Salve Lucrum: The Existential Threat of Greed in US Health Care
jamanetwork.com
jamanetwork.com
If there were a point where things got bad enough that we finally had the will to push for real change through normal political processes, we would have reached it years ago.
Without being too dramatic, I don't see this ending well.
All the incentives are to prolong the process.
The customer's yacht.
It is a joke because the customer cannot afford a yacht once we are through with him.
At a certain point in the very near future, it will become necessary to stop heeding the legal and ethical barriers which protect that power.
I really wish I didn't agree with you. The people that said to keep your guns were right.
Or imagine if a bunch of co-ops formed that built SaaS products/etc and used 100% of the money to expand the business, and build mutual aid networks and eventually buy up hospital assets like urgent cares etc... Then charged much more for insured because they can afford to pay, and gave it free to uninsured under certain income limits.
Basically a big union of worker co-ops pooling resources to build bigger and better systems that are all aligned. There may even be competitors between the co-ops but they're not competitive to the point of disrupting ecosystems and destroying the planet like unchecked corps like Dupont or something.
And also physicians themselves. The fact that the article conspicuously skips that one ruins their entire narrative.
To fix American healthcare a TON of people will lose their jobs, and a ton more will get a pay cut.
There's no other way - it's simple math, if healthcare will be cheaper, then someone has to get less money.
Just making the government pay for everyone at current rates is simply impossible, there's just not enough money. Costs must go down.
Doesn't matter which you prefer: government plans, or private; costs must go down.
This could be the buzzwords for any Texas roofing contractors.
The whole idea that systemic greed has created a situation where each patient has become a profit center that can be milked definitely fits the whole health care and senior care industries.
Many people are comfortable with their own level of greed, but uncomfortable with the next "level up" in wealth.
In terms of healthcare, I think what is actually needed is more competition and less corruption.
We don’t need an absolute scale of greed to make relative judgments about it.
Wanting a basic quality of life isn't a "level up," it's part of the human condition. It's not inherently greedy to seek a comfortable and secure existence for oneself and one's family. Usually, attaining that also benefits society by compound gains with education and productivity.
An insurance company allegedly defrauding the US [1] and not even reading claims [2] before rejecting them is pretty clearly greedy IMO.
I agree that there should be competition and less corruption, but the focus should be on accessible, high-quality care.
[1] https://www.justice.gov/usao-sdny/pr/united-states-files-civ... [2] https://www.propublica.org/article/cigna-pxdx-medical-health...
Of course the author is an MD who doesn’t mention the extremely high salaries paid to physicians in this country, instead acting like they’re somehow victims of high healthcare costs rather than the primary beneficiaries:
> Perhaps the demoralization of professionals, the conflicted consciences of many executives, and the anger of the public represent potential political energy that, with proper leadership, can become kinetic.
> First, health care professionals in all disciplines need to become noisier about the conflict between unchecked greed and the duty to heal. Extortionate drug prices, exploitation of market consolidation, coding games, excessive executive compensation, and promulgation of unnecessary care ought not to be met with silence. Silence is assent.
The median salary for a specialist physician in the US is $346k. Orthopedic surgeons clear north of half a million on average. As a result, “physician” is the most common profession profession among the richest 1%.
Note that this didn’t happen by accident. Groups like the AMA lobby for policies that keep supply low and salaries high. The one time that legislation threatened to reduce physician salaries, Congress passed the infamous “doc fix”
Mind you, residency sucks and many doctors are wonderful, so I mostly don’t begrudge them their pay. But if you’re complaining about the cost of healthcare and mention literally every group except the one you belong to, perhaps you’re being the slightest bit disingenuous.
As for the author, he earned $889,484 back in 2009 running a nonprofit. Does that “unchecked greed” cause him to have a “conflicted conscience,” I wonder?
Sources: https://www.nshss.org/blog/you-want-to-be-a-doctor-here-is-t... https://www.npr.org/sections/money/2014/10/16/356176018/the-... Page 18 for salary: https://pp-990.s3.us-east-1.amazonaws.com/2011_03_EO/38-3017...
