6 ms·

I can think of so many examples of protectionism in society. In Canada the dairy industry is a quota system, not just anyone can sell milk or eggs. The articl

I can think of so many examples of protectionism in society. In Canada the dairy industry is a quota system, not just anyone can sell milk or eggs. The article suggests that there should be government bodies to regulate these industries instead of self regulation, however that lends itself to regulatory capture. It probably would be better than self regulation though, similar to a school board. I think that AI will fundamentally change health care, it's as good as a primary physician in a lot of cases. The barriers need to come down, that's what is driving the costs.

sarchertech 2y ago
> that's what is driving the costs. Physicians salaries make up 8.6% of medical spending. Kaiser did a study that found a 40% reduction in physician salaries would result in a 3% savings to consumers on medical costs.
- thijson 2y ago
  Where are the costs then? Is it the MRI that costs $1000?
  - sarchertech 2y ago
    Equipment is heavily regulated and so it’s insanely expensive, drugs are heavily regulated and expensive to develop in general, infrastructure, malpractice insurance, non-physician labor, regulatory compliance, insanely expensive software, administrators etc… Then you add in the profit that has to be extracted at every level. Private equity buys up hospitals, physicians groups, and ambulance operators. They need to take their cut. Insurance companies need to take their cut. The free market doesn’t work great for to keep rent seekers from extracting profits because of insurance and the very nature of healthcare which reduces the ability of customers to shop around.
    - hedora 2y ago
      Last I checked (10 years ago?), 33% of US healthcare costs went to haggling between the insurance company and the administrative assistants the doctor has to hire. I’d guess it’s higher now. It also seems really easy to fix: Just have a standard price list, and auto accept/reject 99% of procedures at the time of administration. Also, have a billing system that lets the patient pay on discharge (like restaurants). Edit: Concrete example. I needed some medicine. There are two interchangeable options. One retails for $30, and the other for $600. The doctor chose the $600 version, and insurance rejected it. This wasted my afternoon, an hour of the pharmacist’s time, 15 minutes of insurance company time, and at least 45 minutes of time at the doctor’s office. On top of that, the doctor had to context switch back to my case to change the prescription. If the doctor had a UI when writing the prescription that contained a price list, whether insurance covers which drug, and a “no really, we need the expensive one” button (there is already such an override that the insurance company honors), then all of this waste would have been avoided.
      - teruakohatu 2y ago
        Wouldn’t a better regulation be that pharmacists can dispense cheaper generics with patient consent? If the doctor really wants something specific they can state no substitutes on the script. Here in New Zealand I am pretty sure that’s the case.
        zo1 2y ago
        Here in South Africa, the pharmacist is obligated to offer a generic to you, irrespective of which medicine it is. Some days I just go sure, other times I specifically want the non-generic because it is slightly (at least to me) better.
        hedora 2y ago
        It works that way in the US too. These were different drugs, and there is no generic for the expensive one. In my case, there was zero reason to prefer one over the other. That’s not true in all cases.
      - 2y ago
- gruez 2y ago
  >Kaiser did a study that found a 40% reduction in physician salaries would result in a 3% savings to consumers on medical costs. source?
- Onavo 2y ago
  In that case they shouldn't try to use Congress to obstruct training more doctors.
  - sarchertech 2y ago
    [flagged]
- ssivark 2y ago
  It's likely that inefficiencies like this contribute O(40%) to every slice of the pie, so fixing any one slice seems unimportant, but cumulatively they would make a big impact on the situation. A second hypothesis is that the inefficiencies are fractal/recursive -- and that we might be able to squeeze out another one or two 40% savings in some slices even after the first one!
  - sarchertech 2y ago
    >cumulatively the would make a big impact Because of the nature of the healthcare market a reduction in physician salaries would be almost entirely captured by private equity and insurance companies. The only realistic way a reduction in physician salaries leads to a significant reduction in costs is with a single payer system. >fractal/recursive This is just wishful thinking. I can think of zero mechanisms where paying physicians less has a compounding negative effect on prices. I can think of several mechanisms for how it would have a compounding positive effect. Decrease in quality, decrease in recruiting, acceleration of retirement etc…
- snapplebobapple 2y ago
  What was included in physician salaries? I suspect either specialists wernt included or they used take home salary rather than fees because fees by doctors and specialists is a lot more than 8% in canada
  - sarchertech 2y ago
    8% is total physician compensation including specialities. If you look at total billed physician services it's closer to 14%. The difference comes from revenue skimmed off by entities that employ or contract physicians. A huge part of that is profit skimmed off by private equity buying out physician groups over the last 20 years or so.
brador 2y ago
Chestertons fence: https://en.m.wiktionary.org/wiki/Chesterton%27s_fence https://en.m.wiktionary.org/wiki/Chesterton%27s_fence
- gruez 2y ago
  Thought-terminating cliché: https://en.wikipedia.org/wiki/Thought-terminating_clich%C3%A9 https://en.wikipedia.org/wiki/Thought-terminating_clich%C3%A... More to the point, vague and lazy arguments should have little, if any weight when it comes to policy debates. If a given policy has provable and material harms (ie. stifling the supply for hair cutters), and the only opposition is a vague "well it must be there for A Good Reason", then the proper response should be to repeal it, not "well I guess we can't conclusively prove that it wasn't there for a good reason so I guess we should keep it".
- amadeuspagel 2y ago
  If someone is removing a fence, and you don't know why, don't stop them.
- tim333 2y ago
  "The principle that reforms should not be made until the reasoning behind the existing state of affairs is understood." I think we understand the reasoning pretty well. Protectionism. In the UK I don't think we have licensing required for hairdressers or egg sellers and we still have ok haircuts and eggs.

