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The Greedy Doctor Problem

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Re: The Greedy Doctor Problem

#151

Post by spaetzleesser »

infecto wrote: post #46
mattficke wrote: post #24

Earlier quoted context omitted.

This is basically the Kaiser model. Kaiser's doctors are salaried, rather than getting paid per procedure. Works pretty well! (I think the actual answer to the question in the OP is, at least in part, to license more doctors. Then the cartel doesn't have as much pricing power and medical care is less of a luxury good. The rich person should really hire a lobbyist.)

I had Kaiser for a year and I actually enjoyed it. I saw a couple specialist but I never had any major work done so perhaps I am biased. It is funny to say it since I believe Kaiser originally was one of the opponents of a single payer system but using Kaiser kind of felt like what a government health care system should be. Very low friction. Oh I need blood work or whatever done, walk down the hall. Everything felt…

Same here. I enjoyed knowing there is one place where I can go and have everything done. They also sent reminders about vaccinations and checkups. I have moved away from CA so I don't have Kaiser anymore. I generally rarely go to a doctor and if I ever get sick I don't even know where to go :-(

Re: The Greedy Doctor Problem

#152

Post by gampleman »

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…

This comment is like saying that Zeno’s paradox is dumb because proud Achilles would never consent to a foot race with a mere turtle - imagine the insult!

Re: The Greedy Doctor Problem

#153

Post by snarf21 »

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.…

And then you have the current bs where the anesthesiologist for your operation at the hospital system that you always use is somehow un-affiliated and out of network even if everything else in that system is in network.

Re: The Greedy Doctor Problem

#154

Post by spaetzleesser »

zip1234 wrote: post #41
BerislavLopac wrote: post #5

The ideal solution is to move to a country with a great public health care (say, Denmark or Switzerland).

Countries with public health care have problems with health care as well. It is not a silver bullet. The incentives are different but it is still an incentive driven system.

Very true. But it seems these countries try to keep the system accessible and affordable for patients. The US system seems designed to keep profits for providers, instances and employers while the patient has to pay without having having any market power. From a cost and transparency perspective I think it would be hard to design a worse system than the US system.

Re: The Greedy Doctor Problem

#155

Post by poulsbohemian »

gampleman wrote: post #152
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…

This comment is like saying that Zeno’s paradox is dumb because proud Achilles would never consent to a foot race with a mere turtle - imagine the insult!

Look I understand in making the statement I made that I was hanging myself out there for further critique. My points were simply that:

1) The person doing the work often has limited say in the cost / compensation model unless they are also an owner.

2) Yes, there will always be people who prioritize money over the quality of their services. But reputation has a way of reducing their effectiveness.

Re: The Greedy Doctor Problem

#156

Post by omoikane »

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…

This article was really trying to illustrate game theory concepts with a story about greedy doctors, but it was unfortunately framed as if it's trying to solve a greedy doctor problem using game theory. It might have fared better using different analogies.

Re: The Greedy Doctor Problem

#157

Post by aidenn0 »

I must have completely misunderstood the problem because none of the "solutions" proposed occurred to me. Simplifying the goal to be "don't die" why not just pay the doctor a flat rate for every year I'm alive? Then they will (presumably) give me advice that is likely to keep me alive?

Re: The Greedy Doctor Problem

#158

Post by maxk42 »

> How can you design a payment scheme for the medical professional so that you actually get the ideal treatment?

Draw up a contract whereby you are only obligated to pay the doctor while healthy. The doctor loses money as long as your health is suboptimal and therefore it is in the greedy doctor's best interest to do everything they can to keep you healthy.

Re: The Greedy Doctor Problem

#159

Post by Raidion »

efitz wrote: post #109

The ways to address this problem are “usual and customary[ed- autocorrect] prices”, consumer ratings, information transparency, externalities such as courts to punish fraud and malpractice, and skin in the game. I have thought about this a lot in the context of real estate- up to recently, agents typically got a fixed commission (generally 3% each for buyer and seller in the places I’ve lived). There is a moral hazar…

Probable with Realtors (or any other broker): They can value speed a lot more than you do. Getting .5% extra on something might not be worth it, when that would take up 125% of their time, and 25%*normalprofit might exceed 25% extra on one deal.

You have to accurately put your bonus structure >= their normal compensation. That's really hard to do.

Re: The Greedy Doctor Problem

#160

Post by karpierz »

maxk42 wrote: post #158

> How can you design a payment scheme for the medical professional so that you actually get the ideal treatment? Draw up a contract whereby you are only obligated to pay the doctor while healthy. The doctor loses money as long as your health is suboptimal and therefore it is in the greedy doctor's best interest to do everything they can to keep you healthy.

Or the doctor only takes on healthy patients, and refuses to take on anyone with pre-existing conditions.

Also, what happens when people self-select such that only people who often get sick take on these contracts, and people who are normally healthy stick with pay-for-service?

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