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The Greedy Doctor Problem

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Re: The Greedy Doctor Problem

#131

Post by lotsofpulp »

ivalm wrote: post #69
lotsofpulp wrote: post #64

Earlier quoted context omitted.

I pay $25 to $30 per hour to housekeepers. I question the sanity of a doctor charging $135 per month for multiple people.

Typical panel size is ~1200 patients. So to get $300k/year that’s $20.8/person/month.

That’s a good point. I’ll have to ask some friends about overhead. Seems like a weirdly small number though compared to insurance premiums + deductibles, and what doctors usually get per visit when we go for run of the mill fevers for the kids (~$150+ each time).

Re: The Greedy Doctor Problem

#133

Post by lotsofpulp »

dsr_ wrote: post #122
ProjectArcturis wrote: post #105

Earlier quoted context omitted.

I'm kind of surprised that med schools haven't dramatically opened up their admissions, like law schools have over the past 20 years. It's such an obvious source of funds for the school.

The med schools are accredited by (a body completely governed by) the AMA. Number of seats is part of the accreditation. The AMA does not want more competition and lower income per doctor.

AMA claims the real bottleneck is residency funding, since you cannot practice as a doctor without residency, and for some reason, only the federal government funds residencies, and the feds have not changed funding in many, many years.

Also, increasing class sizes is not without its down sides. Pharmacy schools cashed in and blew up the number of pharmacists in the last 10 years, and now the pharmacists’ employers have so much power in the negotiations due to so much supply of labor, that they can make pharmacists accept metrics which pharmacists know are excessive and unsafe since no one can possibly do the job properly in the time they are expected to check the medications and counsel people in.

A pharmacist family member says the law is to counsel patients, but the reality is anyone who did that would be fired and replaced so, in reality, people are not getting the counseling they deserve when they pick up the medications, and pharmacists are not able to properly double check the doctors.

Re: The Greedy Doctor Problem

#134

Post by sokoloff »

rsj_hn wrote: post #108
snarf21 wrote: post #107

Earlier quoted context omitted.

This is such an awful take. So if a doctor prescribes a medicine and the patient never takes it and the patient dies it is somehow the doctor's fault or they don't get paid? Some doctors are greedy. Some ________ are greedy. There are major factors in the waste in our health care system but by and large it isn't doctor's fees. There are so many rent seekers taking a cut. There are other models than fee-for-service. T…

> One simple change is to go to referenced based pricing. You can't charge more than 1.2 the Medicare reimbursement. Agree that this is huge. Price transparency, reference pricing. You know "the law of one price" is supposed to be a pillar of market economics, so this should be a no-brainer. Additionally, don't allow charging more than the insurance will pay with the exception of an agreed upon co-pay ahead of time.…

Most of us have been in a codebase for an issue that turns out larger or more complex than first understood. I don’t want to undergo surgery for cancer X, have the surgeon see nearby, related cancer Y and sew me back up and tell me I also have cancer Y but that he didn’t want to go over the estimate.

When asked for a choice by a medical professional (or a home improvement contractor for that matter), I will more often than not ask “if you were in my shoes, what would you do?” I don’t 100% of the time go with what they say, but I think it helps me understand their expertise and judgment better.

In the surgical case above, if the surgeon would have taken it out and given me a single recovery experience and told me about the bill when I woke up, I’m probably better off for it.

Re: The Greedy Doctor Problem

#135

Post by sokoloff »

thayne wrote: post #130
kuiper0x2 wrote: post #2

The obvious, obvious thing is to simply pay the doctor a fix priced each month wether they diagnose you with something or not. Well above what they would earn elsewhere. Their incentive then becomes to keep a good relationship with you so you continue to pay them. The best way to do that is to keep you healthy and happy.

they also have an incentive to keep you alive as long as possible since they don't get paid if you die.

Having witnessed the terminal stages of several family members, additional days of being undead is not necessarily desirable for the patient.

