted 3y ago
[deleted]

deleted 3y ago

[deleted]

droopyEyelids 3y ago

A move towards "Value Based Pricing" for medical services, where pricing corresponds to the value of our lives.