It’s basic economics, and we’ve seen it work wonderfully in certain health areas like LASIK. We’re thankfully starting to see progress in other areas too, like the movement to have offices just list their prices upfront and not take insurance. Lowers prices dramatically.
Let’s keep pushing, we got this.
If my primary care provider is too expensive or too inept, I should be able to seek out another. This does not happen, because my insurance company locks me into their network and hides the prices and complication rates.
If my healthcare provider denies too many claims, I should find another. This does not happen because either my healthcare provider is selected by my employer, or the claim denial rates are obfuscated.
If enough patients or insurance companies complain about drug prices, hospital administrators should negotiate with drug companies. This does not happen because until last year hospital administrators were able to take kickbacks from drug companies.
At every level the patient is given minimal information and minimal choice. The only way to be guaranteed affordable care without billing surprises is medical tourism.
The greed and grift on government programs isn't new; it's been around for my entire life.
Competition is good, for time insensitive fungible things of comparable quality. It can also be good for a reverse dutch auction (within a geographic area) contract price (going rate for the year / timeframe) for a given number of procedures of a sort.
I think the ACA (Obamacare) tried far too hard to reach a compromise and fell short. A singe player, taxpayer funded baseline medical care for all organized by by the government as a healthcare provider program is the only answer for a society where we agree everyone should have the right to medically necessary procedures so they can be productive members of society.
That's how it used to work. I've seen invoices from the 50s where the cost to deliver a baby is $200. $100 for the doctor, $100 for the hospital.
With a 10x inflation adjustment, that's $2,000 total. That was enough money to deliver a baby in the 50s.
The profit margin there is insane.
An operating theatre cost many thousands of dollars an hour to run, the pre and post care is also very expensive. You may never need them (I hope you do not) but if you do it would almost surely bankrupt you without either socialised medicine (yay - sort of - another story) or insurance.
Certainly when things go wrong it can get more costly but the US consistently costs 2 to 3x more for everything AND usually has worse health outcomes. US maternal mortality is an embarrassment: https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020... .
Do you even know the ballpark of how much an MRI machine costs to operate? Yes healthcare was cheaper in the 50s, but this isn't the 50s.
Or they could keep prices high and "the poors" could just go die...?
Based on recent history I wouldn't bet against that outcome.
The root problem with healthcare in the US in general (with lots of blame to go around for the insurance industry, the healthcare industry itself, politicians, etc) is that we treat it like a commodity with elastic demand when in many situations it isn't, getting rid of health insurance (as terrible as it often is in practice here) with no other safety net in place would likely just make this situation far worse for the majority of people (basically anyone who isn't independently wealthy and suffers any kind of medical condition or emergency).
The problem is that due to highly variable costs between people, everyone has to play games to try to sucker everyone else into paying their fair share, because if they don't, they don't get paid at all.
Reworking health insurance to be insurance would fix this. HSAs are a step towards this, but not enough of a step to start seeing consumers actually change behavior based on price.
We all know the healthcare situation is terrible but the main politicians that want to change this offer 100% government controlled single payer healthcare as the only solution. That would take us from the least socialized system in the world, to literally the most socialized system in the world.
I don't think you have to try very hard to imagine why people are uncomfortable with that.
Edit: Never make one slight error on HN or your entire point is invalid, it would be one of the most socialized by the legislative proposals, but not literally the most.
Well there is Cuba. The best health system in the world, many say.
Single payer is “less socialist” than the UK system that has many of the healthcare providers working directly for the government.
Likewise, the US is not the “least socialist” today. In Nigeria most people just pay out of pocket for healthcare.
It always seemed to me like it's the government wanting people not to get services in order to reduce costs. But I suspect it's more the government being too obsessed with making sure only those who "deserve it" get services.
Just give everyone the benefit and take it back in taxes later. It would cost less in paperwork.
The real answer is more that there's a billion committees, each of which has something they absolutely have to push through, because they have to do something to solve the problem.
Also: The paperwork is the goal. Reduce that, and people lose jobs.