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Such is the problem of not exposing the industry to market forces. The same perverse incentives have permeated into healthcare, which is no longer about owning

Such is the problem of not exposing the industry to market forces. The same perverse incentives have permeated into healthcare, which is no longer about owning the patient's health journey, vs administrators handling contracts, billing , benefits, claims, and shifting responsibility elsewhere

podiki 2y ago
But isn't that exactly it, that these (and healthcare) are very much part of the "market?" The goal to make money and to provide healthcare are at fundamental odds if you ask me. (Or they don't have to be, but the natural "experiment" of for profit healthcare in places like the US tells us much.)
- SoftTalker 2y ago
  It's not a normal market because the customers (the patients) are generally not the people paying for the services.
- IG_Semmelweiss 2y ago
  I think no one is against paying doctors to make a good living. Perhaps even extravangant living. If the product is great, why not? Apple, Tesla, Etc made owners very rich. The problem is your share of health dollars going to administrators, which is bundled with the barriers to entry into healthcare and into insurance. Its very hard to be a doctor that doesnt take insurance, so administrators come to rule the roost. If there was truly a free market, yiud see a material share of doctors working outside the insurance system. Yet no such niche really exists.
  - thefaux 2y ago
    The problem with a doctor making an extravagant living is that it calls into question their motivation for working as a healer. How can I feel good about my patients if I know that they can barely afford to pay for my cafe? Or conversely, what does that say about me if I only work with wealthy patients?
  - SoftTalker 2y ago
    There are a few cash-only medical practices. I know of one personally. They have been operating this way for nearly 20 years so it must be working for them. I would guess that most of their patients are quite well off, given that they have the cash available to pay out of pocket. That probably eliminates quite a lot of issues for the practice, as that would tend to select for reasonably educated and high-functioning patients. They also don't have to deal with insurance companies or collections.
  - deleted 2y ago
    [deleted]
  - xp84 2y ago
    > doctors working outside the insurance system I do see this to a huge extent in the area of mental health in the wealthy area that I live in. Many of the best doctors have no need for insurance- rich people will gladly pay $300 an hour or more for a good therapist so why bother with the insulting $60 reimbursement that a doctor will get after doing a lot of paperwork with an insurance company. I am not sure that this means anything whatsoever about a free market or not - and not all kinds of doctors are doing this, but it’s happening. And it really sucks to be paying the huge insurance premiums I’m paying, and still have the best doctors all out of reach unless I’m willing to shell out MORE money out of pocket.
kube-system 2y ago
I think it's the exact opposite -- this is a problem created by administrators who are treating these institutions like a business and 'selling' these schools to be everything to everyone in order to continually grow enrollment, and grow their administrative empires. Academics works better when relatively isolated from market forces -- the worst thing you can do for academics is to ask it to turn a profit.
- IG_Semmelweiss 2y ago
  Chicken va egg What was first - barriers to entry, or administrative inertia? Im not sure whos right, but im sure between thw two of them, they are making entire industries extremely inefficient.
- nemo44x 2y ago
  And by subsidizing them we are. If actual market forces emerged then they’d stop it with the bullshit degrees that people that can’t afford and go into debt on. Subsidizing as we do today incentivizes them to be everything to everyone because the money keeps rolling in.
  - xp84 2y ago
    Problem is we as a society cannot bear to say to any student, no matter how true it is, that they don’t have a viable path to both fulfillment and financial success that includes “university” and <insert their passion topic>. In fact, we go the opposite direction, telling literally every student in high school that they will be throwing their life away if they choose to work after graduation, and that vocational training is for an underclass. Only university will do, we say. Which is why you have graduates who majored in art because they like manga, or in ethnic/gender studies because identity politics sounds exciting to a teenager. All this is actually fine if you are doing it with an understanding that it’s about becoming more cultured and learned, and that it has nothing to do with career training. But people seem to think there are white-collar jobs waiting for them because of these degrees they’re borrowing to pay for, and then they’re very shocked and have no other plan to support themselves. The millennial generation, I think, is the first to be tricked into this fate en masse, and gen-z even more so. It’s like 2 whole generations were lied to that the full implications of the decline of manufacturing and professional retail jobs that happened 1970-1990 are “only white-collar careers will exist” rather than the more correct “skilled trades and professional services are better bets than simply looking for a factory or clerk job at 18 and working your way up.”

podiki 2y ago

But isn't that exactly it, that these (and healthcare) are very much part of the "market?" The goal to make money and to provide healthcare are at fundamental odds if you ask me. (Or they don't have to be, but the natural "experiment" of for profit healthcare in places like the US tells us much.)

