Medicine is one of the most corrupt industries in the world. Patients are competely at the mercy of their doctors, who very often have a financial conflict of interest in what they prescribe.
The deference shown to those in whose hands one's life, or the lives of their loved ones, sits, means there is even less effort to subject them to accountability than the paltry amount that there would otherwise be.
- Artificial restriction of class sizes in medical schools.
- Egregious costs just to become any sort of practitioner (medical school, residency, etc.).
- Insurance companies are basically always grifting you as a policy, unless you call them out on it (reasonable things will be denied and not covered, because most people won’t fight).
- Hospitals are basically always grifting you, unless you call them out on it (bills are basically fraudulent).
- Pharmaceutical companies are basically always grifting everyone (you, the FDA, the prescribers, the insurance companies, etc.).
- Doctors are basically grifting themselves (going into medicine, and staying, almost always for the wrong reasons).
Medical school class sizes are not artificially restricted. Schools limit class sizes to ensure that almost all graduates can find a residency program slot. There's no point in graduating more MDs if they're never allowed to practice medicine. Everyone should join the AMA in asking Congress for increased graduate medical education funding since that would be the quickest route to having more physicians.
> Medical school class sizes are not artificially restricted. Schools limit class sizes to ensure that almost all graduates can find a residency program slot.
This is paradoxical. Class sizes are limited by the school, but not artificially limited?
Medical school class sizes are artificially restricted by outsized requirements for admissions. For example, the requirement of an undergraduate degree in order to enter medical school is not something that exists in Europe. Or that the admissions and exam requirements are much less hyper-competitive in Europe, than the U.S. This is, of course, “to restrict the supply of residents, so each one can find a job.” It’s still artificial restriction, rather than a natural bottleneck.
The same AMA that “Twenty years ago, the AMA lobbied for reducing the number of medical schools, capping federal funding for residencies, and cutting a quarter of all residency positions,”[0] is now asking for support in reversing its schemes? That’s rich. The same AMA that makes hundreds of millions in revenues, by speculating in securities[1].
Like an alma mater asking you to donate to its investment coffers after it’s shackled you with debt.
Anecdotally, they are also quicker to schedule and treat. This from colleagues who travel back to Taiwan. It doesn't sound like they are held in less regard than in the USA either.
No, I've experienced it in at least one country in Asia, and it can be abusive beyond any comprehension. I think it's inherent to the leverage medical facilities have over their patients, and human nature being what it is.
There are also great medical professionals in both Asia and the West. At their worst though, it's like some kind of dystopian horror film.
This is much more true in the American system than single payer systems. But absolutely, this is an industry where the incentives are misaligned and the patient suffers.
In the single payer system, the only difference is the taxpayer gets financially abused instead of the patient. The problem of the patient receiving sub-par care remains.
The doctor that is the subject of this story was over-prescribing heart procedures for patients enrolled in a single payer program.
What I mean is that the cost from a particular case of fraud is socialized across the population, at the point of taxation (or higher premiums for the mandatory insurance), instead falling on the patient at the point of use.
Which is exactly howbinsurance works, spreading the risk over large enough a population to make insurance affordable for everyone. One of the things Bismarck put on place, that socialist.
Spreading the cost of each instance across everyone doesn’t make it more affordable, since the reduction in magnitude of harm from each instance is offset by a directly proportional increase in the frequency of instances each individual pays for.
I would be curious how willing juries would be to second guess doctors when it comes to medical care. Would a jury really be willing to convict on one doctor's opinion vs another?
The largest letter writing campaign in history to the US federal government was to prevent the FDA from regulating supplements.
Yeah, it would be pretty hard to convince a jury beyond a reasonable doubt that this was actual criminal misconduct vs someone who is simply more aggressive towards surgery.
The real problem I see with government fines is they are generally low enough to simply be a cost of doing business. Bad behavior needs to be more expensive than good behavior!
Reminder of a doctor who had a patient denied for recommended treatment at the insurance getting a second opinion from... a doctor who installed a hip fucking backwards, a fuckup so bad he was banned from performing surgery for the rest of his life. Yep, banned-from-surgery-forever doctor is still working and is working in denying recommended treatments from other doctors for insurance pockets!
They tried to do this to my father a few weeks ago.
The first doctor he saw at the emergency room told him his only option is open heart surgery. He explicitly told us to not waste time getting second opinions.
Thankfully we did not listen and we were able to consult with two different cardiologists. They both independently said that they could easily treat him with an angioplasty.
Very similar story. I wasn't around for when X needed an N-millionth bypass, so Y said yes, and it killed X. Whoever decided that doing a million bypasses on an extremely diabetic one-legged one-lunged smoker needs to have their head examined. I'm just a layman and the whole plan gave me the jibblies. People have a tendency to get way too casual about getting cut open, and cutting people open.
Now, I'm not an idiot - I know X wasn't destined to have a long and happy old age - but a bullet's a bullet.
Eh, many years ago now, maybe I should have fought harder - there were signs they botched something pretty badly. Who knows? Proving that something killed X - besides X - would have been a bear, and of course when it comes to opportunity, you're always the prime suspect in your own death. Lesson for you younguns out there: when you're in the hospital and *The Doctor* comes to give you *The News* - one of life's great repeating acts - that is not the time to shut down or cry it out. Put your radar up, stay frosty, lids open, if you see blood or stuff where it's not supposed to be, then lawyer up pronto. Just the initial consult for this kind of thing won't cost you anything but paperwork and phone calls - something I didn't know at the time.
