More fun with for-profit medicine

[Thailandnotes]

Re: More fun with for-profit medicine

Does anyone reading this thread have a 50,000 dollar deductible? What does the plan cost?

[shiny!]

Re: More fun with for-profit medicine

I recently had a discussion with a doctor friend of mine, he talked about another upcoming wrinkle with healthcare in this country which is the training of doctors.

In his generation (we're in our late 40's), the doctors in resident programs put in insane, mega hours, I don't have numbers, but I recall back then that 100+ hr weeks weren't unusual.

That has changed apparently - hours in many (all?) programs are cut way back, and the current batch of doctors coming off residency don't have the same degree of knowledge/training/experience when they are officially ready to practice.

He told me that his practice recently had to pass on inviting a new grad to join their practice, the fellow just wasn't ready and wasn't good....and, I guess their business model doesn't include training someone.

He also noted that this year marked the first time that the number of doctors employed by others (ie hospitals), exceeded those who work in their own practice (or one that they are a partner in).

The current generation is also looking for the work-life balance (aren't we all?) and prefer to check out at 5 (or whenever their shift ends, he says there is even a term for the doctors who specialize in night shifts, I wish I could recall what it is).

That may have the impact of driving down prices (ie, the doctors are no longer negotiating or as someone said above, playing chicken, with the insurers.....but it also seems apparent that it will push down quality of care as well.

This one is a moving target!

My stepson told me the same thing. He finished his residency five years ago (Internal Medicine/Pediatrics) and was chief resident at his hospital for a couple of years after that. He worked the 80-100 hour weeks when coming up, but hours were reduced around the time he finished.

In his opinion, the push to give interns and residents shorter hours for their health backfired. By making it easier, a lot of less-motivated, less-dedicated doctors are completing training and they are just not very good. He was frequently disgusted by all the hand-holding they required when he was on call... the stupid things they called him about in the middle of the night. Not only were these things that they should have known already, but they were too lazy to look up the answers for themselves. They're just "phoning it in."

[Ghent12]

Re: More fun with for-profit medicine

Just one of the reasons I was forced to abandon my free market principles concerning the healthcare industry. (Along with the intelligent and civil discussion by dcarrigg.)

Here's an interview worth watching. Dr. Smith lays out the perverse incentives that hospitals, insurance companies, and by extension the government operate under.

Check out the prices his center charges: http://www.surgerycenterok.com/pricing.php

[c1ue]

Re: More fun with for-profit medicine

Meh, the perverse incentives thing keeps getting pushed by the 'free market' crowd, but the reality is that single payer works just fine in every single other 1st and most 2nd world countries.

I have no issue with having fully private care also available for those who pay it, but the notion that the 'free market' is necessary to fix the present health care debacle is entirely ideological.

[Ghent12]

Re: More fun with for-profit medicine

Meh, the perverse incentives thing keeps getting pushed by the 'free market' crowd, but the reality is that single payer works just fine in every single other 1st and most 2nd world countries.

I have no issue with having fully private care also available for those who pay it, but the notion that the 'free market' is necessary to fix the present health care debacle is entirely ideological.

Works "just fine" for some. Not for all, like Canadians or British and others who buy their way out of line and into an American OR. There are only tradeoffs, not solutions.

Incentives are always the most important part of any system. Perceived incentives serve to guide behavior, not the intentions of policy makers. As an example, there are reduced incentives to pursue your medical education within Britain and stay there to work due to their national health care system.

[Thailandnotes]

Re: More fun with for-profit medicine

Works "just fine" for some. Not for all, like Canadians or British and others who buy their way out of line and into an American OR.

Less than 1% of Canadians have sought medical treatment in the U.S.

[Ghent12]

Re: More fun with for-profit medicine

Less than 1% of Canadians have sought medical treatment in the U.S.

That's not surprising at all. It costs quite a lot to buy your way out of line, and that would only be likely if you place a very high value for your time (i.e. you are rich). It's kind of like competing with the US Postal Service to send mail to Alaska. Nobody can on simple letters, but that doesn't mean it's good policy for the government to charge $0.45 to send a letter to Anchorage.

There are far more incentives in the American system to be expeditious than in, say, the British or Canadian systems, and that is something important in healthcare too. Cost isn't everything, and you cannot have everything. There are no solutions, only tradeoffs.

Maybe it's time to readjust the system to incentivize cost reduction? The American system has too many incentives for absurd levels of price growth, and it has nothing at all to do with free market principles. Obamacare greatly enhances the incentives to increase the price, and we'll see what Obama can come up with at the end of his second term to save us from Obamacare, while he uses some line like, "Well we tried Obamacare, but greedy corporations were too entrenched to budge, so now the government needs to step in even more..." Meanwhile, in reality, greedy corporations exist in every industry with every result imaginable from cost reduction to cost growth. Does more greed play that large of a role in costs? You can try this at home--become the most greedy person you can possibly imagine, and see how much more you can charge for your goods and/or services.

[c1ue]

Re: More fun with for-profit medicine

Works "just fine" for some. Not for all, like Canadians or British and others who buy their way out of line and into an American OR. There are only tradeoffs, not solutions.

