The AMA is one of the four pigs at the trough of US healthcare:
1) Insurance companies - extract profit from the usual insurance model applied to healthcare.
2) Drug/Device companies - extract maximum profit from patent monopolies, FDA regulatory capture, and marketing.
3) Malpractice lawyers - use regressive law precedent to maximize individual payout and lawyer billing to the detriment of everyone else
4) AMA/Providers - restrict supply, and maximize billing for services
Really, none of these pigs have the interests of overall public health in mind:
- Insurance companies are incentivized to maximize the cost of insurance and deny coverage as much as possible, like any insurance company vertical. Obviously this results in denial of care. However, an insurance company is motivated to reduce provider costs and possibly to incentivize preventative care. Insurance companies are also vertically integrating into owning provider facilities to solidify local monopolies (so people HAVE to use their insurance if they live in an area) and to be able to impose cost cuts to actual providers.
- Drug/Device companies are incentivized to maximize the profits from 20 years of provided patent monopolies, often exploiting desperate people looking for relief from maladies, but the cost is usually beyond the ability of individuals to afford. Lawyers are incentivized to bill/get percentages of settlements and maximize awards of "damages" regardless of the overall impact to health services costs and the implicit denial of care that involves. However, these orgs, while generally not doing the core science of new treatment modalities (universities do that), they do help usher treatments through safety review.
- Trial lawyers are incentivized to maximize their patient damages and billing, which obviously is transferred to higher costs for all. Lawyers are one of the few hammers to get insurance companies to properly pay out, keep hospitals from devolving into managerial corruption, and keep Drug/Device companies from fudging the numbers.
- And the AMA/Providers are incentivized to maximize the billing for their services, overbill for often superfluous services, resist any intermediate level profession (Nurse Practitioners, etc) from devaluing their law-enforced professional monopoly, and incentivized to not address general health of patients but rather bill with expensive specialist care rather than help patients maintain wellness that averts serious illness. In my experience no provider ever cared about how much their services cost the patient, until it became apparent the patient could no longer pay. Then their economic awareness of the cost of care become VERY APPARENT. The AMA is criminally complicit in restricting supply of doctors, which it very well knows raises the cost of medical services and of course denies care to people on the aggregate.
Each of the four pigs simply points to other pigs as someone to blame and lobbies with maximum force to prevent any threat to their gravy train.
To address US healthcare costs will generally require all four pigs: a public insurance option (at a minimum). Reduce patent length or invalidate patents, and with cases like unpatented production that has been monopolized (epipen, insulin) enforce antitrust. Fix prices if necessary. Obviously trial lawyers awards should be capped. Finally, nurse practitioners and AI expert systems used to decrease costs, and supply of doctors increased vastly. Overall, government needs to address the total lack of preventative care.
>resist any intermediate level profession (Nurse Practitioners, etc) from devaluing their law-enforced professional monopoly
Are you aware of the lack of standards in NP education and training? The American public has no idea how raw of a deal they are getting. This is shrinkflation in healthcare, whereas you might have expected to see a doctor before, now you have to see a PA/NP, where the barrier to entry is extremely low and the training standards are loosely enforced, if at all.
In a perfect world, healthcare services would be well-matched to the level of care needed. Standards would be laid out and followed, and effectively priced care delivered.
And then, please don't laugh, if lower cost healthcare was delivered, then premiums would go down. No, no, don't laugh. Okay, you're right, there's no incentive for a local monopoly health insurer that owns the hospitals to pass the money to the consumer. YOU DON'T HAVE A REAL CHOICE. So if you are in buttshit Indiana, you basically get to use Anthem. And they have no incentive to deliver cost savings to the insured.
So of the four pigs, they are all opposed to each other to some degree:
Doctors: hate insurers (who want to lower their salaries/fees/billing) and trial lawyers (who cost them in malpractice insurance).
Drug/Device: hate insurers (who want then to pay less than bloated retail price) and trial lawyers (who sue them in massive class action lawsuits)
Insurers: hate everyone (because they own the money that comes into the system, they attempt to let it go to anyone else, be it drug company, doctor, lawyer, or claim)
Lawyers: hate insurers
BUT, the one shadow incentive they all have is to increase spending on healthcare. So even though the pigs oppose each other on details, they all want people and the government to pay more money for healthcare.
Bit insulting to be called a pig - also why would you want more pigs at the trough if this is a problem?
