It’s a matter of luck whether you encounter it.
It’s a matter of luck whether you encounter it.
If only more people understood capitalism, it wouldn’t need to be this much luck.
Imagine we would pay for health, not sickness. People like this optometrist would “naturally” rise up, while uncaring lens-sellers would go bankrupt. The power of choice needs to move from lobbies and doctors to insurers and health support companies – the ones that profit from health, not the ones that profit from medicine throughput.
There’s this weird misconception that there is only one way to set up capitalistic optimization, and that when it doesn’t work, the only alternative is some centralized, leftist pipe dream. I think the biggest hurdle to humanity’s progress right now is to understand how wrong this is. There are ways to elegantly solve these issues; but we need more people who listen and think before judging.
Sorry for the only-kinda-on-topic tangent.
For me as a dentist the above is really bad. Insurance companies want to make money. So they sell their insurance policies which (more and more) exclude some of the necessary treatments my patients may need. So now what? I just do it for free because some desk clerk at the insurance agency decided that patients don’t get reimbursement for that specific treatment? Or the patient has to pay the bills themselves. It’s really bad to give insurance companies control over health and healthcare professionals. They are interested in making a profit, they really don’t care about quality of good healthcare. They want to keep the costs as low as possible and this is not in the interest of the patient.
In my book, have the national health authority determine with the proper academics what’s a fair income for healthcare professionals. Have this be as “lege artis” as possible by making sure (with those academics) that the standard of care is as high as reasonably achievable. Lock this in with proper coding and descriptions and everyone will go for good quality as opposed to just production and quantity.
Just my 2 cents.
This guy’s really lucky. Even though we do know and read here - it still makes a difference what that doctor or optometrist says, because we have learned they are right (and some are), so it does influence us.
I’m also really happy that I DO NOT have to pay for health! Insurance companies in control? Hell, noooooooooooo…
I think you got this one wrong, probably depending on ecah country’s regulation. Not sure what health support companies are, but doctors and pharma do not profit from heath, but from illnes. Laurens, would you still have a job if everyone was helathy? I believe that preventive check-ups are not paid that well, which is sad.
Also, insurance companies - they don’t care about your health, but about their profit, as Laurens said.
I’m however happy that I am able to do so much for my own health - just moving and sleeping anough, for example.
Aren’t you describing doctors here? Insurance actually has to pay for the consequences of their actions, if the patient has issues later. Most doctors just do their thing and, unless someone sues them, that’s it. If there’s a problem later, that’s just a new bill. They can go for straight profit optimization and nothing else. And that is exactly what I have experienced time and time again in the medical industry.
Surely, insurers could be better. But currently, they are toothless money managers entangled in red tape, who barely get to touch health decisions. This kind of pseudo healthcare provider isn’t the proposal here.
Why’d you prefer lobbyists and bureaucrats?
This is exactly the point! By and large, the market optimizes for profit first, so the profits have to be aligned with the health benefits, or else you get the sabotage we know from optometry, the insulin industry, and so forth.
Do you really think the mathematicians in an insurance company voluntarily pay for ever-increasing minus lenses, and finally surgery and maybe even blindness support? If they were able to make real healthcare decisions, they’d have put an end to this bullshit long ago, and required their myopic patients to either correct their habits or pay extra. Same for smoking and sugar; the “scientific discussion” would be bypassed by companies who exert serious pressure to cut the crap, because they don’t want to pay for the consequences.
Capitalism setup 101: if you don’t like it when people do something, make them pay for the consequences.
I’m most certainly am not. It could be different in Germany but let me give you a few (I have loads, but just some for good measure) very sad examples on what’s going on in the Netherlands. Trust me, they have teeth here, sharks teeth even…
There you have it. Please, don’t put these guys in charge. Have the national health agency check medical professionals and make sure they don’t enrich themselves at the cost of the patient or the tax payer. Make them hold the medical professional accountable if something is a miss. But it has to be a neutral player, not the insurance companies, it’s really really bad for health care if they get to be in command.
The 2 cents from a frustrated Dutch dentist
I get the problems you describe. This is really bad. That said, I’m not sure if it is representative of companies created from unhampered innovation and competition. I mean especially bits like these:
This isn’t capitalism by any reasonable definition. Free choice of price is a fundamental requirement. Variety is a fundamental requirement. If one giant cartel is in bed with the government to determine everything, down to tiny details like prices and treatments, that’s maybe… cronyism? In any case, it’s not expected to show capitalism’s self-optimizing properties. Centrally determining the parameters makes evolution impossible, defeating the whole purpose. Companies need enough freedom to allow the creation of new solutions never implemented before. Since the requirements of such new solutions are unknown, variety should be welcome, and non-essential restrictions are sabotage.
How will this not be infiltrated by corruption and complacency in the same way every such institution has been in the past? This line of thought will end at Plato’s problem of choosing the guardians – an unsolved problem even after thousands of years of theory and practice. And here, the guardians aren’t just on their own; you’d be pitting them against a fully functional market economy, configured to destroy them.
