17 ms·

The shadowy cartel of doctors that controls Medicare

135 points by carbocation 13y ago

droopyEyelids 13y ago
Reading about this, and the recent brouhaha concerning hospitals posting their pricing online, made me realize how essential pricing opacity is if healthcare providers want to maintain their all-knowing god/parent like relationship with the public. Doctors don't quite seem doctorly when they're grubbing for money. (only an observation that seemed funny in my mind, don't bother debating it because it's not 100% serious)
- 46Bit 13y ago
  > (only an observation that seemed funny in my mind, don't bother debating it because it's not 100% serious) No, no, this is a worthwhile point to make. Whether selling used cars, life-saving surgery or hiring young hackers for awful pay, information asymmetry can you give you a sizable advantage by itself. Reading about a system like the RUC is a really good demo of this. To an outsider it might seem the strict confidentiality could be excused for preventing lobbyist influence - yet it also gives free rein to avoid media and public scrutiny in the light of day.
- gohrt 13y ago
  Progressive-minded providers, the ones who want to "do well by doing good", understand that they are providing a valuable service for a fair fee, and they want to cut out the middlemen as much as the patients do. I love doctors who say, "I charge $X. If you have an insurance policy, that's great, tell me where to send the invoice, but YOU are my customer and you are responsible for making sure it gets paid."
- agent00f 13y ago
  Price transparency will NEVER happen in the US market. The insurers all negotiate individual deals with providers, and it's a losing tactic for any one of them to divulge the details of their contracts.
  - anonymoushn 13y ago
    It's a losing tactic for any one insurer, but it may be alright for a practitioner or customer. http://watchdog.org/64814/ok-surgery-centers-cash-only-approach-offers-transparency-efficiency-affordability/ http://watchdog.org/64814/ok-surgery-centers-cash-only-appro...
notdrunkatall 13y ago
I'm always irritated when people blame capitalism and free markets for the high cost of healthcare in the USA. The reality is that healthcare is anything but a free market, and costs aren't going to come down until it becomes one.
- nostromo 13y ago
  Or becomes not one. We have a worse system than both free-market and single-payer, either would be more cost-effective.
  - notdrunkatall 13y ago
    I fully agree.
  - venomsnake 13y ago
    Health care cannot be free market by one simple fact - you have total inflexibility of demand/constant production of goods/information asymmetry. No sane person will buy brain surgery if he has no problems even if it 1$ and he has no choice but to buy one at whatever cost if he has. We should work towards making healthcare cheap in absolute sense - if we could make healthcare cost on average 1000$ per person per year than the question who should foot the bill is moot - it will be such a small sum it won't matter.
    - brazzy 13y ago
      I suspect that's impossible unless you first reach a full post-scarcity economy of nanotech and robotic servants. For rare conditions, it's not overall cost-effective to spend the necessary money to make them cheap, and for everything else there is too much labor involved to ever be cheap.
    - eatitraw 13y ago
      I don't get your point. > No sane person will buy brain surgery if he has no problems even if it 1$ and he has no choice but to buy one at whatever cost if he has. So what? Also, if there are multiple methods to treat his conditions, he may choose more expensive(or more cheap) method. Also, he may choose not to have brain surgery -- and sadly suffer or die. Socialism is hardly a solution here, if state will fail to provide necessary amount of surgeons to fulfill demand for them, then people will die too(not mentioning that there always be better methods and better qualified surgeons, so you won't be able to achieve the same level of healthcare anyway).
AlaLoo 13y ago
I work in the country's largest single payer medical system. It's called the Veterans Administration. The physicians are employed at a fixed salary, with no bonus, so I don't get paid more if I do 1 procedure or 10. But I STILL order tons of unnecessary tests. Why? It's not because I get paid more! It's because I am scared of getting sued. What WILL massively cut costs is doing what New Zealand does, and basically ending the medical malpractice scam that only exists to enrich trial lawyers, whom are a far more insidious lobby than doctors ever will be. 95% of patient injuries have nothing to do with true "malpractice." A doctor cannot promise a good outcome 100% of the time, just like a programmer cannot generate bug-free code 100% of the time. Instead of the current system, make it so that an injured patient is entitled to compensation from a national "patient injury fund." The ambulance chasers make zero dollars, doctors don't have to waste money on "defensive medicine," and injured patients get prompt and fair compensation. And if a physician has too many such episodes, then they can be referred to the licensing board.
- joonix 13y ago
  Not sure why you point as far as NZ when Texas basically eliminated it by capping pain and suffering awards at $250,000. Medical malpractice insurance (which is the tort system manifested as a cost to doctors) is not the most expensive part of healthcare though so your point is not really correct.
  - dantheman 13y ago
    His point was that worrying about malpractice causes doctors to spend more money on tests and other diagnostics than they normally would so that they don't have to worry about being sued.
    - galaxyLogic 13y ago
      Correct. That's the thing to discuss I think. And the suggested solution of national "patient injury fund." seems like the best solution candidate proposed so far. Thanks
  - 13y ago
Scramblejams 13y ago
Single page link: http://www.washingtonmonthly.com/magazine/july_august_2013/features/special_deal045641.php?page=all http://www.washingtonmonthly.com/magazine/july_august_2013/f...
deleted 13y ago
[deleted]
nslocum 13y ago
Do you know of any promising companies that are disrupting healthcare? Of the startups I've seen, drchrono appears to be the best positioned to disrupt, but their mission is focused exclusively on electronic health records. I'd really like to work at a place that attacks some of the flaws in the current system, but most healthcare companies are too invested and/or dependent on the current system to challenge it.
- ameister14 13y ago
  DrChrono, from what I have seen, seems oriented towards private practice. This is an interesting choice since private practices are disappearing all over the country. I'm not really sure they're going to disrupt too much because of that. It's extremely difficult to disrupt hospital controlled medicine, in part because groups of buyers control what hospitals purchase and they are for the most part extremely conservative.
uslic001 13y ago
What a joke. Claiming that the Veteran's Administration provides better care based on faulty propaganda based studies put out by the VA itself to make itself look good instead of the third world medicine they truly provide.