Anyway NPs and PAs are providing the majority of care in hospitals. Please, let “AI” come. My EMR is basically run through telnet (no joke) because the hospital system (biggest in the US) does not want to upgrade.
“Trial lawyer awards” are capped in several states including CA.
I can tell you that more than 75% of my medical school class was not in it for the money, for what it’s worth.
I know several doctors. The ones that GP / Family practice are in it for the "right reasons".
The specialists, the two I know probably make 700k and up, are superficially in it to "help people" but it is apparent they love the money. Radiology, Cardiology, and AssDocs.
US specialists make far too much money, especially considering that GPs barely make 100k sometimes, but for two extra years you get 6-7x the salary? Come on.
I worked at a drug/device company. It started out in a garage and was originally a "morally run company". But it had long devolved into an MBA enshittified acquisition-deal company.
I worked at a major insurance company. They can't for public reasons show TOO much of a profit, which is PERFECT for the MBAs running that company, because they hoover up all the excess in a bloated executive structure and embarrassingly huge bonuses.
Never worked for a law firm. I generally assume them to be the smallest pig, the runt, which is useful for the other pigs to bully and blame for everything.
Uh, your article basically confirms what I was saying: specialists get paid crazy amounts, so the motivation of doctors when they hit the real world is to specialize.
But gp is where you do preventative care to avoid the specialists.
"6-7x" over "100k" you were claiming earlier is not right. mean specialist versus PCP is ~50k on average, with huge regional variability.
Your second point is right, so what are you gonna do? Make a medical system where preventative care and quality of care are valued? Then you'll get called a
"communist" who wants "death camps" and get your birthplace questioned. So here we are.
In the 70s and 80s, I'm told general practitioners made more money then specialists, something I agree with. But even now, lots of people want to do general practice. The smartest person in my med school class went into pediatrics because she loved it. Money is not the biggest motivator for speciality choice, but it is one. Isn't this the case in literally every other field? Maybe SWEs who are full stack get paid more or something?
>I worked at a major insurance company. They can't for public reasons show TOO much of a profit, which is PERFECT for the MBAs running that company, because they hoover up all the excess in a bloated executive structure and embarrassingly huge bonuses.
Nonsense if you read the SEC filings and compare health insurance executive compensation to other business' executives that lead similar number of employees and revenue.
Try to make sense for why people getting paid in equity would want to lower their own compensation by hiding profit. Across the entire industry, at least 7 publicly listed businesses (UNH/Elevance/CVS/Cigna/Humana/Centene/Molina). That would be a very impressive collusion scheme, if they can pull that off maybe they deserve it.
Uhc for example keeps profit low, they grow the equity value by increasing revenues. They also tried the famous stick option backdating.
Insurance company profurs are in the 5-15% range. Drug/device can be in the 50-100% range depending on what patent monopoly they are riding.
But the health insurance companies operate regional monopolies or duopolies, which they achieve with vertical integration with hospital networks.
Health insurance knows they are riding a delicate balancing act. The entire first world besides the us has social health care. They all have better outcomes and vastly reduced costs. They are pure corruption.
So they can't show the drug device profit margins. They have to look like the hood guys who push down costs from the evil drug companies and those know it all doctors/ama.
These claims are all over the place, and false. Insurance profit margins are 2% to 4%, with the exception of UNH which is ~6%. Medicine company profit margins are 20% to 30%. All publicly available information.
Most importantly, though, is you would need to show what incentive an executive of a publicly listed business would have to show less profit rather than more profit (net income). Investors pay higher prices for shares of more highly profitable businesses, and executives get paid in shares.
So claiming that a publicly listed business chooses to somehow hide less net income (ignoring the claim of fraud), first you would have to provide the incentive for why executives would want to earn less.
I just explained this, maybe you didn't live through the Obamacare legislation or didn't bother reading my whole response. I admit I didn't research specific profit margin figures, but your numbers ... simply strengthen my contention.
UHC and other health insurers are swimming in money. Yet the reported profits are very low ... why?
Obamacare was ground zero for public healthcare. If it wasn't for utter slimeball Joe Lieberman doing the dirty work blocking medicare for all for the insurance companies, they would have been tossed out completely.
Again, the US is the ONLY first world economy that doesn't have social health insurance. The economics of our health care system are not sustainable, and large changes will eventually come. The health care cartel cannot show the profit margins of drug/device companies. Insurance companies are the ones that deny coverage, so they are front and center with people hating the current healthcare system.