I don’t see many options here, unless we want to keep living with artificial “epidemics” like obesity, diabetes, depression, or myopia. There are insane doctors just as there are insane insurers. Having more of one or the other doesn’t have much effect, at least not compared to the massive damage caused by the “optimization” to harm people for profit. And that is just the beginning: there are also the unimaginable lost opportunities from not making constructive use of capitalism for healthcare.
My parents were both doctors in Germany. The insurance thing was getting worse every year, I heard the complaining non-stop.
Meanwhile one of the biggest recurring complaints I get is that I dare to charge for BackTo20/20. “You’re just out to make money, Jake!” … so much of that. And I’m thinking, gee, how much more would I make trading for an extra hour, or how much (not much) less if I just didn’t do endmyopia?
Seems to me the right way of thinking would be, awesome, there is an alternative here, the guy is incentivized, I can pay to get answers. Shouldn’t that be a good thing?
Apparently not. If I don’t do most of it for free, it must be a scam. People cause their own collective misery, I think.
I certainly don’t want lobbyists to be in charge!
It’s l ike you say: We - Germany at least - pretend to live capitalism. But we don’t, it’s lobbyism or I don’t know what. Just looking at… myself, colleagues, friends. Some people just work 25% of the time they spend at work. Thre is so much ineffective, work-slowing stuff going on…
I wonder how all these companies can still exist. And then, you’re not allowed to fire the laziest bully because - enter some stupid regulatory reason here.
Stuff like that over here as well, if that helps
I’m however very happy about the internets…And find myself get more and more wary regarding doctors and things.
A friend of mine, doctor herself. She just believes what seh’s been told. Working in a hospital, regular day and some 24 hour shifts, there is never enough staff, neither doctors nor nurses. She now has a cleaner at home. But never enough time or sleep. She gained a lot of weight because: no time to eat at work, so just stuff whatever you find whenever you can.
She used to climb/run and care about what she eats, a bit. At the beginning of her studies, she said: Oh doctors know, but people just won’t follow a healthy diet, or sports.
Now, she doesn’t do sports herself because she has no time - and doesen’t want to put pressure on herself. I knew about this inhuman system, but seeing her runing her life because of no time just shocked me.
You are very correct in your observations about all this. Most European countries are partially capitalistic and partially socialistic by default. That’s why it’s so strangely regulated in the Netherlands.
A centralized organ would be a hindrance to innovation for sure. Unless they consist of a very diverse board of members and the mission statement is crystal clear being that good health care for a fair price is possible, that new technologies should be able to get implemented and that the science should be leading in what the preferred course of action is in terms of best standard of care. This is really complex to get properly regulated.
Some more niceties about the rules here. Let’s say that you are my patient and I want to do some innovative dentistry, but there are no codes for me to utilize to bill this properly. We might strike a deal and come to an agreement regarding the care and payment. If I were to do that, it’d be a violation of the rules and it’s actually considered a misdemeanor.
My brother in law (again) would love to take time to teach his patients how they should eat and drink properly. There is just no time. He doesn’t have a consultation fee at his disposal to compensate him for his time spend on really educating the patient and going after the cause and not the symptom. It’s so sad really.
I can’t do innovative and state of the art dentistry here, doctors here can’t take the necessary time to really teach their patients what they should be doing in terms of becoming healthier. It’s a viscous cycle.
I like this interview with Dr. Robert Lustig which is related to this topic:
Yes, same here. General practicioner ist paid only once every quarter for one patient. So if I go there, 4 times in 2 weeks, he’s paid only once. Of course he has no time for me, or anyone else…
If you’re in this job and really want to help, you’ll probably be frustrated quite soon…
Wow, those stories are even worse than I thought. But the market is behaving just as economics would predict. @Tii_Chen, you’re putting it perfectly. A lot of it is pretending to be capitalism, but not acting it at all.
Some ideas on what a reasonably configured society could offer here:
@jakey, and other alternative health approaches, could be paid per achieved improvement, via an escrow and betting service that judges outcomes. The contract can be configured such that no party can gain if they don’t hold up their end of the bargain. Customers who fail to update their habits would have their fee taken by the escrow. So nobody can dodge paying, Jake gets paid for results, and the escrow risks their reputation if they pass false judgment – and also doubles as evidence whether the method is working. The time and money saved from scams should easily finance the work of impartial escrows.
@Laurens could be contracted by health providers who pay according to an evaluation of longer-term patient outcomes. No need to micro-manage any methods; if teaching people about sugar and dental hygiene works, the provider is just as happy as with other methods, since they are only liable for outcomes. Statistical tools would be used to compensate for a patient’s initial status – these are automatically available, because the provider needs them to calculate the costs of each insurance policy.