sarchertech 2y ago

> that's what is driving the costs. Physicians salaries make up 8.6% of medical spending. Kaiser did a study that found a 40% reduction in physician salaries would result in a 3% savings to consumers on medical costs.

thijson 2y ago
Where are the costs then? Is it the MRI that costs $1000?
- sarchertech 2y ago
  Equipment is heavily regulated and so it’s insanely expensive, drugs are heavily regulated and expensive to develop in general, infrastructure, malpractice insurance, non-physician labor, regulatory compliance, insanely expensive software, administrators etc… Then you add in the profit that has to be extracted at every level. Private equity buys up hospitals, physicians groups, and ambulance operators. They need to take their cut. Insurance companies need to take their cut. The free market doesn’t work great for to keep rent seekers from extracting profits because of insurance and the very nature of healthcare which reduces the ability of customers to shop around.
  - hedora 2y ago
    Last I checked (10 years ago?), 33% of US healthcare costs went to haggling between the insurance company and the administrative assistants the doctor has to hire. I’d guess it’s higher now. It also seems really easy to fix: Just have a standard price list, and auto accept/reject 99% of procedures at the time of administration. Also, have a billing system that lets the patient pay on discharge (like restaurants). Edit: Concrete example. I needed some medicine. There are two interchangeable options. One retails for $30, and the other for $600. The doctor chose the $600 version, and insurance rejected it. This wasted my afternoon, an hour of the pharmacist’s time, 15 minutes of insurance company time, and at least 45 minutes of time at the doctor’s office. On top of that, the doctor had to context switch back to my case to change the prescription. If the doctor had a UI when writing the prescription that contained a price list, whether insurance covers which drug, and a “no really, we need the expensive one” button (there is already such an override that the insurance company honors), then all of this waste would have been avoided.
    - teruakohatu 2y ago
      Wouldn’t a better regulation be that pharmacists can dispense cheaper generics with patient consent? If the doctor really wants something specific they can state no substitutes on the script. Here in New Zealand I am pretty sure that’s the case.
      - zo1 2y ago
        Here in South Africa, the pharmacist is obligated to offer a generic to you, irrespective of which medicine it is. Some days I just go sure, other times I specifically want the non-generic because it is slightly (at least to me) better.
        hedora 2y ago
        It works that way in the US too. These were different drugs, and there is no generic for the expensive one. In my case, there was zero reason to prefer one over the other. That’s not true in all cases.
    - 2y ago
gruez 2y ago
>Kaiser did a study that found a 40% reduction in physician salaries would result in a 3% savings to consumers on medical costs. source?
Onavo 2y ago
In that case they shouldn't try to use Congress to obstruct training more doctors.
- sarchertech 2y ago
  [flagged]
ssivark 2y ago
It's likely that inefficiencies like this contribute O(40%) to every slice of the pie, so fixing any one slice seems unimportant, but cumulatively they would make a big impact on the situation. A second hypothesis is that the inefficiencies are fractal/recursive -- and that we might be able to squeeze out another one or two 40% savings in some slices even after the first one!
- sarchertech 2y ago
  >cumulatively the would make a big impact Because of the nature of the healthcare market a reduction in physician salaries would be almost entirely captured by private equity and insurance companies. The only realistic way a reduction in physician salaries leads to a significant reduction in costs is with a single payer system. >fractal/recursive This is just wishful thinking. I can think of zero mechanisms where paying physicians less has a compounding negative effect on prices. I can think of several mechanisms for how it would have a compounding positive effect. Decrease in quality, decrease in recruiting, acceleration of retirement etc…
snapplebobapple 2y ago
What was included in physician salaries? I suspect either specialists wernt included or they used take home salary rather than fees because fees by doctors and specialists is a lot more than 8% in canada
- sarchertech 2y ago
  8% is total physician compensation including specialities. If you look at total billed physician services it's closer to 14%. The difference comes from revenue skimmed off by entities that employ or contract physicians. A huge part of that is profit skimmed off by private equity buying out physician groups over the last 20 years or so.

brador 2y ago

Chestertons fence: https://en.m.wiktionary.org/wiki/Chesterton%27s_fence https://en.m.wiktionary.org/wiki/Chesterton%27s_fence

gruez 2y ago
Thought-terminating cliché: https://en.wikipedia.org/wiki/Thought-terminating_clich%C3%A9 https://en.wikipedia.org/wiki/Thought-terminating_clich%C3%A... More to the point, vague and lazy arguments should have little, if any weight when it comes to policy debates. If a given policy has provable and material harms (ie. stifling the supply for hair cutters), and the only opposition is a vague "well it must be there for A Good Reason", then the proper response should be to repeal it, not "well I guess we can't conclusively prove that it wasn't there for a good reason so I guess we should keep it".
amadeuspagel 2y ago
If someone is removing a fence, and you don't know why, don't stop them.
tim333 2y ago
"The principle that reforms should not be made until the reasoning behind the existing state of affairs is understood." I think we understand the reasoning pretty well. Protectionism. In the UK I don't think we have licensing required for hairdressers or egg sellers and we still have ok haircuts and eggs.