[arkades]

Largely they lack context to interpret what they’re seeing. One that jumped out at me a while back:

They were showing physician payouts from Medicare and presenting them as though they were salaries. Problem: some specialties carry overhead in their Medicare payout.

When your cardiologist prescribes you a blood pressure medication, that money goes to a pharmacy, not to the doctor. So your physician payout is X (cost of visit.)

An oncologist prescribing you a chemo infusion, however, has to buy that infusion from the pharmacy. Medicare then reimbursed doc Z (cost of the drug plus a couple of percentage points). Docs Medicare payout looks like Z; his take-home salary is actually about 0.03*Z.

The failure to distinguish between these meant that PP’s data massively over-inflates these specialties’ salaries. PP just presents them at face value.

Or another: hospitals rarely charge their publicly posted prices. The vast majority of their pay comes via rates negotiated with insurers. PP loves to post their public numbers and go on about high variance numbers without any recognition that those numbers are in no way pegged to the actual negotiated rates. PP presents them at face value.

Largely, PP just doesn’t ever seem to dig deeply enough to find the nuances and caveats in their data, to find how they relate to the actual underlying questions that they -superficially- seem to answer, like “how much are hospitals charging people for this procedure?” or “what kind of money are doctors taking home?”

[klenwell]

Here's the introduction at the top of the ProPublica page cited by the GP:

Pharmaceutical and medical device companies are required by law to release details of their payments to a variety of doctors and U.S. teaching hospitals for promotional talks, research and consulting, among other categories. Use this tool to search for general payments (excluding research and ownership interests) made from August 2013 to December 2016.

https://projects.propublica.org/docdollars/

That seems like pretty fair context. You seem to be referencing a different article about Medicare reimbursement without actually citing it. That's a dodge.

If the medical industry requires reams of context to understand its practices and pricing, it's largely because pharma, insurers, medical groups, and individual providers often go to obscene lengths to obscure their practices and pricing.

I'm not going to waste skepticism on ProPublica that could better directed at the American medical-industrial complex.

[arkades]

> That seems like pretty fair context. You seem to be referencing a different article about Medicare reimbursement without actually citing it. That's a dodge.

I'm not dodging anything. I'm pointing out that when I bother to read their articles, they repeatedly get things wrong. The whole point of the Gell-Man effect is: "I read things I'm an expert on. They get those things really wrong. I am skeptical when they continue to write (on that topic) and (other topics), because why would they get other things any more right?"

I'm not an expert on the nuances of the pharma payout reporting. I am an expert on health care policy, health insurance, and clinical practice. Everything they write related to that, that I have read, tends to be off-base. If they regularly get healthcare stuff wrong, then yes, I apply skepticism to them writing about closely related topics which I may not have the same expertise in.

> If the medical industry requires reams of context to understand its practices and pricing, it's largely because pharma, insurers, medical groups, and individual providers often go to obscene lengths to obscure their practices and pricing.

(a) Any data of any complex, multi-component system requires reams of context to understand. This is why "domain expertise" is considered one of the key components of a competent data scientist.

(b) Our system is complex in part because >60% of our healthcare dollars derive from either federal programs, state programs, or an intersection of the two, which means they come with piles of regulatory things that complicate the issue.

(c) Our system is complex in part because we have a free market system, which is a fractured, multi-actor system (as opposed to a single-party-system). This means cash-flow gets complicated by the fact that reimbursement flows to lots of different interacting groups with dis-aligned interests.

(d) Our system is complex because we have a privatized insurance system, which puts a for-profit actor between the consumer and the physician - and one who, in partnering with certain provider groups, specialty pharmacies, etc. effectively channels the demands of the consumers into preferred paths - preferences determined by negotiated rates.

(e) Pricing tends to lack transparency because the vast majority of healthcare dollars are via these third-party insurers, who each negotiate separate rates with providers. Everyone involved in these negotiations has an incentive to not let their negotiated rates become widely public.

If your need to point a finger of blame undermines your willingness to understand the complexity of the system, you only do a disservice to yourself. The system doesn't get simpler just because you don't like its outcomes - and attempting to modify it without understanding the interacting components is doomed to massive unintended consequences. Or, in short, don't tear down the fence until you understand why it was built.

>I'm not going to waste skepticism on ProPublica that could better directed at the American medical-industrial complex.

That's a false dichotomy.

People providing inaccurate reporting that is critical of an industry don't become more accurate because you are also critical of that industry. That's just rationalization: "these guys must be above criticism because they validate beliefs I already hold."

You could be skeptical of both parties. You could be skeptical of the medical industry and shitty reporting on the medical industry. You could be skeptical of FB and NYT's recent obsession with it. You could be skeptical of etc. etc.