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Comment by tiahura | Hacker News Reader

He was a work comp claim administrator - in the US, they are some of the worst people on the planet.

This was before doctors became incurably greedy - so a bit early for first party health insurance.

>He was a work comp claim administrator - in the US, they are some of the worst people on the planet.

Whoah now, don't talk about my dad like that! In all seriousness though, my dad said that all the places he worked at over the years generally accepted over 99% of the claims they received.

My dad did develop a visceral hatred for chiropractors over the course of his career though.

I have my suspicions but I'm still gonna ask the reason for the chiropractor hate.

Chiropractors learned their trade from a ghost

Science research fraudsters could learn a lesson from them in how to get away with it

Some Chiropractors and their patients are under the impression that actual diseases and injuries can be cured by performing the manual adjustments of the body, which leads to people dying of untreated cancer, or orthopedic injuries being aggravated instead of treated properly. Not to say that there aren’t good Chiropractors who recognize their limits, but they all tend to get painted with the same brush.

For my neighbor when I was growing up, it was diabetes.

In a discussion around worker's comp claims it would be about the chiropractor's who make all their money from worker's comp claims and accident settlements. Every person who walks in that door will need unending treatment at the chiropractor. They walk hand in hand with the ambulance chasing lawyers.

For some people this is their only experience with a lawyer and chiropractor might be when someone walks in, "slips" in their store, and they get sued. The chiropractor is one method the lawyer uses to run up the total. It's always a back pain that can never be fully diagnosed or treated.

Over the years, the chiropractic field as a whole has backed off from curing everything to being split between something in the neighborhood of a massage including joint mobility (which is fine), and the fraud.

Because of the countless times he had to deal with claimants going to the chiropractor and the chiropractor claiming that in order to treat their injury they need to come in three times a week for the next 20 years. I exaggerate but there are plenty of dishonest chiropractors trying to milk everything they can out of worker's comp insurance, even if it is of little to no benefit to the patient.

Chiropractic is a pseudoscience without any provable benefits. At best its placebo, at worst you die from it. It's literally a big scam made by a serial snake oil salesman, that has embedded itself in our health systems.

Workman’s comp in Canada typically takes over seven years to process and never actually compensated you, it’s always a fraction of what you’d need to even make up for lost income

> This was before doctors became incurably greedy

Doctors are not the reason healthcare is expensive.

Well, the AMA does constrain the number of doctors in the US so that supply and demand part is on them.

Talk to any doctor about the priorities of the MBA-holding decision-makers at their hospitals.

When each one accuses someone else of gouging us, assume that they're all gouging us.

Doctors are paid the same as software engineers for a job that is like 10x as hard.

MBA hospital administrators have greed as their official main job responsibility.

On average they seem seem to be paid quite a bit more (at least by 2x?).

Research shows that nurses have outcomes comparable to do those of doctors. It's not 10x as hard as SWE, don't buy into that. Plus, thats irrelevant, doctors supply is limited artificially and for no good reasons. The main culprit of high costs are is the insurance companies greed, but doctors are far from being blameless.

> Doctors are paid the same as software engineers

The average physician salary in 2023 is $352K. I wouldn't say that.

Are salaries the only source of income that they derive from the medical industry? My doctor is a part owner of his provider network which also is the insurer.

Don't even start me on diagnostic imaging.

The big DI manufacturers have consulting arms that will help physicians with financing to buy CTs, MRI, PET, that will help them obtain Certificates of Need.

And having a hard time finding it now, but physicians who own a share in a DI lab tend to refer their patients for imaging far more generously than those who don't...

Doctors don't work for hospitals.

Go and talk to a doctor about the upcoming reimbursement cuts by Medicare - 3.36% this upcoming fiscal year.

Then compare how much Medicare compensates doctors compared to compensation in other countries.

Quite many countries limit the supply of doctors with less expensive health schemes.

In the UK the government both limits the supply of doctors and manages a fairly cheap National Health Service. How? It is rationed by queuing and achieves poor medical outcomes.

I don't think any country has a healthcare system privatized to a higher degree than Switzerland? Yet they still manage to spend quite a bit less per capita than the US.

From the AMA:

https://www.ama-assn.org/sites/ama-assn.org/files/2023-03/20...

That doesn't prove your point.

Any chance the US has of achieving the cost savings of other industrialized nations depends crucially on doctors making a lot less.

https://www.beckersasc.com/benchmarking/how-physician-pay-in...

IIRC about 40 percent of all medical expenses are administrative costs and about 20 percent is drug costs. Improving those could drop healthcare costs by nearly half, without lowering healthcare salaries.

To lower medical salaries, we need to address (a) the AMA acting as a cartel, (b) residency slots being paid for by Medicare and being limited, and (c) crippling student debt problems. As an example, nurse practitioner salaries have dropped as supply has increased.

> Improving those could drop healthcare costs by nearly half

Wouldn't you have to decrease spending on admin and drugs up to 10x which would likely bring US well below the costs in most/all other rich c

I'm not sure how feasible it would be to reduce admin and drug costs by almost 10x?

Edit: to be fair 10x might not that far-fetched as I might have thought, admin costs are massively higher than anywhere else:

https://www.statista.com/statistics/1264127/per-capita-healt...

I'd assume the way they measure it might differ significantly between some countries. Also ~1000 is just 10% of per capita spending in the US.

If we look at drugs:

https://www.statista.com/statistics/266141/pharmaceutical-sp...

The gap is quite a bit smaller. Also in total drugs+admin seem to be about 25% or so?

Total per capita healthcare spend in the US is something like $13k, so yeah, much closer to 25% than 60%.

Also, you have to be careful about how you account for “administrative costs”. Medicare has low “administrative costs” but correspondingly high rates of fraud vs. a typical private insurer who has the incentive to spend more looking for it—administrative costs.

Huh, the numbers I’ve seen are much higher than that. 18% for prescription drugs [1], ~6% for retail drugs [1], and 34% for admin costs depending on how it’s accounted for [2]. A lot of places don’t seem to account for insurance related costs (billing/coding/etc.) in administrative costs, which may be the source of the difference.

[1] https://aspe.hhs.gov/sites/default/files/documents/88c547c97...

[2] https://time.com/5759972/health-care-administrative-costs/?a...

Rather than it being greediness by a class of individuals, in my view, it is that capitalism rewards greediness, and sometimes it obligates you to be greedy when you are just an employee or selling a service. People are inserted in a system composed by many layers that incentivize and obligate greediness.

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