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The Greedy Doctor Problem

universalprior.substack.com

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Re: The Greedy Doctor Problem

#141

Post by rsj_hn »

sokoloff wrote: post #134
rsj_hn wrote: post #108

Earlier quoted context omitted.

> 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 ofte…

So in a surgery situation where you are under and something else is discovered, then that's a situation of unexpected costs. So you look to who is best able to bear them and that's who bears them. What exactly is the purpose of insurance if they do not cover you from unexpected costs? And if there is no insurance (say a cash procedure), then the hospital bears the cost and bakes the possibility of complications into the price.

Point is, you need clarity of prices rather than the situation today where you sign a promise to pay whatever costs the hospital decides to charge you, and you may not even know what those are until weeks after the procedure. There is no meaningful way a market can operate under conditions in which blank checks are demanded in order to get anything done.

If that can't work, and the hospital insists it cannot quote you a cost at all, then go full socialized healthcare since obviously no market is possible.

Re: The Greedy Doctor Problem

#142

Post by lupire »

zz865 wrote: post #33
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.

Or even better pay nothing and get a government run system that is smart enough to figure out what is important and what is wasteful.

Thats a wish, not a plan. Medicare just committed to spend $250 per person (not per patient) per year on an ineffective Alzheimers drug....

https://arstechnica.com/science/2021/11/dubious-56000-alzhei...

Re: The Greedy Doctor Problem

#143

Post by lupire »

wayoutthere wrote: post #45
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 do this! I’ve found that my employer-provided health insurance is less than worthless for routine health care. I actually pay less by going to providers who don’t accept insurance — even though I maintain bare-minimum coverage and an HSA. I don’t think I used my health insurance at all this year — at least not enough to come close to meeting the deductible. My primary care doctor uses this model — I pay $300/yr for…

Thar only wokrs because you don't need substantial healthcare. Like driving a car wothout insurance and not getting crashed.

Re: The Greedy Doctor Problem

#144

Post by joshuaheard »

kwhitefoot wrote: post #95
joshuaheard wrote: post #86

Competition cures greed. Instead of going to one doctor, go to three. Go with the doctor that has the best value (price/service). If the doctor gets greedy, shop around. Tell the doctor you found a lower price, and if he is not competitive, you will fire him, and find a new doctor.

How many people are in a position to find out which doctor has the best value? Is there even a theoretical possibility that this could be done other than after the fact?

Just like any service provider, there are crowdsourced ratings like Yelp.

Re: The Greedy Doctor Problem

#146

Post by CPLX »

dang wrote: post #125
CPLX wrote: post #94

Earlier quoted context omitted.

Welcome to Hacker News, a popular discussion forum where vigorous conversations are initiated using the text of recent headlines.

" Please don't sneer, including at the rest of the community. " It's a particularly low-value form of comment, and also very common, I think mostly because we try to secure our identity in opposition to others. Since this mechanism appears to work the same way in everyone, such comments are repetitive and extremely tedious. https://news.ycombinator.com/newsguidelines.html

Point taken! Just for reference though it wasn't a sneer at all. I love HN and think this format where people get into a broader discussion about the general themes implied by the article, rather than stick narrowly to the actual text of the story, has been a successful one.

Re: The Greedy Doctor Problem

#147

Post by jmull »

Not sure this is all that useful or interesting as thought experiment...

That the Doctor is greedy is in the premise, but why would anyone settle for a greedy doctor at all?

Re: The Greedy Doctor Problem

#149

Post by themacguffinman »

kwhitefoot wrote: post #96
goopthink wrote: post #85

The article proposes prepayment options. Why not go to the "other, other obvious" solution, which is results-based payments? In healthcare, that's value-based care. In other industries w/ agent-principle problems, it's called "taking on risk". You're incentivizing results and outcomes, rather than whatever specific actions lead up to those results. It means that the focus is no longer on the activity provided by the…

> Why not go to the "other, other obvious" solution, which is results-based payments? There is a story about doctors in ancient China who are paid by their clients only so long as the client is healthy. When they fall sick, the doctor is not paid again until the patient is healthy again. Then the goal is not a cure for a disease but the prevention of disease. I don't know if any such thing ever really happened but it…

I think this only works if there's a scarcity of patients but it's rarely true that patients are rare. This will probably suffer from the real estate agent problem: in theory, real estate agents are incentivized to get you the best price because they get a cut for their efforts, but in practice it's more lucrative for them to flip more houses than put in the extra effort into your case. Likewise, I suspect doctors will find it easier & cheaper to not care about you and just move onto taking in other healthy patients.

Re: The Greedy Doctor Problem

#150

Post by spaetzleesser »

poulsbohemian wrote: post #140

>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…

"But a professional will put their client above money assuming no other perverse incentives."

After dealing with some surgeons I am not so sure about this anymore. They seem to feel very entitled to have big houses and nice cars.

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