The Dark Side of Doctoring

Control of consciousness is only one part of the intervention. Much of it is physical intervention with intravenous cannulation, intubation, extubation, ventilation management, and management of cardiovascular dynamics. Closed loop systems for sedation/unconsciousness may make inroads in the next 10 years but general anaesthesia will require physically capable robots.

Doing this everyday and knowing technology and robots the capabilities are a long way away.

In other words, regulations, mostly from the government, prevents competition from resulting in variety. I propose to fix it by less regulation--letting more of the benefits of competition be realized. You propose to fix that--how, exactly? With more regulation?

> Price competition simply will not happen in medical care

In the current regulatory regime, you are correct, it won't, because there is no incentive for it. But that's not because price competition is inherently impossible in health care? Or is it because the regulations are removing the incentives for it?

> I think you miss the difficulty of walking out in mid treatment.

I agree that it's hard to change providers in mid treatment when it's urgent, yes. But urgent care is not the only opportunity you have to evaluate providers. In a competitive environment, smart providers would view ordinary care like annual physicals or shots as opportunities to show potential patients their competence, and smart patients would take such opportunities to evaluate the competence of providers. Plus, families and friends can pool information--people do that now. The value of such information is limited now because there is not much choice in the marketplace, yes (hence your McDonalds vs. Burger King analogy). But, once more, why is there such limited choice? Because competition is inherently impossible in this domain? Or because it's regulated out of existence?

I'm sorry, but I don't buy this assertion of yours, and since we disagree on something so fundamental we're unlikely to be able to have a useful discussion.

> which is exactly what has happened in every unregulated industry in the history of the world.

This is an extremely strong claim which requires extremely strong evidence. Do you have any?

> the entire crux of health care is not only that it is essential to living and therefore has an infinite price

By this logic any action which carries any risk of reducing your life span and is not absolutely necessary should not be done. Do you live your life that way? Does anyone?

> unfettered free market capitalism is the system where a rich man's dog eats 5 course gourmet meals while his poor neighbor's child dies of hunger

This certainly happens in systems that are regulated by governments--such as ours. Where is your evidence that it happens, and is worse, in systems that are not regulated by governments?

> if food is available but inaccessible to the poor

In a free market, what would prevent the poor from producing their own food? In the US, historically, this is how most people got their food--they grew it or hunted it or fished for it themselves. Or they lived in small communities where everyone knew each other personally, so they knew the people producing their food. Our current system, in which almost all of us are dependent on a small number of food producers whom we don't know and cannot influence on our own, is, as you appear to agree, a product of massive government regulation--combined, as you conveniently forgot to state, with massive regulatory capture on the part of the corporations that own most of the food production capacity.

Yes, the government inspects food to see that it doesn't contain harmful microbes--but people knew how to do that before the government got into the act (if not, humans would have gone extinct long ago from food poisoning). The government also subsidizes the production of high fructose corn syrup and factory farmed meat and poultry. It subsidizes wheat and corn so that most of the US's acreage goes to those crops instead of a greater and healthier variety. (And then it subsidizes ethanol from corn so that we can burn food in our cars while poor people starve.) I could go on and on. Why does the government do all these things? Because it has the power to do it, and that power can be bought, and has been.

Of course this system, now that it exists and we are all caught in it, is by no means simple to escape from. But that does not mean it was inevitable, nor that it is good.

The managing class (Company CEO, Hospital/University administrators) is ever in the pursuit of more profit, euphemized as "efficiency" or "optimization", at the expense on everything else. How can we squeeze the employees a little harder so we don't have to hire as many? How can we increase "productivity" so more patients can be seen(and pay up)? How can we eliminate waste (lower cost of care as much as possible so we can make more) to the patient? How can we make more money by tweaking our charging model (Insurance rewarding loyal customer by charging them more, Hospital Chargemaster etc)? Oops, I see people are complaining a lot. Let me pay some lip service about appreciating our employees and valuing our customer/patients. Heck I am feeling extra generous right now , let's put up some cheap program they can participate in. There, they should feel happy now.

This is all too familiar in the corporate world. Any employees with a half a brain will get the message loud and clear: employers do NOT care. Or maybe they do, just nowhere near money. See, their incentive is aligned quite nicely: cost cutting/profit increasing actions are how they justify their pay and the profit it generates is how they pay themselves. Everything else can be sacrificed.

Caring for a patient is a very intellectual, specialized and dare I say it creative task. Doctors are paid well above many other professions though one can argue it is not for the years they have to invest into training and the work hours. The point is, at the end of day they are glorified laborers, being told by their boss what to do, just like the rest of us. Prestige has shielded the medical profession for decades but now the grip of corporate America has finally caught up. And lo and behold, what scant voice and influence do we have!

We absolutely do need managers/administrators. We need them to make sure companies/hospitals are running smoothly, is well funded and serve the customer well. But the lack of voice and the power imbalance in employment is suffocating. We are partners not servants or slaves. And the all consuming focus on money has got to stop. Human welfare deserve to be at the top. not profit.

I heard the story of a good neurosurgeon who, one day, made a serious mistake during a surgery and paralyzed his patient. It haunted him so much that he eventually took his own life, after he dealt with the malpractice lawsuit.