Putting universal healthcare on top of a health provider/insurance-based system is easy: the responsible institution gets funding per person in the country, and gives everyone individual, rules-based suggestions for suitable healthcare providers. People who do nothing get assigned to one of their suggested providers, paid with the per-person funding. People who choose their own provider simply get the money. (Well, maybe after some basic checks that stop people from using the money for drugs or something.)
Of course, there will be some corruption in the institution making the default choices. But this is manageable, as all the corruption is concentrated in a small domain, where the public can watch out for it, and nobody has the authority to stop the rest of the market form showing how it’s done.
Am I some crazy capitalist or is society crazy for not trying this?
Great stuff. It would be really good if this system got implemented. It’d be in the interest of everyone and no one will be the “victim” of the system.
I do think that it’s also great to tax sugar and processed food (basically tax anything that’s bad for an individual and in turn society). If you do that, people can still get it and eat/drink it. But they do end up paying for the extra healthcare they’re going to require.
Uuuh, I don’t know…
Maybe I’m too much of a pessimist but I believe that corruption might find a way.
Also, who are we or who is anyone to judge what is bad for an individual? Really, that thought frightens me…
Just think about all the things that were said to be bad - eggs, sports after surgery, moving when back pain, glasses are good, lower prescriptions will be taxed now?
Regarding studies and science: Who will fund those… Even independent studies may lead to false results, we do not have tools to measure everything yet (and might never have those).
Plus, each individual is different. I heard from a lady who thought she would die, when she changed her diet to mainly meet. Turned out she’s one of the few who don’t tolerate most plant food, and since she’s changed her diet, she hasn’t had all her digesting problems which she always had had before.
So, careful here!
Right now, it’s not that bad. Use the internets, there’s so much more than facebook…
I think you’re both right on this one. Taxing is still better than dictating how people should behave, but as Tii says, we ought to be very careful with telling others how to live.
Education IMO also has a lot of potential. I imagine having various great role models speak about their lifestyle in schools. (Or, better, do a similar optimization process with the education system.)
Another thought about taxes: they are problematic no matter what is taxed, so I think it’s fine to tax luxuries. It’s a way of taxation that isn’t too hard on the poor, nor disturbs important markets. Many people want to tax investment or speculation, which always gives me the creeps, because these are the backbone of stable supplies for the whole society. What’s worse, not being able to afford luxury items, or a supply shock in food, energy, the labor market, …?!
I’m gonna stop now; if I start ranting about taxation now, I’d have completed the derailment of this thread to where it has nothing to do with the original post anymore.
I mean that it should only be taxed if the science is irrefutable. Meaning that the science has to be sound and up to specs. If it’s not or too ambiguous, no go. For sugar the evidence is there, for lots of processed food too.
Strict criteria have to be met in order for us to go and tax something. If something is bad for the health of the population it either has to go or it gets taxed. This is my (not so humble) opinion on the matter.
Latest from me here since this thread is indeed getting derailed by us .
I try to be as healthy as I can possibly (and reasonably) get. The vast majority of people do not do this and on average cost society more money in terms of health costs. So I get to (hopefully) live a healthy long life and part of the taxes I pay go to people that just do whatever the hell they want and burden the healthcare system beyond measure. If something has been proven to be bad, tax it. That way I don’t end up paying for others who are careless about their health and refuse to change anything. It’s a matter of fairness, you want to do whatever you feel like doing, fine, but that never ever has to cost others who are doing their utmost best for their own health money.
Move this to a new topic, maybe? I don’t know how!
I think it’s interesting.
I dont have a solution and I understand how you feel @Laurens. I do so as well sometimes.
But then… my bike is my car. There are people who say it’s irresponsible to do that due to traffic accidents. In some situations, me, and I’m quite sure it’s true for everyone, I’m taking unnecessary risks.
Where would we draw the line? I don’t know of any possible way.
One little risky moment is enough. Look at Jake, kite surfing! I did a kite surfing course (had no wind ), and it’s considered as extreme sports, you need special insurance. Am I being healthy here, or do I make others pay, risking an accident?
Also, it’s the system. So many treatments that are proved to be of no help at all, are still paid by insurance. 90% of back surgeries are unnecessary/bring zero relief.
Then I think of all the taxes that are wasted for other useless things - like highway bridges, never to be finished, built miles away from the actual highway in nowhereland because someone wasn’t (or was maybe exactly) doing his job. So why be angry at unhealthy people. I do eat chocolate, too… and have a drink sometimes. I might even enjoy it
I think noone is just healthy or unhealthy, just good or just bad.
We do stuff that’s healthy, and stuff that’s not.
My brain hurt after all these posts…
Lets all hope the real doctors, dentists, optometrists with real respect to human health (like Laurent and Jake - okay, Jake is hmmm, the greatest eye guru) rise above the profit-minded companies/individuals…
After all, what have initially gained my trust was Jake’s story, especially the part with the boy in glasses which was a perfect candidate at school for bullying.
What strikes me, is that we tend to trust people which we can correlate with…
What strikes me again, is that very different people can have very good discussions here…