Basic problem of for-profit medical care

Patterns: Doctor’s Stake in Lab Affects Biopsy Rate

http://www.nytimes.com/2012/04/17/science/urologists-stake-in-laboratory-affects-number-of-prostate-biopsies.html?src=me&ref=science

Urologists with a financial interest in a laboratory send more prostate biopsies for analysis and have a lower rate of cancer detection than those who use independent labs, according to a new study.


Years ago my physician recommended that I start taking a certain drug. I resisted when I read about some of the side effects.

A few months later I read about how the drug company was giving kickbacks to doctors who perscribed that drug.

I’d guess many people have similar stories.

I think this is at least part of the reason the USA spends nearly twice the proportion of GNP as most developed nations on medical care and has worse results than those same nations. (Lower life expectancy, higher infant mortality)

Another basic problem is that every dollar of profit is a dollar not spent on helping someone.

Some conservatives think that non-profit health care means doctors are enslaved, but that’s another story.

Again, these results are skewed by a disconnect between payer and patient. This problem is inherent in government provided health care and health care paid for by a private insurer.

The best way to ensure lower costs and patient involvement in health decisions is fee-for-service. Think about this the next time you hear a LASIK ad on the radio.

You’re wrong of course. Truly government run health care is cheaper, provides a higher percentage of population covered and produces better results than ours. That’s factual.

That’s because ours is not fee-for-service.

Look, I am not a zealot here - I am aware that there are costs and benefits for all of these models. Most systems around the world arrive at some mixed system where government pays some portion of cost, industry another portion, with a private option available for those who want or need it.

Canada in theory has no private option. In practice most Canadians live within a few hours’ drive of American hospitals that they take advantage of rather routinely.

Couldn’t the same be said of any industry? Every dollar of profit in agriculture is a dollar not spent on feeding someone. Every dollar of profit in the clothing industry is a dollar not spent on clothing someone. You can do this with every industry.

What did Moto say? Did he deny that gov’t run health care is cheaper, covers more and gives better results than the current US system? Did he say he was in favor of the US health care system? He recommended fee-for-service as opposed to the two previous options.

Maybe optional things like Lasik and plastic surgery could be done on a fee-for-service basis, and stuff that’s actually necessary for survival could be paid for by the government. People can make a rational, non-emotional decision about whether they want Lasik or not. They can’t always do the same thing about bypass surgery or chemotherapy. Desperate people don’t always make rational decisions. The fact that people are going to find it hard to refuse lifesaving care opens the door to jacking up the prices on the necessary stuff. It might be better to let someone with no emotional investment make the decisions on how much to pay for bypass surgery.

And medical care is different. It is something everyone needs and it, because our system is rubbish, priced out of reach of much of the country.

On a purely practical level, the cost of agriculture isn’t growing much faster than inflation. Other countries have a solution that works much, much better than our system. There is something uniquely pathetic about the US where we demand that we are the best, when we pay twice as much and aren’t in the top thirty.

Fee for service works okay for lasik and dental, but in each of those there aren’t huge cost possibilities. Fee for service and no insurance means that people just won’t get heart bypasses.

Wouldn’t avoiding the OP entail the complete nationalization of health care, from doctor offices to labs? As long as a private lab gets paid, there is an incentive to provide doctors with kickbacks. That’s a far cry from a single-payer system.

That’s a little misleading:[

](http://en.wikipedia.org/wiki/Health_care_in_Canada)

I think this is more a regulation problem than a profit problem.

When industries were small and markets had numerous independent choices, free market principals worked in the consumers favor. As industries have become more and more consolidated and intertwined and true competition has all but disappeared, more and more the market works against the consumer.

Maybe it is time to treat health care in America a little more like we treat electric utilities.

Are you joking?

You’re half right. Many people support the current system on the grounds that the free market is more efficient than the government. These people are retards. Our medical system is about as far from free market as you can get: prices are not set competitively, most people have little to no choice over which large company’s plan will determine what they can and can’t do and how much they’ll pay for it, and said large companies siphon a big chunk of cash out of the system at every turn.

So if you’re going to support private health care, it’s logical to push for truly private health care, where every service is a standalone product. At least then the free market has a chance to drive some costs down. The problem is that health care isn’t like toothpaste or automobiles: consumers don’t know in advance if/when they’ll need a particular medical service, and would rarely be able to shop around for it or walk away if the market’s prices are too high. And no one can afford the rare catastrophic situations, that’s why we share our risk in the first place. Same as with firefighting, police, and national defense.

What it comes down to is that the free market is very good at doing what it is designed to do: maximize the profits of whichever company can deliver good and services to consumers as efficiently as possible. It’s not good at maximizing the overall health of a populace as inexpensively as possible. That’s just not what it is designed to do. Profits, yes. So you end up with insurance companies who know how to structure plans to give the best appearance of coverage to the healthy, while not screwing over the sick so badly that future people don’t sign up for them. Take them out of the equation and you have a chance at doing the cheap stuff a lot better (e.g. preventative care) so you don’t end up treating expensive stuff via the emergency room.

Ha ha ha ha ha!

You are wrong of course.

So that would be 0.125% of Canadians traveled to the US expressly for healthcare.

Rather routinely you say? Bullshit I say.

This is one of the things about the healthcare debate that pisses me off. Folks routinely pull a nugget of crap out of their asses, and try to pass it off as fact. Then when the actual data is pointed out to them, they frequently disappear and all you hear is crickets. Wait a while though, and they reappear and post the same bullshit again. It’s like playing whack a mole.

Different than agriculture? Everyone doesn’t need food?

Having trouble with the reading? You don’t suddenly need $500k worth of food or you’ll die.

Do you really not understand this, or is this an ideological thing?

Technically, yeah.

With a bit of work and not too much expertise, you can grow at least some of your own food, even if it’s probably going to be limited to a few vegetables or something. And if you were gung-ho about it and had some resources, you could become a full time farmer or at least nearly self-sufficient, food wise.

There’s a vanishingly small probability that Joe Average could get enough training to be self-sufficient in terms of medical care, no matter how much effort or money was tossed into the attempt.

No, I think you’re having trouble remembering what you argument was. You said:

Someone asked you how this differs from other industries, like agriculture. You still haven’t told us how that is different from saying that every dollar of profit made in agriculture is a dollar not spent on feeding someone.

Rather than nitpicking the exact wording one poster used, how about replying to the sentiment behind it, e.g.

Wouldn’t that be more useful and interesting than playing gotcha?

Would you happen to have any data on how many Americans attempt to go to Canada for health care?