135 points by carbocation 13y ago

Reading about this, and the recent brouhaha concerning hospitals posting their pricing online, made me realize how essential pricing opacity is if healthcare providers want to maintain their all-knowing god/parent like relationship with the public. Doctors don't quite seem doctorly when they're grubbing for money. (only an observation that seemed funny in my mind, don't bother debating it because it's not 100% serious)

46Bit 13y ago
> (only an observation that seemed funny in my mind, don't bother debating it because it's not 100% serious) No, no, this is a worthwhile point to make. Whether selling used cars, life-saving surgery or hiring young hackers for awful pay, information asymmetry can you give you a sizable advantage by itself. Reading about a system like the RUC is a really good demo of this. To an outsider it might seem the strict confidentiality could be excused for preventing lobbyist influence - yet it also gives free rein to avoid media and public scrutiny in the light of day.
gohrt 13y ago
Progressive-minded providers, the ones who want to "do well by doing good", understand that they are providing a valuable service for a fair fee, and they want to cut out the middlemen as much as the patients do. I love doctors who say, "I charge $X. If you have an insurance policy, that's great, tell me where to send the invoice, but YOU are my customer and you are responsible for making sure it gets paid."
agent00f 13y ago
Price transparency will NEVER happen in the US market. The insurers all negotiate individual deals with providers, and it's a losing tactic for any one of them to divulge the details of their contracts.
- anonymoushn 13y ago
  It's a losing tactic for any one insurer, but it may be alright for a practitioner or customer. http://watchdog.org/64814/ok-surgery-centers-cash-only-approach-offers-transparency-efficiency-affordability/ http://watchdog.org/64814/ok-surgery-centers-cash-only-appro...

notdrunkatall 13y ago

I'm always irritated when people blame capitalism and free markets for the high cost of healthcare in the USA. The reality is that healthcare is anything but a free market, and costs aren't going to come down until it becomes one.

