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Comment by wawayanda | Hacker News Reader

The guy in the article is a doctor, so it's not as easy just saying "so slack off for four months."

Also incredibly ugly that a company would put doctors in this position. Basic healthcare and profit motives don't mix.

They mix pretty well (e.g. Germany's private health care system is doing fine, it's the public one that struggles). It's more that profit-seeking, few laws around labor contracts and zero morals don't mix well. That's not as much of a problem in Germany because there's lots of labor law regulating all kinds of things keeping the zero-morals-people in check, and voila, you don't see that kind of exploitation outside of criminal enterprises.

That said, at least 4 weeks notice are required in Germany, and you can sign a contract to increase the period, but the employee can never have a longer notice period than the employer.

> They mix pretty well (e.g. Germany's private health care system is doing fine, it's the public one that struggles)

The public one in Germany is struggling precisely why every public one everywhere is struggling: They defund the public healthcare to cripple it to justify privatizing it by saying 'it doesnt work'. Works every time as public believe it like idiots.

And no, the one that you have is not a mixed system 'that works'. Its a system in the middle of its privatization phase. When the transition is complete, youll see how things change.

Every time anything goes wrong in any public administration, people rush to assume it's a "starve the beast" tactic even when there's no evidence whatsoever it's the case.

You're making a lot of very confident assertions in that post without bothering to back them up.

> Every time anything goes wrong in any public administration, people rush to assume it's a "starve the beast" tactic

People rush to assume that because they have seen it many times before.

If a public administration is having trouble and it is poorly funded, then at this point I think the burden of proof is on the one trying to claim the poor funding is not a) the cause of the poor performance, and b) a deliberate tactic on the part of those who want to take the money for themselves and their corporate friends.

The problem is that people simply claim that something is poorly funded without ever looking at the data, and then march on from that point. Here's some data: https://data.oecd.org/healthres/health-spending.htm

It's weird, like someone once had a flat tire on their bike and now whenever someone says that their bike is broken, they can't imagine it to be anything but a flat tire. Brakes aren't working? That's because you have a flat tire. Pedals are falling off? It's just a trick to confuse you so you don't notice the flat tire. Handlebar is backwards? You've just been trained to ignore the flat tire.

It is well-known that the US spends vastly more than other countries on health care for, at best, similar outcomes. And not only is most of our healthcare spending not actually through public institutions, the absolutely awful way our public and private healthcare institutions are set up actively prevents reasonable levels of spending.

Pointing at healthcare spending in the US and saying "ha-HA! that proves that public institutions aren't poorly funded!" really says much more about you than it does about healthcare, or public institutions.

Except I wasn't, I was talking about Germany, rank two in the list of spending (in this whole thread which nobody bothers to read, apparently). Only Germany's education system doesn't leave med students in debt, and they don't earn hundreds of thousands of euros a year, you don't get giant hospital bills etc.

Seriously, not every post on this site is talking about the US, especially when they specify otherwise. Americans only knowing their system and then extrapolating and assuming that it's the exact same everywhere one the planet is tiring.

> rank two in the list of spending

And as long as the privatization continues, it will keep staying at rank two or rising. Looking at the state of a public healthcare system that is in the process of being privatized is not an argument for anything.

The public insurance system isn't being defunded or privatized, and it's the one that struggles to pay for services and requires a lot of taxes to kept upright. Hospitals were privatized decades ago, yes, and that lead to higher demands on the doctors and nurses, but that's not really the "struggling" part (they struggle finding staff, but that's another issue). And individual practitioners have always been private individuals running their own business.

> Its a system in the middle of its privatization phase.

Yeah, no, it's been set up this way since the beginning, feel free to look into it instead of speculating. The way it's set up is that doctors bill 2-2.3x to private insurances and subsidize their work for the public insurance system where they're very limited in how much they may bill per patient, regardless of how much time they spend on treatment.

> The public insurance system isn't being defunded or privatized, and it's the one that struggles to pay for services and requires a lot of taxes to kept upright

That's intentional. Part of the crippling of the public healthcare is done to force the people to go to private healthcare, who then bill the government for the services. Its how they such taxpayer money during the privatization phase.

> Yeah, no, it's been set up this way since the beginning, feel free to look into it instead of speculating

No public healthcare system was set up this way 40 years ago. Even in jurisdictions that had the potential to end up like this because of what was legally allowed, nowhere in the West it was like this. Creeping privatization of the last 40 years did this. Nothing else. Its time people stopped rationalizing and justifying how things are tumbling downhill.

> No public healthcare system was set up this way 40 years ago.

Okay. I mean, you could look it up [1] and check when the private insurance companies and coops (kinda) in Germany were founded, or you could just declare that it definitely wasn't ever done so. Whatever floats your boat.

[1] https://en.wikipedia.org/wiki/Healthcare_in_Germany

You must have missed the part that I said that there being legal allowances for the system to have turned out how it is now does not mean that it was set up like that. Solely the strong presence of the state and the state rendering sufficient number of services can keep things under control in an actual mixed landscape through the pressure of pricing and availability. Which was the case in most jurisdictions.

Privatization in such systems starts when the state supplied services are crippled by 'reformers'. Even in wholly public systems, first allowing 'some' private medicine then strangling the public one to channel the activity to private ones and then justify privatizing everything is the go-to tactic.

There was a comment on this site recently that proposed the reason every healthcare system in the world is struggling is because medical research has been very effective at inventing newer and more involved procedures that make it possible to solve almost any problem but at increasing resource consumption.

Previously for many issues the treatment was very basic and ineffective but now we can 3D print organs, do complex transplants, and all kinds of crazy things which work but require immense resources that society can't afford. So we are left with the unpleasant situation of "Yes we do know how to cure this, but we can't afford to".

Not to mention that a company which would do this seems like exactly the kind of place which would threaten to report slacking to the state medical board if they could find a way to portray it as endangering patients.

Just work supper slow and do a super good job; spend one hour or two with each patient. I don't see how that would result in any complaint to medical board. If patients complain, just tell them that the company is scheduling too many patients per day... Dare Concentra to release one earlier. What happens if one takes long lunch, show up to work late and leave early, calls in sick often? Is there any issue with the medical board? Does concentra have other stuff written into the contract about performance where one would have to pay 4 months of one's salary?

Oh, I’m not saying it can’t be done - just that it seems like the type of company which would be punitive to any perceived disobedience.

Yes this poor worker, who was probably coerced into signing the contract, will have to take a cut on his 300,000$ salary. Capitalism sucks.

Indeed. People like to forget that doctors as a class are the primary beneficiaries of America's for-profit medical system, and their political influence is the strongest reason it continues. Debts owed to doctors is the leading cause of bankruptcy in America.

Doctors lower on the totem pole get screwed by doctors further along in their career, but that hardly phases them. This is a profession where the institution of hazing deeply entrenched. Doctors-in-training are hazed with sleep deprivation and overworking during residency, to the detriment of patients who suffer increased rates of medical errors. The harm is well understood but doctors continue this anyway, evidently under the logic of "I suffered through it, so I'll make the new guys suffer the same."

So allow me to play the world's smallest violin for the plight of these doctors.

There’s a huge generational component here, however: older doctors did quite well setting up independent, profitable practices but the younger ones are increasingly getting all of the drawbacks where insurance and market forces push them into corporate jobs which pay less and mean they’re subject to things like this. The money isn’t bad but as in most other fields it seems like the MBAs’ relentless value extraction is pushing the system towards the breaking point (it’ll be nurses first, but it’s not uncommon for there to be shortages of doctors, either).

Are you conflating all medical debt with "debt owed to doctors"?

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