Most malpractice is hidden by arbitration agreements. We see a tiny sliver in these civil suits because the government only cares about money, not regulating the standard of care.
Professions are those guilds that control their own standards and pace, and regulate their own members. The healing and legal professions are supposed to put their clients' interests first, and mostly do when they would otherwise lose business.
But for those working at government piece rates, the only way to get ahead is to do more pieces, which can skew judgment. The bulk of private equity funding flowing into buying practices targets specialties where local monopolies are possible: anaethesia (great b/c no one chooses their anesthesiologist), dermatology (great b/c you can run through old folks' homes and clip every possible mole), etc.
I'd guess the real rate of over-(and under-) treatment is much higher than reported. Even within a practice group not subject to adverse incentives, there are difference of opinion regarding best treatment. Only when the study sizes are very large can you make generalizations. So it's pretty much an unanswerable question.
Let's not give US all the flak. Here in Switzerland pretty much everywhere I look people have to live with f'ed up orthopedic jobs: my son-in-law can't play football anymore because they botched his knee job, a family friend learns to walk again after a botched hip job, a customer has an unusable hand because of a severed nerve in an elbow op... and guess what, all those doctors and surgeons are fine and dandy. Why? On one side, the hospitals belong to local authorities and good luck suing them, and on the other hand no doctor, but really no one, ever, would give you an expertise showing malpraxis (yes everybody asks but nobody gets). The system is tightly knit and protects itself. Lesson: DON'T do surgery in Switzerland. Just don't.
38 comments
[ 4.4 ms ] story [ 89.8 ms ] threadThe deference shown to those in whose hands one's life, or the lives of their loved ones, sits, means there is even less effort to subject them to accountability than the paltry amount that there would otherwise be.
- Egregious costs just to become any sort of practitioner (medical school, residency, etc.).
- Insurance companies are basically always grifting you as a policy, unless you call them out on it (reasonable things will be denied and not covered, because most people won’t fight).
- Hospitals are basically always grifting you, unless you call them out on it (bills are basically fraudulent).
- Pharmaceutical companies are basically always grifting everyone (you, the FDA, the prescribers, the insurance companies, etc.).
- Doctors are basically grifting themselves (going into medicine, and staying, almost always for the wrong reasons).
This is just to name a few.
https://www.ama-assn.org/education/gme-funding/medical-stude...
This is paradoxical. Class sizes are limited by the school, but not artificially limited?
Medical school class sizes are artificially restricted by outsized requirements for admissions. For example, the requirement of an undergraduate degree in order to enter medical school is not something that exists in Europe. Or that the admissions and exam requirements are much less hyper-competitive in Europe, than the U.S. This is, of course, “to restrict the supply of residents, so each one can find a job.” It’s still artificial restriction, rather than a natural bottleneck.
The same AMA that “Twenty years ago, the AMA lobbied for reducing the number of medical schools, capping federal funding for residencies, and cutting a quarter of all residency positions,”[0] is now asking for support in reversing its schemes? That’s rich. The same AMA that makes hundreds of millions in revenues, by speculating in securities[1].
Like an alma mater asking you to donate to its investment coffers after it’s shackled you with debt.
[0] https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope...
[1] https://www.epsilontheory.com/ama-bitfd/
They created the problem. Just because they’re now trying to fix it means nothing
There are also great medical professionals in both Asia and the West. At their worst though, it's like some kind of dystopian horror film.
The doctor that is the subject of this story was over-prescribing heart procedures for patients enrolled in a single payer program.
Seems pretty obvious.
The largest letter writing campaign in history to the US federal government was to prevent the FDA from regulating supplements.
The real problem I see with government fines is they are generally low enough to simply be a cost of doing business. Bad behavior needs to be more expensive than good behavior!
Scum.
https://twitter.com/generalorthomd/status/163207481637850726...
The first doctor he saw at the emergency room told him his only option is open heart surgery. He explicitly told us to not waste time getting second opinions.
Thankfully we did not listen and we were able to consult with two different cardiologists. They both independently said that they could easily treat him with an angioplasty.
Now, I'm not an idiot - I know X wasn't destined to have a long and happy old age - but a bullet's a bullet.
Eh, many years ago now, maybe I should have fought harder - there were signs they botched something pretty badly. Who knows? Proving that something killed X - besides X - would have been a bear, and of course when it comes to opportunity, you're always the prime suspect in your own death. Lesson for you younguns out there: when you're in the hospital and *The Doctor* comes to give you *The News* - one of life's great repeating acts - that is not the time to shut down or cry it out. Put your radar up, stay frosty, lids open, if you see blood or stuff where it's not supposed to be, then lawyer up pronto. Just the initial consult for this kind of thing won't cost you anything but paperwork and phone calls - something I didn't know at the time.
Professions are those guilds that control their own standards and pace, and regulate their own members. The healing and legal professions are supposed to put their clients' interests first, and mostly do when they would otherwise lose business.
But for those working at government piece rates, the only way to get ahead is to do more pieces, which can skew judgment. The bulk of private equity funding flowing into buying practices targets specialties where local monopolies are possible: anaethesia (great b/c no one chooses their anesthesiologist), dermatology (great b/c you can run through old folks' homes and clip every possible mole), etc.
I'd guess the real rate of over-(and under-) treatment is much higher than reported. Even within a practice group not subject to adverse incentives, there are difference of opinion regarding best treatment. Only when the study sizes are very large can you make generalizations. So it's pretty much an unanswerable question.