nostromo 13y ago
Or becomes not one. We have a worse system than both free-market and single-payer, either would be more cost-effective.
- notdrunkatall 13y ago
  I fully agree.
- venomsnake 13y ago
  Health care cannot be free market by one simple fact - you have total inflexibility of demand/constant production of goods/information asymmetry. No sane person will buy brain surgery if he has no problems even if it 1$ and he has no choice but to buy one at whatever cost if he has. We should work towards making healthcare cheap in absolute sense - if we could make healthcare cost on average 1000$ per person per year than the question who should foot the bill is moot - it will be such a small sum it won't matter.
  - brazzy 13y ago
    I suspect that's impossible unless you first reach a full post-scarcity economy of nanotech and robotic servants. For rare conditions, it's not overall cost-effective to spend the necessary money to make them cheap, and for everything else there is too much labor involved to ever be cheap.
  - eatitraw 13y ago
    I don't get your point. > No sane person will buy brain surgery if he has no problems even if it 1$ and he has no choice but to buy one at whatever cost if he has. So what? Also, if there are multiple methods to treat his conditions, he may choose more expensive(or more cheap) method. Also, he may choose not to have brain surgery -- and sadly suffer or die. Socialism is hardly a solution here, if state will fail to provide necessary amount of surgeons to fulfill demand for them, then people will die too(not mentioning that there always be better methods and better qualified surgeons, so you won't be able to achieve the same level of healthcare anyway).

AlaLoo 13y ago

I work in the country's largest single payer medical system. It's called the Veterans Administration. The physicians are employed at a fixed salary, with no bonus, so I don't get paid more if I do 1 procedure or 10. But I STILL order tons of unnecessary tests. Why? It's not because I get paid more! It's because I am scared of getting sued. What WILL massively cut costs is doing what New Zealand does, and basically ending the medical malpractice scam that only exists to enrich trial lawyers, whom are a far more insidious lobby than doctors ever will be. 95% of patient injuries have nothing to do with true "malpractice." A doctor cannot promise a good outcome 100% of the time, just like a programmer cannot generate bug-free code 100% of the time. Instead of the current system, make it so that an injured patient is entitled to compensation from a national "patient injury fund." The ambulance chasers make zero dollars, doctors don't have to waste money on "defensive medicine," and injured patients get prompt and fair compensation. And if a physician has too many such episodes, then they can be referred to the licensing board.

joonix 13y ago
Not sure why you point as far as NZ when Texas basically eliminated it by capping pain and suffering awards at $250,000. Medical malpractice insurance (which is the tort system manifested as a cost to doctors) is not the most expensive part of healthcare though so your point is not really correct.
- dantheman 13y ago
  His point was that worrying about malpractice causes doctors to spend more money on tests and other diagnostics than they normally would so that they don't have to worry about being sued.
  - galaxyLogic 13y ago
    Correct. That's the thing to discuss I think. And the suggested solution of national "patient injury fund." seems like the best solution candidate proposed so far. Thanks
- 13y ago

Scramblejams 13y ago

Single page link: http://www.washingtonmonthly.com/magazine/july_august_2013/features/special_deal045641.php?page=all http://www.washingtonmonthly.com/magazine/july_august_2013/f...

deleted 13y ago

[deleted]

nslocum 13y ago

Do you know of any promising companies that are disrupting healthcare? Of the startups I've seen, drchrono appears to be the best positioned to disrupt, but their mission is focused exclusively on electronic health records. I'd really like to work at a place that attacks some of the flaws in the current system, but most healthcare companies are too invested and/or dependent on the current system to challenge it.

ameister14 13y ago
DrChrono, from what I have seen, seems oriented towards private practice. This is an interesting choice since private practices are disappearing all over the country. I'm not really sure they're going to disrupt too much because of that. It's extremely difficult to disrupt hospital controlled medicine, in part because groups of buyers control what hospitals purchase and they are for the most part extremely conservative.

uslic001 13y ago

What a joke. Claiming that the Veteran's Administration provides better care based on faulty propaganda based studies put out by the VA itself to make itself look good instead of the third world medicine they truly provide.