Re: The Greedy Doctor Problem

#136

Post by michaelrpeskin »

lotsofpulp wrote: post #64
michaelrpeskin wrote: post #35

Earlier quoted context omitted.

That's what I do. It's called "direct primary care". In the last 10 years, I've used two DPC doctors. I loved my first doctor because we had the same philosophies towards health. Last year she started drifting too "mainstream" and I didn't like her style, so I switched and took my money elsewhere. I found a new guy who is really aligned with me and it's been great. It's almost as if having choice and market can work…

I pay $25 to $30 per hour to housekeepers. I question the sanity of a doctor charging $135 per month for multiple people.

He’s solidly middle class. Not pulling in tons of money. But he doesn’t have crazy stress either. He doesn’t do insurance or Medicare, so his overhead and admin cost are really low.

Re: The Greedy Doctor Problem

#137

Post by skinner_ »

The original post focuses on the limiting edge case where the only information coming out of the doctor is a single bit: Treatment vs Healthy. I believe the subject can reasonably expect some explanation from the doctor, and then we are in the territory of Interactive Proofs and Arthur-Merlin Games. (https://en.wikipedia.org/wiki/Interactive_proof_system) Actually I'm a bit surprised they were not mentioned in the original post, nor in any of the 127 comments so far. They are the computational complexity models of a situation when a (computationally) all-powerful but unreliable agent has to convince another, (computationally) limited agent. If there's a second greedy doctor, or a greedy detective, we have Multi-prover Interactive Proofs.

Re: The Greedy Doctor Problem

#138

Post by gwerbret »

gwerbret wrote: post #3
kuiper0x2 wrote: post #2

The obvious, obvious thing is to simply pay the doctor a fix priced each month wether they diagnose you with something or not. Well above what they would earn elsewhere. Their incentive then becomes to keep a good relationship with you so you continue to pay them. The best way to do that is to keep you healthy and happy.

I agree with the idea of paying the doctor a flat fee every month, but in my variant, the doctor has to repay you the entire sum you've paid to date, with 10% interest, if you succumb to any preventable illnesses; in other words, the doctor now has some real skin in the game. S/he becomes motivated not only to keep you well, but to keep the fees reasonable.

Upon reading the responses my earlier comments generated, I suppose I should have disclaimed that I'm seeing this problem as the OP had portrayed it, which is as a thought problem in logic and economics, rather than an actual approach to preventative medicine. As a thought problem, it can be broken into basic, of-necessity simplified elements, e.g. preventable vs. non-preventable illnesses, fee optimization, etc.

The idea of actual healthcare being dependent solely on optimization of greed is, of course, ludicrous.

Re: The Greedy Doctor Problem

#139

Post by solatic »

apyrros wrote: post #129
dasudasu wrote: post #98

Earlier quoted context omitted.

Then doctors filter what patients they take to guarantee these good outcomes. This is already done by some surgeons. Surgery is already a subset of medicine heavily judged on outcomes.

Cherry picking and lemon dropping does happen in value-based systems, but there has been work to address the issue. No simple answer, but basically you pay doctors more for select patients. https://relentlesshealthvalue.com/audios/ep322/

Within the context of the article though, if one assumes greedy doctors, then essentially cooperating doctors can cooperate to refuse treatment N times, where N is an equilibrium between the lemon-picking bonus and never accepting any patients at all (and therefore never having any revenue), in order to get the system to label non-lemons as lemons.

Re: The Greedy Doctor Problem

#140

Post by poulsbohemian »

>The medical professional is greedy, i.e. they want to charge you as much money as possible, and they do not (per se) care about your health. They only care about your health as far as they can get money from you.

I'm not even going to read the rest of the article because the premise up front is so flawed. It assumes that doctors alone have say over pricing / compensation, and that's just not reality. It's much like engineers being blamed for things that rest entirely with management. It also makes the same flawed premise that I deal with in my profession every day - that I'm so greedy and so focused on my own pocketbook that I will screw over my clients. Are people motivated by money? Certainly. But a professional will put their client above money assuming no other perverse incentives.

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