Spot on. It becomes more clear when you ask who pays medical professionals salaries?
Insurance companies do.
Insurance companies are medical professionals’ bosses.
The customer receiving treatment has no influence on the standard of care.
Insurance companies do.
Insurance companies are medical professionals’ bosses.
The customer receiving treatment has no influence on the standard of care.
For instance, I specialize in neuromodulation for highly-treatment-resistance psychiatry. I'm very good at what I do; my mentor is (IMO) better, and one of the absolute best in the country. A single consultation session with him is around $200 if he happens not to take your insurance. If you have a highly-treatment resistant condition, and are about to embark on a course of neuromodulation, it absolutely behooves you to go to him for a single session consultation to plan out your intervention before going to some local mediocre whatever to actually slap the equipment on your head and carry out the intervention.
For instance, people have incredibly debilitating autoimmune conditions. Rheumatic conditions are notable for their polymorphic presentations. It absolutely behooves you to go to an absolute top rheumatologist for one to three visits to confirm your diagnosis before going on a lifelong adventure of immune modulating drugs.
But folks hear "this guy doesn't take my insurance" and treat it as equivalent to "I can't get care there," even when they can afford it. I have a chronic condition, it's terrible, and my absolute world-famous specialist costs me about $250/yr - a small fraction of my monthly insurance premium. Less than my monthly prescription costs. Yet people will go to whatever specialist happens to be near them, while bearing all those other costs, and not investing in the linchpin.
Even a doctor pulling down $1m a year is only about $500 an hour, and that could be entirely worth it to get their time and dedicated.
The office manager may not be able to accommodate you, but if it can be done, they're the ones with the authority and autonomy to make it happen.
It's not always a guaranteed correct answer - I know for a fact of some people at absolutely top ranked institutions, with top pedigrees, who clearly got there by academic skills and are absolute shit as clinicians - but for the most part, it'll get you where you need to go. Generally the only way you'll end up with one of those shiny pieces of shit is if referred to them strictly by reputation; no one that's worked with them would make that referral.
It's also an answer likely to overlook excellent clinicians - many (many!, maybe most) very good clinicians aren't academics, and this won't route you to them. But you're okay with overlooking excellent docs, as long as you end up at a top doc.
Finding excellent doctors without shiny pedigrees is not something a layman can do. It's just something that local docs eventually come to know about other docs in their social-professional network, and by no means is it an unbiased assessment.
If all you have available is people's online CVs, look strongly at people with mediocre or shitty medical schools and highly prestigious residencies and fellowships. Those are people who had networking and social signaling working actively against them, and managed to positively impress everyone they worked with. E.g., a buddy of mine got into a shit medical school, and got one of the country's most prestigious subspecialties in a prestigious institution. He had to impress every single person he worked with, had to do surpass everyone on his standardized exams, and otherwise be top-of-the-top in every way. He's a ridiculously top-notch doc.
I realized then that I was part of the problem, not on a personal level, but part of everyone's high medical bills ended up in my pocket as a developer at this random healthcare company awkwardly filling our niche.
15% of US workers are in the healthcare industry, and they're not all doctors and nurses. All those people have to be paid, and all of them have to be paid by that ridiculously high medical bill you just received. Sadly, making healthcare cheaper will involve pushing a lot of these people out of the industry, and that won't be politically popular. The insurance companies are going to have to become smaller and lose some profits before things get better.
As someone 20 years into a chronic condition who has to deal with this mess constantly. We'd be ahead if we paid those people to stay home and drink themselves to death. Because it's not just the money it's also the interference in care. That sounds harsh but above and beyond the stress they are actually killing people.
Anybody with a chronic condition needs to go see a doctor at least once a year in order to get the same prescriptions they've been on for decades. There are dozens, if not hundreds of conditions that could be handled by a pharmacy.
I need an asthma inhaler every so often. I have to call a medical doctor in order to receive a prescription for an asthma inhaler. They're non-narcotic, I will always have asthma. But I need to bother a doctor for a medication that should be over the counter. It's silly.
I doubt newer cancer care, medicines, imaging, or other care would be cheap in any world, with or without insurance.
The limitation on doctors in the U.S. is based on the available funding for residents. The government supplies the money because private institutions largely are unwilling to do so.
https://www.reddit.com/r/medicine/comments/a0pufi/comment/ea...
Constrained physician supply doesn't do much when physicians can't raise prices in the face of greater demand.
People in these discussions always make things about physician costs. The majority of expenditures in the healthcare system are on drugs and equipment, followed by procedures - physician visits make up a tiny fraction of that.