[lordnacho]

It sounds to me that what is being monetized is the authority of doctors. There's a lot of medical conditions where you rely on the doctor to tell you what to do. After all, you don't have a degree in that.

Now I can buy a clinic and pressure all the doctors through an incentive scheme that they are not used to, and get them all to nudge the borderline cases into must-act cases. And chances are each individual case is somewhat defensible, and the doctor is still an authority. It's perfect, the doctors are not even going to admit their bias. But as a whole, a lot of people will be on treatments that they wouldn't have been on.

[maxxxxx]

That's one thing I noticed at my dentist years ago. It used to be a family practice but then they sold to a larger company. From then on every time I was there they tried to push another expensive treatment in addition to regular teeth cleaning. I am not an expert so how could I judge this recommendation? Maybe it's in my best interest or maybe they just want to make more money. Eventually I just stopped going there because I had a bad feeling. You should be able to trust your doctor but it's really hard to do so knowing that they are after profit mainly.

[sizzle]

Yup same here, they had a rotating team of dentists who swapped seats every week and often times tried to upsell me on procedures and one had the audacity to joke I was costing them money cause I had no cavities or work needed "it's good for you, not good for me" said with a chuckle, while I rolled my eyes and got the hell out of there eventually finding a family practice I could trust.

[profalseidol]

Sounds like car dealers.

[fjuerfilis]

It sounds to me that what is being monetized is the authority of doctors.

I think what you've described is really the US healthcare system as a whole.

I really don't understand why this isn't more of a focus of discussion. The US healthcare system is so monopolized, and so lacking in competition and transparency, it's obvious why healthcare costs are skyrocketing.

I understand the outrage over this story, but I don't understand why it might be surprising to some. So much of the US healthcare system is driven by similar incentives, especially at private, for-profit hospitals (and even at nonprofit public hospitals).

Think about it this way. Take some fundamental human need. Now legislate and structure society so only a relatively tiny number of people with a specific certificate, based on program completion, not skills demonstration per se, can supply that need. Go even further and structure the regulation of that certification by people who already have the certificate, under the argument that they are the only ones who are in a position to judge it. Now reinforce the whole thing by FUD arguments that any other approach will lead to catastrophe, illness, and death.

What do you think is going to happen?

Almost everything about the US healthcare system is characterized by rent-seeking, monopolies, or power structures and lack of transparency. It's begging for corruption. If you wanted to design an economic sector so as to drive up costs, you'd end up with something that looks basically like US healthcare.

[killjoywashere]

Are socialized medicine systems less evil?

[stirlo]

Who do you expect to sell more? A salesperson on commission or a salesperson on salary?

[justtopost]

A salaried person still has room for perverse incentives. The wine-ing and dining by drug companies is famous, and not counted on any salary form. It makes no difference.

[your-nanny]

if it makes no difference tgen you must think that commissioned persons are less susceptible to wining and dining incentives

[mindslight]

Yes, the situation described by the OP is ultimately due to those incentives not being kept in check by the customer, as there is little incentive for them to research the care.

A socialized healthcare system is actually truer to a functioning free market than what we currently have. By negotiating prices and treatment ahead of time (albeit collectively), both sides of the transaction have the ability to make informed decisions. Whereas in our current system prices are (at best!) negotiated by a sick person while they're over a barrel, and in most cases not even negotiated just let ride on the roulette wheel of health "insurance".

An open market (transparent, competitive, and payer-indifferent prices) could be even better, especially for more elective less time sensitive procedures like dermatology. But that's a long ways away from how things currently are, and in the opposite direction of how they're moving.