So the healthcare companies DON'T show profit, instead they expand revenue as much as possible, and the executives funnel money to a bloated management structure. You don't need high profits to drive stock growth, you just need to get ... bigger, and that's what they do. You can do other things to boost stock price without showing profits ... use ... wait for it ... excess revenue to do stock buybacks. You can "reinvest" into expanding the vertical integration of your monopoly. You can buyout more hospital networks, effectively expanding the number of people that HAVE to use your insurance.
Let me give another example. Why are MBAs flocking to nonprofit universities? There's no stock options. There's no cashing out in mergers and acquisitions. Why?
Money floods into the universities as the endowments explode, every year the tuition increases well above inflation. Yes there is a facilities race, but why do MBAs love it? Well, it is a cushy job, universities are nice places to work. But, since there's no shareholders, no owner to show profits to, they can skim off the vast revenue increase from exploding endowments and tuition increases and... pay themselves more money.
> You don't need high profits to drive stock growth, you just need to get ... bigger, and that's what they do. You can do other things to boost stock price without showing profits ... use ... wait for it ... excess revenue to do stock buybacks.
This is false. Stock buybacks can only happen from net income, which is why health insurers don’t do them…since they have very little net income (aka profit).
> executives funnel money to a bloated management structure
You will have to provide proof that at least 7 publicly listed companies’ executives are colluding in such a manner AND their shareholders are willingly going along with employees enriching themselves at the shareholders’ expense. Lots of bold claims with no evidence, and some outright wrong ones.
>If it wasn't for utter slimeball Joe Lieberman doing the dirty work blocking medicare for all for the insurance companies, they would have been tossed out completely.
Also, there are 100 senators, and so legislation passing/not passing can never be blamed on just one. Leiberman took the public relations hit, but there were 40 other nay votes to blame also.
1) Insurance companies - extract profit from the usual insurance model applied to healthcare.
2) Drug/Device companies - extract maximum profit from patent monopolies, FDA regulatory capture, and marketing.
3) Malpractice lawyers - use regressive law precedent to maximize individual payout and lawyer billing to the detriment of everyone else
4) AMA/Providers - restrict supply, and maximize billing for services
Really, none of these pigs have the interests of overall public health in mind:
- Insurance companies are incentivized to maximize the cost of insurance and deny coverage as much as possible, like any insurance company vertical. Obviously this results in denial of care. However, an insurance company is motivated to reduce provider costs and possibly to incentivize preventative care. Insurance companies are also vertically integrating into owning provider facilities to solidify local monopolies (so people HAVE to use their insurance if they live in an area) and to be able to impose cost cuts to actual providers.
- Drug/Device companies are incentivized to maximize the profits from 20 years of provided patent monopolies, often exploiting desperate people looking for relief from maladies, but the cost is usually beyond the ability of individuals to afford. Lawyers are incentivized to bill/get percentages of settlements and maximize awards of "damages" regardless of the overall impact to health services costs and the implicit denial of care that involves. However, these orgs, while generally not doing the core science of new treatment modalities (universities do that), they do help usher treatments through safety review.
- Trial lawyers are incentivized to maximize their patient damages and billing, which obviously is transferred to higher costs for all. Lawyers are one of the few hammers to get insurance companies to properly pay out, keep hospitals from devolving into managerial corruption, and keep Drug/Device companies from fudging the numbers.
- And the AMA/Providers are incentivized to maximize the billing for their services, overbill for often superfluous services, resist any intermediate level profession (Nurse Practitioners, etc) from devaluing their law-enforced professional monopoly, and incentivized to not address general health of patients but rather bill with expensive specialist care rather than help patients maintain wellness that averts serious illness. In my experience no provider ever cared about how much their services cost the patient, until it became apparent the patient could no longer pay. Then their economic awareness of the cost of care become VERY APPARENT. The AMA is criminally complicit in restricting supply of doctors, which it very well knows raises the cost of medical services and of course denies care to people on the aggregate.
Each of the four pigs simply points to other pigs as someone to blame and lobbies with maximum force to prevent any threat to their gravy train.
To address US healthcare costs will generally require all four pigs: a public insurance option (at a minimum). Reduce patent length or invalidate patents, and with cases like unpatented production that has been monopolized (epipen, insulin) enforce antitrust. Fix prices if necessary. Obviously trial lawyers awards should be capped. Finally, nurse practitioners and AI expert systems used to decrease costs, and supply of doctors increased vastly. Overall, government needs to address the total lack of preventative care.