SoftTalker 2y ago
It's not a normal market because the customers (the patients) are generally not the people paying for the services.
IG_Semmelweiss 2y ago
I think no one is against paying doctors to make a good living. Perhaps even extravangant living. If the product is great, why not? Apple, Tesla, Etc made owners very rich. The problem is your share of health dollars going to administrators, which is bundled with the barriers to entry into healthcare and into insurance. Its very hard to be a doctor that doesnt take insurance, so administrators come to rule the roost. If there was truly a free market, yiud see a material share of doctors working outside the insurance system. Yet no such niche really exists.
- thefaux 2y ago
  The problem with a doctor making an extravagant living is that it calls into question their motivation for working as a healer. How can I feel good about my patients if I know that they can barely afford to pay for my cafe? Or conversely, what does that say about me if I only work with wealthy patients?
- SoftTalker 2y ago
  There are a few cash-only medical practices. I know of one personally. They have been operating this way for nearly 20 years so it must be working for them. I would guess that most of their patients are quite well off, given that they have the cash available to pay out of pocket. That probably eliminates quite a lot of issues for the practice, as that would tend to select for reasonably educated and high-functioning patients. They also don't have to deal with insurance companies or collections.
- deleted 2y ago
  [deleted]
- xp84 2y ago
  > doctors working outside the insurance system I do see this to a huge extent in the area of mental health in the wealthy area that I live in. Many of the best doctors have no need for insurance- rich people will gladly pay $300 an hour or more for a good therapist so why bother with the insulting $60 reimbursement that a doctor will get after doing a lot of paperwork with an insurance company. I am not sure that this means anything whatsoever about a free market or not - and not all kinds of doctors are doing this, but it’s happening. And it really sucks to be paying the huge insurance premiums I’m paying, and still have the best doctors all out of reach unless I’m willing to shell out MORE money out of pocket.

kube-system 2y ago

I think it's the exact opposite -- this is a problem created by administrators who are treating these institutions like a business and 'selling' these schools to be everything to everyone in order to continually grow enrollment, and grow their administrative empires. Academics works better when relatively isolated from market forces -- the worst thing you can do for academics is to ask it to turn a profit.

IG_Semmelweiss 2y ago
Chicken va egg What was first - barriers to entry, or administrative inertia? Im not sure whos right, but im sure between thw two of them, they are making entire industries extremely inefficient.
nemo44x 2y ago
And by subsidizing them we are. If actual market forces emerged then they’d stop it with the bullshit degrees that people that can’t afford and go into debt on. Subsidizing as we do today incentivizes them to be everything to everyone because the money keeps rolling in.
- xp84 2y ago
  Problem is we as a society cannot bear to say to any student, no matter how true it is, that they don’t have a viable path to both fulfillment and financial success that includes “university” and <insert their passion topic>. In fact, we go the opposite direction, telling literally every student in high school that they will be throwing their life away if they choose to work after graduation, and that vocational training is for an underclass. Only university will do, we say. Which is why you have graduates who majored in art because they like manga, or in ethnic/gender studies because identity politics sounds exciting to a teenager. All this is actually fine if you are doing it with an understanding that it’s about becoming more cultured and learned, and that it has nothing to do with career training. But people seem to think there are white-collar jobs waiting for them because of these degrees they’re borrowing to pay for, and then they’re very shocked and have no other plan to support themselves. The millennial generation, I think, is the first to be tricked into this fate en masse, and gen-z even more so. It’s like 2 whole generations were lied to that the full implications of the decline of manufacturing and professional retail jobs that happened 1970-1990 are “only white-collar careers will exist” rather than the more correct “skilled trades and professional services are better bets than simply looking for a factory or clerk job at 18 and working your way up.”