The problem is: how many in Canada and the UK is the system not working for?

I'll bet you dollars for donuts that the ratio in the US is far, far, far higher.

The fact that the health care systems in all of the of the 1st world and most of the 2nd world aren't perfect doesn't override the equal fact that they work far better and at a far lower cost than what is in the US.

[LazyBoy]

Re: More fun with for-profit medicine

Works "just fine" for some. Not for all, like Canadians or British and others who buy their way out of line and into an American OR.

Less than 1% of Canadians have sought medical treatment in the U.S.

That's not surprising at all. It costs quite a lot to buy your way out of line, and that would only be likely if you place a very high value for your time (i.e. you are rich).

So you're upset that it doesn't work "just fine" for the rich?

[radon]

Re: More fun with for-profit medicine

The more I think about this subject, the more I thing the lack of upfront pricing is the root of the problem. Its not only that people could shop around, but that any gouging would quickly become public information, and those responsible would feel the wrath of the press and public. Imagine going to a restaurant and being charged $2000 for a steak. Word would get out quickly and they'd be out of business almost overnight. Who wouldn't love to run a business where you just charge whatever you feel you can get away with, and threaten to ruin people's credit if they don't pay. Perhaps its time at least Emergency procedures should have some limits placed on them. I don't know.

Indeed. Imaging going to a restaurant that cannot bill you directly but has to submit a bill to your hunger insurance plan. The restaurant is run by some poor schmuck who cant even find out what to charge you for the steak he just sold until he submits a claim to the insurance company. He can't negotiate a price for the steak because he has no pricing power. You see, you aren't the one who is paying him, your insurance company is, and he is forced to accept their policies on steak because there are no cash paying customers anymore. He loves to cook and wants to see happy customers, but he is really in a bind. So he closes up shop and goes to work for the really big steak shop chain. He thinks the food is bland and tasteless and has no control over the menu anymore, but somebody else takes care of billing.

The entire arrangement is crazy if you ask me.

[radon]

Re: More fun with for-profit medicine

Meh, the perverse incentives thing keeps getting pushed by the 'free market' crowd, but the reality is that single payer works just fine in every single other 1st and most 2nd world countries.

I have no issue with having fully private care also available for those who pay it, but the notion that the 'free market' is necessary to fix the present health care debacle is entirely ideological.

The US health care system hasn't resembled a free market since the rise of managed care in the 70s. The integration of large pharma and its subsequent finalization have made things even worse. If you ask me a free market would be a step in the right direction. The rise of these large "non-profit" hospitals isn't really conducive to free market forces either.

[radon]

Re: More fun with for-profit medicine

In his opinion, the push to give interns and residents shorter hours for their health backfired. By making it easier, a lot of less-motivated, less-dedicated doctors are completing training and they are just not very good. He was frequently disgusted by all the hand-holding they required when he was on call... the stupid things they called him about in the middle of the night. Not only were these things that they should have known already, but they were too lazy to look up the answers for themselves. They're just "phoning it in."

Your stepson may not have realized it, but I'll bet his chief had similar impressions of his residents. The reality is that being chronically sleep deprived is a serious impairment. Complaining about the 80hr a week cap is foolish if you really care about quality training and patient care. I bet this is really about expanding programs to fill staffing slots.

[shiny!]

Re: More fun with for-profit medicine

Your stepson may not have realized it, but I'll bet his chief had similar impressions of his residents. The reality is that being chronically sleep deprived is a serious impairment. Complaining about the 80hr a week cap is foolish if you really care about quality training and patient care. I bet this is really about expanding programs to fill staffing slots.

I don't necessarily disagree with you.

[Thailandnotes]

Re: More fun with for-profit medicine

This show is maybe worth a listen

http://thedianerehmshow.org/shows/20...ansparency-can

From the transcript

You know, last year there were a record number of hospitals acquisitions and mergers in the United States. The Federal Trade Commission's actually looking into antitrust violations. And some of us have actually been saying, are we creating institutions that are too big to fail in some of these large rural areas? I mean, St. Vince's Hospital in New York was basically the victim of bad management and collapsed. And if that happened at another place outside of New York -- in New York you've got other hospitals you can go to -- what about these hospital systems that dominate an entire state in providing the health care system.


"Just recently retired from a long health care career. The major hospital system in my area here in Virginia has hospital-employed physicians do their own hospital billing. This is how the hospital incentivizes the doctors. True example, hospital list tells me that length of stay doesn't matter to his hospital. He had a patient ready to go home that day and yet because his billing was low, he was being texted, emailed, called and reminded to get his billing up to that of his colleagues. He was going to have to keep this patient in the hospital another day or two and find things to do to her -- that's a direct quote -- to get his billing up."

[Ghent12]

Re: More fun with for-profit medicine

So you're upset that it doesn't work "just fine" for the rich?

I was merely making observations.

There are more problems with British, Canadian, and other nationalized health care services than the huge increase in time required for service. That is simply a highlighted example. If you think it's "just fine" for people to wait because they have no choice but to wait, then that's your sin.