The "only physicians should run hospitals" doesn't make that much sense to me. Reminds of the technocratic argument you used to see a lot on the internet that instead of politicians we should have scientists and engineers in legislature.
The issue is if you have someone with a scientific background doing politics, what you have at the end is still a politician. Same thing here. An MD doing hospital administration is an administrator.
Which is not to devalue specialist expertise in these roles. I definitely think you want people with these backgrounds in those roles as well. Just not necessarily exclusively. A career administrator has different skills than a physician, you want people with both, and other, roles working to run a hospital.
The real problem as I see it is probably the incentives, constraints, and pressures they work under, or towards. A physician forced to run a for-profit hospital maximizing returns is going to make a lot of the same decisions as someone with a business background in the same situation. The thing is to change the situation, not put different people into that role and expect them to do it dramatically better.
Works pretty well for lawyers. It's not perfect, but lawyers have to adhere to a code of legal ethics, and only lawyers can have equity in law firms. Seems like this model could be transferred directly to the medical industry. It would not solve every problem ever, but it is an interesting thing to look into.
Yeah that sounds fine too if you can do it. Anything that prevents hospitals from being operated by large profit-seeking entities with no other stake in them would probably be a strict improvement over the current system.
I think the practical issue is those fields that have similar restrictions basically predate a major societal shift. We now consider the only valid limits on profit and ambition to be market forces. I'm not sure restricting hospitals in this way is less radical than just nationalizing them, in terms of practical politics.
Anyway, again, sure. I'm not informed enough on this subject to know what model would actually work best. I think the problem is the raw exclusive profit motive rather than who specifically is running them, but there are a lot of ways to eliminate that.
There might be a parallel to a medical group or a professional corporation, but a law firm is a vastly simpler operation than a hospital. Orders of magnitude simpler.
The problem with this is that the MBA programs that churn out hospital administrators tend not to be very good...focus on mergers, cost cutting, not so much on optimizing care. The pendulum has swung too much onto the MBA for MBA's sake hospital administrators and less so on actual medicine.
> A physician forced to run a for-profit hospital maximizing returns is going to make a lot of the same decisions as someone with a business background in the same situation.
Indeed! Whereas a doctor might say yes, give that patient with cancer the treatment they need, the MBA is going to say no, it costs to much, let them die. If the goal is to maximize profit, the MBA is doing a better job. If the goal is to maximize the health of your patients, the doctor is. We must realize that these two goals are fundamentally in conflict with one another.
The question isn't whether a doctor or an MBA should be running a for profit hospital, it's whether we should even have for profit hospitals. If we care about people more than profits, then clearly we should not.
At some point, you have to put a value on a human life.
It sucks and no one likes it, but what is the alternative?
Each human life is worth infinity? So we should bankrupt the entire country, spending 10 trillion dollars on a surgery that has a 1% chance to save a 98 year olds life?
Obviously that is an extreme example.. but the point is sound. We only have so many resources, how do they get divided up? Should be spend millions to give 80 year olds 1 more year of life? Do we value life on the reverse of age, so a baby we value at 10 million dollars, but a 90 year old we value at $20,000? What if that 90 year old is your Grandpa?
> So we should bankrupt the entire country, spending 10 trillion dollars on a surgery that has a 1% chance to save a 98 year olds life?
This is a pretty wild straw man fallacy, but I'd like to give a good faith response nonetheless.
You may not know, but the US spends more per capita on healthcare than any other country in the world, by a longshot. Many other countries provide unimpeded treatment for all of their patients. If a doctor in Japan wants chemo, the patient gets chemo, and treatment starts immediately. So how does it make sense that we spend more on our patients but doctors are still told no, the patient can't have that treatment? It's because a larger share of our biggest-in-the-world healthcare spending goes to for profit companies, like insurance companies, than anywhere in the world.
So when an insurance company says no to a treatment, it's not because we don't collectively spend enough for that treatment, we do! It's just that the insurance company wants that spending for themselves.
Spoiler alert -- the author being interviewed doesn't have a solution, quick, easy or otherwise. But the history is fascinating -- in the end there are a lot fewer villians than you might imagine. A lot of good faith decisions seemingly made in the public interest over the past 150 years have led us into a weird local minimum that seems inescapable. Where we are was not inevitable, and as they say if something is unsustainable it has to end eventually, but before suggesting sweeping solutions I'd recommend hearing a detailed history.
Let's not be obtuse though. The majority of healthcare costs are incurred at end of life. Perhaps insurers and the government should not subsidize any life saving care for those over the average mortality.
I know for example, my grandmother who lived in europe many years ago, had failing kidneys. While today it's likely she could have subsisted for more years on dialysis, perhaps that money didn't need to be spent.
Life is finite, and racking up bills at EOL is a waste. People need to learn how let others die with grace, instead of giving chest compressions to a 85 year old 80lb grandmother.
You didn't address the scenario as presented, or demonstrate how it violated a principle you had described. Instead, you shifted to excoriating the insurers for greed and waste.
Should the insurance company bankrupt itself on the first client? If not, how should they decide how much to spend on each? I should note that non-profit hospitals have similar results as for-profit hospitals (in the USA), so there's little evidence of shareholder greed playing a significant role (though there are many other stakeholders including employees).
We already have decent (not always great but decent enough) government provided healthcare for the elderly through Medicare. So in fact, we've completely avoided your example already and said "yep, all life has value if you're eligible for medicare".
Of course resources are finite, nobody ever argues that they're infinite. But we treat healthcare as if there's a constant scarcity of medicine with how much is charged because there's a constant urge to squeeze even more profits out of patients who probably have only 2 choices- pay for the medicine or die.
The counterpoint is that you have the exact same decisions being made in systems like the UK. People get refused cancer treatment because they were too old and their were younger patients that had a better prognosis. The fact is both types of systems don't have unlimited resources.
Yes, care rationing is a thing. But in the UK care is rationed due to capacity constraints whereas in the US it's rationed in order to make a profit. These are very, very different things. It means that people's welfare, and death, is being traded for profit.
The issue is if you have someone with a scientific background doing politics, what you have at the end is still a politician. Same thing here. An MD doing hospital administration is an administrator.
Which is not to devalue specialist expertise in these roles. I definitely think you want people with these backgrounds in those roles as well. Just not necessarily exclusively. A career administrator has different skills than a physician, you want people with both, and other, roles working to run a hospital.
The real problem as I see it is probably the incentives, constraints, and pressures they work under, or towards. A physician forced to run a for-profit hospital maximizing returns is going to make a lot of the same decisions as someone with a business background in the same situation. The thing is to change the situation, not put different people into that role and expect them to do it dramatically better.