[gwerbret]

I agree with the idea of paying the doctor a flat fee every month, but in my variant, the doctor has to repay you the entire sum you've paid to date, with 10% interest, if you succumb to any preventable illnesses; in other words, the doctor now has some real skin in the game. S/he becomes motivated not only to keep you well, but to keep the fees reasonable.

[chriscross]

That’s horribly ignorant considering that many diseases have a large genetic component and people are rarely 100% compliant with the things they need to do to prevent a disease. Even when a doctor lets them know how to prevent the disease. How would this work for a disease, for example, like Alzheimer’s where the onset is much earlier in life (40s) but doesn’t manifest until much later in life and has no diagnostic test at age 40? What about hypertension where the majority of it is idiopathic? Would the doctor be blamed for all this despite practicing evidenced based medicine? I’d argue that a lot of diseases are this way and placing the blame on a doctor is a way to shift personal responsibility.

[oaktrout]

Seconding your view points. If a patient dies from a hypertension related cause (say stroke), and the patient has not followed the strict low salt diet the doctor recommended, does the doctor pay for that? At what point does the doctor stop seeing patients who do not follow their recommendations to the exact letter?

[R0b0t1]

I know you're framing it as patient choice, but it would incentivize doctors to actually want to research new solutions instead of give stale advice that doesn't seem to work.

[chriscross]

Do you really think that doctors don't keep up on education? All doctors are required to do continuing education every year to keep up to date on the latest advances. Most I know go to national conferences to learn more about their speciality. Then you have the portion of doctors that conduct research and actively advance medicine. Most doctors I know (anecdotal, I know) are constantly striving to do more, to learn more because they care. Doctors know how much responsibility they have to help people and even save lives.

[R0b0t1]

> Do you really think that doctors don't keep up on education?

No, I know they don't.

[oaktrout]

The advice works if patients listen (which is patient choice). Reducing salt intake and losing weight are simple ways to lower blood pressure and they are also effective.

[sxg]

This is such an oversimplified view of how medicine works. I'm not even sure how to begin a counterargument. In medicine, bad outcomes can occur without being sure of the cause. For example, let's say a patient who currently smokes gets lung cancer. Did the patient get lung cancer from smoking, or is this a sporadic non-smoking related cancer? There's no way to definitively find the answer to that question. But for the sake of discussion, let's say it is due to smoking. Do you fault the patient for smoking and not quitting? Or do you fault the doctor for being unable to convince the patient to quit smoking?

[pc86]

Even for HN this is a pretty shockingly out of touch "I don't know anything about $X but I can figure it out 'from first principles!!1'" type of comment.

[dstroot]

The doctor will purchase "refund insurance" and pass that cost along in the monthly retainer.

[gwerbret]

Fair point, but if the client does develop a preventable condition, it would be easy to show this is due to dereliction/negligence on the part of the physician, so the insurance would not pay out. If the client came down with a condition and the physician was not negligent, the condition would likely be non-preventable, wherein the refund clause wouldn't apply, anyway. Thus, regardless of outcome, insurance can never pay out, and the physician retains all the liability, i.e. no use for insurance.

[pc86]

How is it "easy" to show negligence?

[gruez]

Yeah that just passes the buck to someone else (the insurer), who is incentivized to investigate malfeasance.

[catlikesshrimp]

Some insurance policies must not exist. Malpractice policies must not exist.

I am sure if I asked my mates they would all disagree with me on this. Bad luck for the patients.

[oaktrout]

Without malpractice insurance, would doctors be incentivized to not take on risky patients? Risky could be defined as litigious (I know this patient has sued another doctor before) or medically difficult to treat (this patient needs this surgery but they are at high risk of poor outcome due to their current state of health).

Having sued a doctor once, you might never be able to get medical treatment again.

[pc86]

Which would also disincentivize ridiculous lawsuits that you'd almost certainly lose.

[lotsofpulp]

It would also disincentivize legitimate lawsuits.

[gwerbret]

Upon reading the responses my earlier comments generated, I suppose I should have disclaimed that I'm seeing this problem as the OP had portrayed it, which is as a thought problem in logic and economics, rather than an actual approach to preventative medicine. As a thought problem, it can be broken into basic, of-necessity simplified elements, e.g. preventable vs. non-preventable illnesses, fee optimization, etc.

The idea of actual healthcare being dependent solely on optimization of greed is, of course, ludicrous.