[detrites]

Whether true or apocryphal, there exists this intriguing idea that in China's past, they had a system of medicine where doctors were paid a salary when the client was in good health, which immediately ceased if they fell ill.

What's interesting about this, is the rest of the world typically does exactly this, with almost everything but not medicine. With medicine, people can pay more and more for products and services that are working less and less.

[luckylion]

We do that with "almost everything"? I can't think of anything.

I don't think e.g. phone service is comparable, because while you might not pay when the service is down, the service's uptime doesn't depend on you. If you destroy your cell phone, you can't use the service, but the service is still working.

If you sold "medicine as a service", it would just include that, but it couldn't guarantee that you'd always be healthy, no matter what choices you made.

[detrites]

Sure we do, as soon as anything degrades or completely stops working, whether a product or service, we ditch it and/or it is worked on until it's fixed.

Whereas with medicine, people will sit there and let the system slowly and agonisingly fail them over and over again, at tremendous personal expense, until they are literally dead.

Medical malpractice - that is, a medical professional getting their treatment provably wrong to the point it causes death instead of prevents it - has been a leading cause of death (in the top 5) for decades.

It's somewhat of an inversion of capitalism that such a dysfunction persists in just this one area.

Your analogy with cellphones doesn't relate this because cellphones work.

If instead, they also ranked top 5 out of all failed any-distance communications methods, alongside smoke-signals, pigeons, cans-on-a-string and megaphones, development would be focused on until they rank better.

When medical malpractice ranks in the bottom 5 causes of death, the positive mechanisms of capitalism will be functioning in this area.

[luckylion]

> Your analogy with cellphones doesn't relate this because cellphones work.

So do humans. But sometimes both of them stop working, or some part of them stops working. The service provider will not care if you break your cellphone, they only provide the cell service.

The problem with the idea of "you pay a flat fee for your health, and someone else makes sure you're healthy" doesn't work unless you also give them control over most of your life: what and how much (and when?) you eat, when and how much you sleep, any other substance you (ab-) use, what and how much physical activity you engage in. But who wants that?

Malpractice is a serious issue, but it won't be solved by "payment on success only", you just won't have anyone take on cases that are somewhat complicated, and then litigate forever to define what "success" means.

[detrites]

Mostly agree. The point of my bringing up the Chinese story was to highlight how far medicine, and apparently only medicine, seems to diverge from common principles, and - expounding later - how this is coincident with its failures.

Something is up with healthcare, and I don't claim to know exactly what it is, or what the solutions would be.

Where I don't agree is your misinterpreting the analogy to self-serve. A cellphone that works as bad as cans on a string is analogous to the healthcare industry working as bad as accidents. No one should put up with either.

But with healthcare, we do.

[ProjectArcturis]

If that were the system, doctors would be incentivized to sign up as many healthy young people as possible, and to fire them as patients as soon as they got sick.

[detrites]

Agree, it's not a system that would work as I described it - for me it just raises interesting questions.

One way it could be modified would be if doctors had a cap on patients, couldn't refuse to treat their existing ones, and couldn't take on new ones. The cap amount being based on life expectancy balanced against a competitive income.