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What our "system" seems to actually incentivize is keeping people chronically ill so that they're forced to continually pay for their non-treatment. It's hard

What our "system" seems to actually incentivize is keeping people chronically ill so that they're forced to continually pay for their non-treatment. It's hard not to be incredibly cynical in the face of things like this. Way more than once have I thought "this is a cruel and unusual punishment" -- wait aren't those prohibited?? Oh right we get around that by making cruelty usual.

liquidise 1y ago
I feel this is more a societal failing than a medical one. Most people don’t want to take better care of themselves: eating better, portion control, more regular exercise, etc. Too hard. People want a pill to solve the ailments they have.
- kjkjadksj 1y ago
  Exactly why weight loss pills are a multibillion dollar industry today.
  - nradov 1y ago
    Technically those are mostly weight loss injections now. The pills don't work nearly as well.
tekla 1y ago
People want medication to solve their problems, not actually try and solve things without paying money for it
- const_cast 1y ago
  You can't solve your health issues without paying money. If you have high cholesterol and you decide to make lifestyle changes, you still have to go to the cardiologist. Because you have absolutely no idea if you actually lowered your cholesterol. A big fallacy is people thinking they know if they are healthy or they know about their bodies. You don't. Even if you live a very healthy lifestyle, you still have to go to the doctor. You still need screening.
margalabargala 1y ago
I see this view sometimes and it really annoys me. The number of doctors and nurses that attempt to keep people chronically ill rather than curing them if possible, is essentially zero. People get into that field frequently because they actually care, and people that actually care are the most likely to not follow a vague profit incentive that actively hurts people. Similarly, most medical researchers would love to cure diseases, and actively seek out jobs where they do so and will object if asked to suppress curative research. To the extent that what you describe exists, it is limited to MBA people at insurance companies and big pharma determining what gets funded for research. While exceptions always exist, the incidence of that attitude among the people actually doing the work is very close to nil.
- Henchman21 1y ago
  I think we agree on this point almost entirely. But let’s not pretend the doctors, nurses, and researchers are running the show. This attitude of mine persists because of the way the insurance companies run the system: profits first, patients last. Sorry to annoy you.
  - margalabargala 1y ago
    There are a lot of doctors and researchers running research arms of large, well funded institutions. Sloan Kettering for example. I'll grant you that that is a low percentage of the total US medical research spend. But also, most of the world does not have the same profit motive; in most Western countries, a cure is categorically cheaper for everyone than a chronic illness, because healthcare is paid for by taxpayers. And countries besides the US do plenty of medical research. If the hypothesis were true that there exist cures to many diseases that simply haven't been explored due to profit motive, then I would expect countries without that profit motive to have a higher proportion of cures among their medical.discoveries than the US. I don't believe that is true though. Basically my point is that the effect you mention likely has little actual impact on the larger medical field.
  - BobaFloutist 1y ago
    There's pretty universally much more demand for doctors than supply. And insurance companies, the other major power that's, to an upsetting degree, "running the show" would love for everyone to be perfectly healthy so they can collect premiums and never pay out.
nradov 1y ago
Nonsense. The clinicians working in the healthcare system have zero incentive to keep patients chronically ill. This isn't a matter of keeping patients coming back: most doctors already have more workload than they can even handle. Most chronic diseases are primarily caused by lifestyle choices. This is largely outside the scope of medical practice. A doctor can prescribe metformin to treat type-2 diabetes and a statin to reduce cholesterol but they can't force you to clean up your diet and get some exercise. https://peterattiamd.com/outlive/ https://peterattiamd.com/outlive/

liquidise 1y ago

I feel this is more a societal failing than a medical one. Most people don’t want to take better care of themselves: eating better, portion control, more regular exercise, etc. Too hard. People want a pill to solve the ailments they have.

kjkjadksj 1y ago
Exactly why weight loss pills are a multibillion dollar industry today.
- nradov 1y ago
  Technically those are mostly weight loss injections now. The pills don't work nearly as well.

tekla 1y ago

People want medication to solve their problems, not actually try and solve things without paying money for it

const_cast 1y ago
You can't solve your health issues without paying money. If you have high cholesterol and you decide to make lifestyle changes, you still have to go to the cardiologist. Because you have absolutely no idea if you actually lowered your cholesterol. A big fallacy is people thinking they know if they are healthy or they know about their bodies. You don't. Even if you live a very healthy lifestyle, you still have to go to the doctor. You still need screening.

margalabargala 1y ago

I see this view sometimes and it really annoys me. The number of doctors and nurses that attempt to keep people chronically ill rather than curing them if possible, is essentially zero. People get into that field frequently because they actually care, and people that actually care are the most likely to not follow a vague profit incentive that actively hurts people. Similarly, most medical researchers would love to cure diseases, and actively seek out jobs where they do so and will object if asked to suppress curative research. To the extent that what you describe exists, it is limited to MBA people at insurance companies and big pharma determining what gets funded for research. While exceptions always exist, the incidence of that attitude among the people actually doing the work is very close to nil.

Henchman21 1y ago
I think we agree on this point almost entirely. But let’s not pretend the doctors, nurses, and researchers are running the show. This attitude of mine persists because of the way the insurance companies run the system: profits first, patients last. Sorry to annoy you.
- margalabargala 1y ago
  There are a lot of doctors and researchers running research arms of large, well funded institutions. Sloan Kettering for example. I'll grant you that that is a low percentage of the total US medical research spend. But also, most of the world does not have the same profit motive; in most Western countries, a cure is categorically cheaper for everyone than a chronic illness, because healthcare is paid for by taxpayers. And countries besides the US do plenty of medical research. If the hypothesis were true that there exist cures to many diseases that simply haven't been explored due to profit motive, then I would expect countries without that profit motive to have a higher proportion of cures among their medical.discoveries than the US. I don't believe that is true though. Basically my point is that the effect you mention likely has little actual impact on the larger medical field.
- BobaFloutist 1y ago
  There's pretty universally much more demand for doctors than supply. And insurance companies, the other major power that's, to an upsetting degree, "running the show" would love for everyone to be perfectly healthy so they can collect premiums and never pay out.

nradov 1y ago

Nonsense. The clinicians working in the healthcare system have zero incentive to keep patients chronically ill. This isn't a matter of keeping patients coming back: most doctors already have more workload than they can even handle. Most chronic diseases are primarily caused by lifestyle choices. This is largely outside the scope of medical practice. A doctor can prescribe metformin to treat type-2 diabetes and a statin to reduce cholesterol but they can't force you to clean up your diet and get some exercise. https://peterattiamd.com/outlive/ https://peterattiamd.com/outlive/