
The shadowy cartel of doctors that controls Medicare - carbocation
http://www.washingtonmonthly.com/magazine/july_august_2013/features/special_deal045641.php
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AlaLoo
I work in the country's largest single payer medical system. It's called the
Veterans Administration. The physicians are employed at a fixed salary, with
no bonus, so I don't get paid more if I do 1 procedure or 10.

But I STILL order tons of unnecessary tests. Why? It's not because I get paid
more! It's because I am scared of getting sued.

What WILL massively cut costs is doing what New Zealand does, and basically
ending the medical malpractice scam that only exists to enrich trial lawyers,
whom are a far more insidious lobby than doctors ever will be.

95% of patient injuries have nothing to do with true "malpractice." A doctor
cannot promise a good outcome 100% of the time, just like a programmer cannot
generate bug-free code 100% of the time.

Instead of the current system, make it so that an injured patient is entitled
to compensation from a national "patient injury fund."

The ambulance chasers make zero dollars, doctors don't have to waste money on
"defensive medicine," and injured patients get prompt and fair compensation.

And if a physician has too many such episodes, then they can be referred to
the licensing board.

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joonix
Not sure why you point as far as NZ when Texas basically eliminated it by
capping pain and suffering awards at $250,000.

Medical malpractice insurance (which is the tort system manifested as a cost
to doctors) is not the most expensive part of healthcare though so your point
is not really correct.

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dantheman
His point was that worrying about malpractice causes doctors to spend more
money on tests and other diagnostics than they normally would so that they
don't have to worry about being sued.

~~~
galaxyLogic
Correct. That's the thing to discuss I think. And the suggested solution of
national "patient injury fund." seems like the best solution candidate
proposed so far. Thanks

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droopyEyelids
Reading about this, and the recent brouhaha concerning hospitals posting their
pricing online, made me realize how essential pricing opacity is if healthcare
providers want to maintain their all-knowing god/parent like relationship with
the public. Doctors don't quite seem _doctorly_ when they're grubbing for
money.

(only an observation that seemed funny in my mind, don't bother debating it
because it's not 100% serious)

~~~
agent00f
Price transparency will NEVER happen in the US market. The insurers all
negotiate individual deals with providers, and it's a losing tactic for any
one of them to divulge the details of their contracts.

~~~
anonymoushn
It's a losing tactic for any one insurer, but it may be alright for a
practitioner or customer.

[http://watchdog.org/64814/ok-surgery-centers-cash-only-
appro...](http://watchdog.org/64814/ok-surgery-centers-cash-only-approach-
offers-transparency-efficiency-affordability/)

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nslocum
Do you know of any promising companies that are disrupting healthcare? Of the
startups I've seen, drchrono appears to be the best positioned to disrupt, but
their mission is focused exclusively on electronic health records.

I'd really like to work at a place that attacks some of the flaws in the
current system, but most healthcare companies are too invested and/or
dependent on the current system to challenge it.

~~~
ameister14
DrChrono, from what I have seen, seems oriented towards private practice. This
is an interesting choice since private practices are disappearing all over the
country.

I'm not really sure they're going to disrupt too much because of that.

It's extremely difficult to disrupt hospital controlled medicine, in part
because groups of buyers control what hospitals purchase and they are for the
most part extremely conservative.

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Scramblejams
Single page link:
[http://www.washingtonmonthly.com/magazine/july_august_2013/f...](http://www.washingtonmonthly.com/magazine/july_august_2013/features/special_deal045641.php?page=all)

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uslic001
What a joke. Claiming that the Veteran's Administration provides better care
based on faulty propaganda based studies put out by the VA itself to make
itself look good instead of the third world medicine they truly provide.

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notdrunkatall
I'm always irritated when people blame capitalism and free markets for the
high cost of healthcare in the USA. The reality is that healthcare is anything
but a free market, and costs aren't going to come down until it becomes one.

~~~
flexie
Yeah well. Are there any free market industries in the US?

Financial sector, energy, car manufacturing, IT, education, news, health care,
law, home buying, defense - those are all in one or more ways deeply
subsidized or maintain such close relationship with government that it's
difficult to say whether they are part of the government.

Take Google: A single company that somehow manages to sit on almost all
searches, most of the online add market, a good chunk of the email market. Yet
it avoids being split up in antitrust cases.

Google started as a government sponsored research project that was spun out
from a government subsidized institution (Stanford). Then it raised tax
subsidized financing (venture capital). It has what seems to be a free flow of
information with different government institutions such as the NSA.

Google doesn't really pay tax on most of its world wide income and it has some
20,000 government granted monopolies (also known as "patents").

Is Google a private company in a free market?

Exactly what US industry should health care emulate?

~~~
yummyfajitas
_Google doesn 't really pay tax on most of its world wide income_

In other news, Guinness also does not pay taxes to the US for beer sold in
Ireland. It only pays taxes on profits made from beer sales in the US. Those
green fiends!

I know it's shocking, but there is a world outside America, and the US
government does not get to collect taxes on all of it.

~~~
flexie
My point wasn't that Google should pay US tax on its foreign income. On the
contrary Google's foreign income should be taxed in the countries where it's
earned. Right now, though, it's by-and-large taxed nowhere:
[http://www.bloomberg.com/news/2010-10-21/google-2-4-rate-
sho...](http://www.bloomberg.com/news/2010-10-21/google-2-4-rate-shows-
how-60-billion-u-s-revenue-lost-to-tax-loopholes.html)

Now, I doubt that it's the government of Bermuda or the mighty army of Ireland
or the important trade with Isle of Man that scares off the US government from
closing those loopholes to American tech companies. Obviously, the US
government uses its influence in such way that international tax law allows
American tech companies to transfer their international income to tax havens.
After all, the US government could quickly use its influence to close those
gaps if it felt any real need for it. Ergo - another subsidy.

